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Hudson RE, Metz TD, Ward RM, McKnite AM, Enioutina EY, Sherwin CM, Watt KM, Job KM. Drug exposure during pregnancy: Current understanding and approaches to measure maternal-fetal drug exposure. Front Pharmacol 2023; 14:1111601. [PMID: 37033628 PMCID: PMC10076747 DOI: 10.3389/fphar.2023.1111601] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 03/13/2023] [Indexed: 04/11/2023] Open
Abstract
Prescription drug use is prevalent during pregnancy, yet there is limited knowledge about maternal-fetal safety and efficacy of this drug use because pregnant individuals have historically been excluded from clinical trials. Underrepresentation has resulted in a lack of data available to estimate or predict fetal drug exposure. Approaches to study fetal drug pharmacology are limited and must be evaluated for feasibility and accuracy. Anatomic and physiological changes throughout pregnancy fluctuate based on gestational age and can affect drug pharmacokinetics (PK) for both mother and fetus. Drug concentrations have been studied throughout different stages of gestation and at or following delivery in tissue and fluid biospecimens. Sampling amniotic fluid, umbilical cord blood, placental tissue, meconium, umbilical cord tissue, and neonatal hair present surrogate options to quantify and characterize fetal drug exposure. These sampling methods can be applied to all therapeutics including small molecule drugs, large molecule drugs, conjugated nanoparticles, and chemical exposures. Alternative approaches to determine PK have been explored, including physiologically based PK modeling, in vitro methods, and traditional animal models. These alternative approaches along with convenience sampling of tissue or fluid biospecimens can address challenges in studying maternal-fetal pharmacology. In this narrative review, we 1) present an overview of the current understanding of maternal-fetal drug exposure; 2) discuss biospecimen-guided sampling design and methods for measuring fetal drug concentrations throughout gestation; and 3) propose methods for advancing pharmacology research in the maternal-fetal population.
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Affiliation(s)
- Rachel E. Hudson
- Division of Clinical Pharmacology, Department of Pediatrics, School of Medicine, The University of Utah, Salt Lake City, UT, United States
| | - Torri D. Metz
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, School of Medicine, The University of Utah, Salt Lake City, UT, United States
| | - Robert M. Ward
- Division of Clinical Pharmacology, Department of Pediatrics, School of Medicine, The University of Utah, Salt Lake City, UT, United States
| | - Autumn M. McKnite
- Department of Pharmacology and Toxicology, College of Pharmacy, The University of Utah, Salt Lake City, UT, United States
| | - Elena Y. Enioutina
- Division of Clinical Pharmacology, Department of Pediatrics, School of Medicine, The University of Utah, Salt Lake City, UT, United States
| | - Catherine M. Sherwin
- Department of Pediatrics, Boonshoft School of Medicine, Wright State University, Dayton, OH, United States
| | - Kevin M. Watt
- Division of Clinical Pharmacology, Department of Pediatrics, School of Medicine, The University of Utah, Salt Lake City, UT, United States
| | - Kathleen M. Job
- Division of Clinical Pharmacology, Department of Pediatrics, School of Medicine, The University of Utah, Salt Lake City, UT, United States
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Ao Z, Wu Z, Zhao H, Wu Z, Li Z. Associations of cord metabolome and biochemical parameters with the neonatal deaths of cloned pigs. Reprod Domest Anim 2021; 56:1519-1528. [PMID: 34487580 DOI: 10.1111/rda.14014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 09/05/2021] [Indexed: 11/30/2022]
Abstract
Neonatal cloned pigs generated via somatic cell nuclear transfer (SCNT) have high incidences of malformation and mortality. The mechanisms underlying the massive loss of cloned pig neonates remain unclear. We compared the cord serum metabolic profiles and biochemical indexes of SCNT-derived piglets that died within 4 days (SCNT-DW4), SCNT-derived piglets that survived over 4 days (SCNT-SO4) and artificial insemination (AI)-generated piglets that survived over 4 days (AI-SO4) to investigate the associations of serum metabolomics and biochemical indexes in umbilical cord (UC) sera at delivery with the neonatal loss of cloned pigs. Results showed that compared with SCNT-SO4 and AI-SO4 piglets, SCNT-DW4 piglets had lower birth weight, placental indexes, placental vascularization scores, UC scores, vitality scores, serum glucose and levels but higher creatinine, urea nitrogen and uric acid levels in cord sera. Metabolomics analysis revealed alterations in lipid, glucose and purine metabolism in the cord sera of SCNT-DW4 piglets. These results indicated that the disturbance of the cord serum metabolome might be associated with the low birth weight and malformations of cloned neonates. These effects were likely the consequences of the impaired placental morphology and function of SCNT-derived piglets. This study provides helpful information regarding the potential mechanisms responsible for the neonatal death of cloned pigs and also offers an important basis for the design of effective strategies to improve the survival rate of these animals.
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Affiliation(s)
- Zheng Ao
- Key Laboratory of Animal Genetics, Breeding and Reproduction in the Plateau Mountainous Region, Ministry of Education, College of Animal Science, Guizhou University, Guiyang, Guizhou, China.,National Engineering Research Center for Breeding Swine Industry, College of Animal Science, South China Agricultural University, Guangzhou, Guangdong, China.,Guizhou Provincial Key Laboratory of Animal Genetics, Breeding and Reproduction, College of Animal Science, Guizhou University, Guiyang, China
| | - Zhimin Wu
- Key Laboratory of Animal Genetics, Breeding and Reproduction in the Plateau Mountainous Region, Ministry of Education, College of Animal Science, Guizhou University, Guiyang, Guizhou, China.,Guizhou Provincial Key Laboratory of Animal Genetics, Breeding and Reproduction, College of Animal Science, Guizhou University, Guiyang, China
| | - Huaxing Zhao
- National Engineering Research Center for Breeding Swine Industry, College of Animal Science, South China Agricultural University, Guangzhou, Guangdong, China
| | - Zhenfang Wu
- National Engineering Research Center for Breeding Swine Industry, College of Animal Science, South China Agricultural University, Guangzhou, Guangdong, China
| | - Zicong Li
- National Engineering Research Center for Breeding Swine Industry, College of Animal Science, South China Agricultural University, Guangzhou, Guangdong, China
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Nelson HA, Wood KE, McMillin GA, Krasowski MD. Umbilical Cord Drug Screening in Multiple Births: Experience from a Reference Laboratory and Academic Medical Center. J Anal Toxicol 2021; 46:611-618. [PMID: 34165142 DOI: 10.1093/jat/bkab077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 06/15/2021] [Accepted: 06/23/2021] [Indexed: 11/15/2022] Open
Abstract
The objective of this study was to review the results of umbilical cord drug screening in twins and triplets (multiples) to compare drug(s) and/or drug metabolite(s) detected. Results that did not agree between multiples were considered mismatched and were investigated. A retrospective analysis was conducted using de-identified data from a national reference laboratory, and results were compared with data from an academic medical center, where detailed medical chart review was performed. Umbilical cord was analyzed for stimulants, sedatives, opioids, and other drugs and metabolites. For the reference laboratory dataset, 23.3% (n=844) of 3,616 umbilical cords from twins (n=3,550) or triplets (n=66) were positive for one or more drugs and/or metabolites. Of these, mismatched results were identified for thirty-seven sets of twins (2.1%) and no sets of triplets. The most frequent mismatches were found in opioids (n=24), with morphine (n=5) being the most mismatched of any single analyte in the panel. Mismatches for the marijuana metabolite 11-nor-9-carboxy-delta-9-tetrahydrocannabinol (9-COOH-THC) in the reference laboratory dataset occurred in six of 737 sets of twins (0.8%) and no triplets. For the academic medical center dataset, 21.9% (n=57) of 260 umbilical cords tested positive for one or more drugs and/or metabolite(s). Of these, 4 mismatches (3.2%) were identified, including 9-COOH-THC (n=2), phentermine (n=1), and oxycodone (n=1), all involving twins. All involved cases where the discrepant analyte was likely present in the negative twin but either slightly below reporting cutoff threshold, or failed analytical quality criteria. Mismatched results of umbilical cord drug screening occur in less than 4% of twins and most often occur when the analyte is slightly above the reporting cutoff in just one infant.
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Affiliation(s)
- Heather A Nelson
- Department of Pathology, University of Utah, Salt Lake City, UT 84112, USA
| | - Kelly E Wood
- Stead Family Department of Pediatrics, University of Iowa Stead Family Children's Hospital, Iowa City, IA, 52242, USA
| | - Gwendolyn A McMillin
- Department of Pathology, University of Utah, Salt Lake City, UT 84112, USA.,ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, UT 84108, USA
| | - Matthew D Krasowski
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA
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