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Onken M, Lohse L, Coulm B, Beghin D, Richardson JL, Bermejo-Sánchez E, Aguilera C, Bosch M, Cassina M, Chouchana L, De Santis M, Duman MK, Gören MZ, Johnson D, Bera APJ, Kaplan YC, Kennedy D, Kwok S, Lacroix I, Lepelley M, Pistelli A, Schaefer C, Te Winkel B, Uysal N, Winterfeld U, Yakuwa N, Diav-Citrin O, Vial T, Dathe K. Effects of maternal modafinil treatment on fetal development and neonatal growth parameters - a multicenter case series of the European Network of Teratology Information Services (ENTIS). Acta Psychiatr Scand 2023. [PMID: 38110225 DOI: 10.1111/acps.13643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 11/10/2023] [Accepted: 11/19/2023] [Indexed: 12/20/2023]
Abstract
OBJECTIVE In recent years, safety concerns about modafinil exposure during pregnancy have emerged. In particular, increased risks for major congenital anomalies (MCA) and impaired fetal growth were reported, although study results were conflicting. Our investigation aims to examine previously reported safety signals. METHOD Multicenter case series based on data from 18 Teratology Information Services from 12 countries. Modafinil exposed pregnancies with an estimated date of birth before August 2019 were included in this study. For prospectively ascertained pregnancies, cumulative incidences of pregnancy outcomes, rate of nonchromosomal MCA in first trimester exposed pregnancies and percentiles of neonatal/infant weight and head circumference (HC) were calculated. Potential dose-dependent effects on fetal growth were explored by linear regression models. Retrospectively ascertained cases were screened for pattern of MCA and other adverse events. RESULTS One hundred and seventy-five prospectively ascertained cases were included, of which 173 were exposed at least during the first trimester. Cumulative incidences for live birth, spontaneous abortion and elective termination of pregnancy were 76.9% (95% CI, 68.0%-84.8%), 9.3% (95% CI, 5.0%-16.9%), and 13.9% (95% CI, 8.1%-23.1%), respectively. Nonchromosomal MCA was present in 3/150 live births, corresponding to an MCA rate of 2.0% (95%CI, 0.6%-6.1%), none were reported in pregnancy losses. Compared to reference standards, birth weight (BW) tended to be lower and neonatal HC to be smaller in exposed newborns (data available for 144 and 73 of 153 live births, respectively). In nonadjusted linear regression models, each 100 mg increase of average dosage per pregnancy day was associated with a decrease in standard deviation score (SDS) of -0.28 SDS (95% CI, -0.45 to -0.10) for BW and of -0.28 SDS (95% CI, -0.56 to 0.01) for HC. Screening of 22 retrospectively reported cases did not reveal any specific pattern of MCA or other adverse outcomes. CONCLUSION The results do not indicate an increased risk of MCA after in utero exposure to modafinil, but a tendency toward lower BW and reduced neonatal HC. However, these findings should be regarded as preliminary. Until further studies allow for a definite conclusion, modafinil should not be used during pregnancy.
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Affiliation(s)
- Marlies Onken
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Clinical Pharmacology and Toxicology, Embryotox Center of Clinical Teratology and Drug Safety in Pregnancy, Berlin, Germany
| | - Lukas Lohse
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Clinical Pharmacology and Toxicology, Embryotox Center of Clinical Teratology and Drug Safety in Pregnancy, Berlin, Germany
| | - Bénédicte Coulm
- AP-HP.Sorbonne Université, Hôpital Trousseau, Département de Santé Publique, Centre de Référence sur les Agents Tératogènes (CRAT), Paris, France
| | - Delphine Beghin
- AP-HP.Sorbonne Université, Hôpital Trousseau, Département de Santé Publique, Centre de Référence sur les Agents Tératogènes (CRAT), Paris, France
| | - Jonathan L Richardson
- UK Teratology Information Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Eva Bermejo-Sánchez
- Institute of Rare Diseases Research (IIER), Research Unit on Congenital Anomalies-UIAC and Spanish Teratology Information Services SITTE and SITE, Instituto Salud Carlos III (ISCIII), Madrid, Spain
| | - Cristina Aguilera
- Clinical Pharmacology Service, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Montserrat Bosch
- Clinical Pharmacology Service, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Matteo Cassina
- Clinical Genetics Unit, Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Laurent Chouchana
- Assistance Publique-Hôpitaux de Paris, Hôpital Cochin, Service de pharmacologie périnatale, pédiatrique et adulte, Centre Régional de Pharmacovigilance, Paris, France
| | - Marco De Santis
- Teratology Information Service, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Mine Kadioglu Duman
- Teratology Information Service, Department of Pharmacology, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - M Zafer Gören
- Department of Medical Pharmacology, Faculty of Medicine, Marmara University, İstanbul, Turkey
| | - Diana Johnson
- Department of Pediatrics, University of California, San Diego, California, USA
| | - Annie Pierre Jonville Bera
- Service de Pharmacosurveillance, Centre Régional de Pharmacovigilance Centre-Val de Loire, Tours, France
| | - Yusuf C Kaplan
- Department of Pharmacology, Izmir Katip Celebi University School of Medicine, Training and Research Center, Izmir, Turkey
| | - Debra Kennedy
- MotherSafe, The Royal Hospital for Women, Randwick, New South Wales, Australia
| | - Susan Kwok
- MotherSafe, The Royal Hospital for Women, Randwick, New South Wales, Australia
| | - Isabelle Lacroix
- Service de pharmacologie médicale et clinique, centre régional de pharmacovigilance, faculté de médecine, CHU de Toulouse, Toulouse, France
| | - Marion Lepelley
- Université Grenoble Alpes, Centre régional de pharmacovigilance, Grenoble, France
| | - Alessandra Pistelli
- Toxicology Unit and Poison Control Centre, Teratology Information Service, Careggi University Hospital, Florence, Italy
| | - Christof Schaefer
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Clinical Pharmacology and Toxicology, Embryotox Center of Clinical Teratology and Drug Safety in Pregnancy, Berlin, Germany
| | - Bernke Te Winkel
- Teratology Information Service, Netherlands Pharmacovigilance Centre Lareb, 's-Hertogenbosch, The Netherlands
| | - Nusret Uysal
- Department of Pharmacology, Izmir Katip Celebi University School of Medicine, Training and Research Center, Izmir, Turkey
| | - Ursula Winterfeld
- Swiss Teratogen Information Service, Service de Pharmacologie Clinique, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Naho Yakuwa
- Japan Drug Information Institute in Pregnancy, National Center for Child Health and Development, Tokyo, Japan
| | - Orna Diav-Citrin
- The Israeli Teratology Information Service, Ministry of Health, Hebrew University Hadassah Medical School, Jerusalem, Israel
| | - Thierry Vial
- Pharmacovigilance Center, Hospital University Pharmacotoxicology Department, Lyon, France
| | - Katarina Dathe
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Clinical Pharmacology and Toxicology, Embryotox Center of Clinical Teratology and Drug Safety in Pregnancy, Berlin, Germany
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