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An Z, Li Y, Li J, Jiang Z, Duan W, Guo M, Zhu Y, Zeng X, Wang L, Liu Y, Li A, Guo H, Zhang X. Associations between co-exposure to per- and polyfluoroalkyl substances and organophosphate esters and erythrogram in Chinese adults. CHEMOSPHERE 2024; 362:142750. [PMID: 38960049 DOI: 10.1016/j.chemosphere.2024.142750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 03/31/2024] [Accepted: 06/30/2024] [Indexed: 07/05/2024]
Abstract
Erythrogram, despite its prevalent use in assessing red blood cell (RBC) disorders and can be utilized to evaluate various diseases, still lacks evidence supporting the effects of per- and polyfluoroalkyl substances (PFASs) and organophosphate esters (OPEs) on it. A cross-sectional study involving 467 adults from Shijiazhuang, China was conducted to assess the associations between 12 PFASs and 11 OPEs and the erythrogram (8 indicators related to RBC). Three models, including multiple linear regression (MLR), sparse partial least squares regression, and Bayesian kernel machine regression (BKMR) were employed to evaluate both the individual and joint effects of PFASs and OPEs on the erythrogram. Perfluorohexane sulfonic acid (PFHxS) showed the strongest association with HGB (3.68%, 95% CI: 2.29%, 5.10%) when doubling among PFASs in MLR models. BKMR indicated that PFASs were more strongly associated with the erythrogram than OPEs, as evidenced by higher group posterior inclusion probabilities (PIPs) for PFASs. Within hemoglobin and hematocrit, PFHxS emerged as the most significant component (conditional PIP = 1.0 for both). Collectively, our study emphasizes the joint effect of PFASs and OPEs on the erythrogram and identified PFASs, particularly PFHxS, as the pivotal contributors to the erythrogram. Nonetheless, further investigations are warranted to elucidate the underlying mechanisms.
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Affiliation(s)
- Ziwen An
- Department of Toxicology, School of Public Health, Hebei Medical University, Shijiazhuang, 050017, China
| | - Yanbing Li
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, 100005, China; Center of Environmental and Health Sciences, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100005, China
| | - Jing Li
- Department of Toxicology, School of Public Health, Hebei Medical University, Shijiazhuang, 050017, China
| | - Zexuan Jiang
- Department of Toxicology, School of Public Health, Hebei Medical University, Shijiazhuang, 050017, China
| | - Wenjing Duan
- Department of Toxicology, School of Public Health, Hebei Medical University, Shijiazhuang, 050017, China
| | - Mingmei Guo
- Department of Toxicology, School of Public Health, Hebei Medical University, Shijiazhuang, 050017, China
| | - Yiming Zhu
- Department of Toxicology, School of Public Health, Hebei Medical University, Shijiazhuang, 050017, China
| | - Xiuli Zeng
- Department of Toxicology, School of Public Health, Hebei Medical University, Shijiazhuang, 050017, China
| | - Linfeng Wang
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, China
| | - Yi Liu
- Department of Toxicology, School of Public Health, Hebei Medical University, Shijiazhuang, 050017, China; Hebei Key Laboratory of Environment and Human Health, Hebei Province, Shijiazhuang, 050017, China
| | - Ang Li
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, 100005, China; Center of Environmental and Health Sciences, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100005, China; Hebei Key Laboratory of Environment and Human Health, Hebei Province, Shijiazhuang, 050017, China
| | - Huicai Guo
- Department of Toxicology, School of Public Health, Hebei Medical University, Shijiazhuang, 050017, China; Hebei Key Laboratory of Environment and Human Health, Hebei Province, Shijiazhuang, 050017, China.
| | - Xiaoguang Zhang
- Core Facilities and Centers of Hebei Medical University, 361 East Zhongshan Road, Shijiazhuang, 050017, Hebei Province, China.
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Costa B, Gouveia MJ, Vale N. Safety and Efficacy of Antiviral Drugs and Vaccines in Pregnant Women: Insights from Physiologically Based Pharmacokinetic Modeling and Integration of Viral Infection Dynamics. Vaccines (Basel) 2024; 12:782. [PMID: 39066420 PMCID: PMC11281481 DOI: 10.3390/vaccines12070782] [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: 05/05/2024] [Revised: 07/11/2024] [Accepted: 07/15/2024] [Indexed: 07/28/2024] Open
Abstract
Addressing the complexities of managing viral infections during pregnancy is essential for informed medical decision-making. This comprehensive review delves into the management of key viral infections impacting pregnant women, namely Human Immunodeficiency Virus (HIV), Hepatitis B Virus/Hepatitis C Virus (HBV/HCV), Influenza, Cytomegalovirus (CMV), and SARS-CoV-2 (COVID-19). We evaluate the safety and efficacy profiles of antiviral treatments for each infection, while also exploring innovative avenues such as gene vaccines and their potential in mitigating viral threats during pregnancy. Additionally, the review examines strategies to overcome challenges, encompassing prophylactic and therapeutic vaccine research, regulatory considerations, and safety protocols. Utilizing advanced methodologies, including PBPK modeling, machine learning, artificial intelligence, and causal inference, we can amplify our comprehension and decision-making capabilities in this intricate domain. This narrative review aims to shed light on diverse approaches and ongoing advancements, this review aims to foster progress in antiviral therapy for pregnant women, improving maternal and fetal health outcomes.
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Affiliation(s)
- Bárbara Costa
- PerMed Research Group, Center for Health Technology and Services Research (CINTESIS), 4200-450 Porto, Portugal;
- CINTESIS@RISE, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
- Department of Community Medicine, Health Information and Decision (MEDCIDS), Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
- Centre for Parasite Biology and Immunology, Department of Infectious Diseases, National Health Institute Dr. Ricardo Jorge, 4000-055 Porto, Portugal;
| | - Maria João Gouveia
- Centre for Parasite Biology and Immunology, Department of Infectious Diseases, National Health Institute Dr. Ricardo Jorge, 4000-055 Porto, Portugal;
- Center for the Study in Animal Science (CECA/ICETA), University of Porto, 4051-401 Porto, Portugal
| | - Nuno Vale
- PerMed Research Group, Center for Health Technology and Services Research (CINTESIS), 4200-450 Porto, Portugal;
- CINTESIS@RISE, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
- Department of Community Medicine, Health Information and Decision (MEDCIDS), Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
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Wanninayake S, Ochoa‐Ferraro A, Patel K, Ramachandran R, Wierzbicki AS, Dawson C. Two successful pregnancies -in patients taking Volanesorsen for familial chylomicronemia syndrome. JIMD Rep 2024; 65:249-254. [PMID: 38974616 PMCID: PMC11224504 DOI: 10.1002/jmd2.12435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 05/17/2024] [Accepted: 05/23/2024] [Indexed: 07/09/2024] Open
Abstract
Familial chylomicronemia syndrome (FCS) is a rare inherited disorder characterized by severe hypertriglyceridemia, posing a heightened risk of acute pancreatitis. Recently, Volanesorsen, an APOC3 antisense oligonucleotide, gained approval for FCS treatment in the UK. Caution is advised during pregnancy due to limited safety data, although animal studies show no toxicity/teratogenicity. Two case scenarios are presented: In the first case, a patient with FCS continued Volanesorsen injections without having thrombocytopenia during an unplanned pregnancy until third trimester, maintaining triglyceride control. Upon discovering the pregnancy at 38 weeks, Volanesorsen was ceased, and a low-fat diet reinstated. Despite a heightened risk of pancreatitis, no episodes of pancreatitis occurred during the pregnancy. In the second case, stopping Volanesorsen before conception led to elevated triglycerides, and an episode of acute pancreatitis at 22 weeks, despite strict very low-fat diet and fibrate therapy from 14 weeks. At 23 weeks, Volanesorsen was reintroduced concurrently with regular therapeutic plasma exchange. No further episodes of pancreatitis occurred. In both case, fetal health was maintained throughout pregnancy, fetal scans revealed no anomalies, and planned C-sections delivered healthy babies without congenital issues. Both babies are well and developing normally at 24 and 19 months.
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Affiliation(s)
- Subadra Wanninayake
- Department of Diabetes, Endocrinology and MetabolismUniversity Hospitals Birmingham NHS Foundation TrustBirminghamUK
| | - Antonio Ochoa‐Ferraro
- Department of Diabetes, Endocrinology and MetabolismUniversity Hospitals Birmingham NHS Foundation TrustBirminghamUK
| | | | - Radha Ramachandran
- Department of Adult Inherited Metabolic Diseases, Metabolic Medicine and Chemical PathologyGuys and St Thomas' Hospitals NHS Foundation TrustLondonUK
| | - Anthony S. Wierzbicki
- Department of Adult Inherited Metabolic Diseases, Metabolic Medicine and Chemical PathologyGuys and St Thomas' Hospitals NHS Foundation TrustLondonUK
| | - Charlotte Dawson
- Department of Diabetes, Endocrinology and MetabolismUniversity Hospitals Birmingham NHS Foundation TrustBirminghamUK
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Mohammed A, Amsalu B, Hailu M, Sintayehu Y, Weldeamanuel T, Belay Y, Hassen Z, Dinkesa T, Dechasa N, Mengist B, Mengesha T, Nuri A, Getnet T, Manaye Y, Aliyi Usso A, Legesse H, Sertsu A. Indigenous herbal medicine use and its associated factors among pregnant women attending antenatal care at public health facilities in Dire Dawa, Ethiopia: a cross-sectional study. BMJ Open 2024; 14:e079719. [PMID: 38830740 PMCID: PMC11149149 DOI: 10.1136/bmjopen-2023-079719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 02/29/2024] [Indexed: 06/05/2024] Open
Abstract
OBJECTIVE The aim of this study was to investigate the prevalence of indigenous herbal medicine use and its associated factors among pregnant women attending antenatal care (ANC) at public health facilities in Dire Dawa, Ethiopia. DESIGN A facility-based cross-sectional study design. SETTING The study was conducted in seven public health facilities (one referral hospital, three urban and three rural health centres) in Dire Dawa, Ethiopia, from October to November 2022. PARTICIPANTS 628 pregnant women of any gestational age who had been on ANC follow-up at selected public health facilities were included. MAIN OUTCOME MEASURES Prevalence of indigenous herbal medicine (users vs non-users) and associated factors. RESULTS The study revealed that 47.8% (95% CI 43.8% to 51.6%) of pregnant women used herbal medicines. Lack of formal education (adjusted OR, AOR 5.47, 95% CI 2.40 to 12.46), primary level (AOR 4.74, 95% CI 2.15 to 10.44), housewives (AOR 4.15, 95% CI 1.83 to 9.37), number of ANC visits (AOR 2.58, 95% CI 1.27 to 5.25), insufficient knowledge (AOR 4.58, 95% CI 3.02 to 6.77) and favourable perception (AOR 2.54, 95% CI 1.71 to 3.77) were factors significantly associated with herbal medicine use. The most commonly used herbs were garden cress (Lepidium sativum) (32%), bitter leaf (Vernonia amygdalina) (25.2%), moringa (Moringa oleifera) (24.5%). Common indications were related to gastrointestinal problems, blood pressure and sugar. CONCLUSION The prevalence of herbal medicine use is high (one in two pregnant women) and significantly associated with education level, occupation, ANC visits, knowledge and perceptions. The study's findings are helpful in advancing comprehension of herbal medicines using status, types and enforcing factors. It is essential that health facilities provide herbal counselling during ANC visits, and health regulatory bodies ought to raise awareness and implement interventions to lower the risks from over-the-counter herbal medicine use by pregnant women.
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Affiliation(s)
- Aminu Mohammed
- Department of Midwifery, College of Medicine and Health Sciences, Dire Dawa University, Dire Dawa, Ethiopia
| | - Bezabih Amsalu
- Department of Public Health, College of Medicine and Health Sciences, Dire Dawa University, Dire Dawa, Ethiopia
| | - Mickiale Hailu
- Department of Midwifery, College of Medicine and Health Sciences, Dire Dawa University, Dire Dawa, Ethiopia
| | - Yitagesu Sintayehu
- Department of Midwifery, College of Medicine and Health Sciences, Dire Dawa University, Dire Dawa, Ethiopia
| | - Tadesse Weldeamanuel
- Department of Midwifery, College of Medicine and Health Sciences, Dire Dawa University, Dire Dawa, Ethiopia
| | - Yalelet Belay
- Department of Midwifery, College of Medicine and Health Sciences, Dire Dawa University, Dire Dawa, Ethiopia
| | - Zeyniya Hassen
- Department of Midwifery, College of Medicine and Health Sciences, Dire Dawa University, Dire Dawa, Ethiopia
| | - Tesema Dinkesa
- Department of Midwifery, College of Medicine and Health Sciences, Dire Dawa University, Dire Dawa, Ethiopia
| | - Natnael Dechasa
- Department of Midwifery, College of Medicine and Health Sciences, Dire Dawa University, Dire Dawa, Ethiopia
| | - Betelhem Mengist
- Department of Midwifery, College of Medicine and Health Sciences, Dire Dawa University, Dire Dawa, Ethiopia
| | - Teshale Mengesha
- Department of Pediatrics and Child Health Nursing, College of Medicine and Health Sciences, Dire Dawa University, Dire Dawa, Ethiopia
| | - Aliya Nuri
- Department of Public Health, College of Medicine and Health Sciences, Dire Dawa University, Dire Dawa, Ethiopia
| | - Tewodros Getnet
- Department of Public Health, College of Medicine and Health Sciences, Dire Dawa University, Dire Dawa, Ethiopia
| | - Yibekal Manaye
- Department of Public Health, College of Medicine and Health Sciences, Dire Dawa University, Dire Dawa, Ethiopia
| | - Ahmedin Aliyi Usso
- School of Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Henok Legesse
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Addisu Sertsu
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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Simons E, Camidge DR. Lung Cancer Oncogene-Directed Therapy, Fertility, and Pregnancy. J Thorac Oncol 2024; 19:866-876. [PMID: 38185202 DOI: 10.1016/j.jtho.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 12/18/2023] [Accepted: 01/04/2024] [Indexed: 01/09/2024]
Abstract
INTRODUCTION Alterations in the highly actionable lung cancer oncogenes, EGFR, ALK, and ROS1, occur across the age spectrum. Pregnancy and plans for motherhood consequently overlap with diagnoses of advanced oncogene-driven NSCLC. Guidelines for cytotoxic agents and pregnancy are well established. Nevertheless, accessible data on targeted lung cancer therapy during pregnancy or egg retrieval has not been collated previously, nor have the issues of reproduction in the setting of specific oncogene-addicted advanced NSCLC been widely discussed. METHODS We performed a narrative review of ex vivo placenta perfusion studies, pharmacologic characteristics, mutagenicity, animal embryo-fetal development studies, and case reports of pathways to motherhood, pregnancies, and egg retrieval while on EGFR-, ALK-, or ROS1-targeted therapy. RESULTS EGFR inhibitors may reduce female fertility while on therapy owing to decrease in corpora lutea. Odds of pregnancy in women on EGFR and ALK inhibitors may be reduced owing to potential increase in postimplantation loss found in animals. Crizotinib and entrectinib exhibit in vitro mutagenic potential. Several effects on human pregnancies have been noted; however, 11 EGFR and ALK tyrosine kinase inhibitor-exposed infants have been documented free of substantial adverse health effects by ages 4 months to 2 years. Successful gestational surrogacy has been reported in two women treated with crizotinib. Adoption and termination approaches have also been undertaken by some patients. CONCLUSIONS Reproduction may not be out of reach for some patients with advanced NSCLC. Additional explorations of the impact and optimal timing of targeted therapy in egg capture and pregnancy are needed. Wider scientific and societal discussion about the issues of reproduction in advanced NSCLC is warranted.
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Affiliation(s)
- Emily Simons
- University of Colorado Cancer Center, Aurora, Colorado; Banner MD Anderson Cancer Center, Loveland, Colorado.
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Todorović Z, Dragović G, Lukić R. Pharmacokinetic and toxicological considerations affecting antiretroviral drug dosing in pregnant women. Expert Opin Drug Metab Toxicol 2024; 20:419-437. [PMID: 38738389 DOI: 10.1080/17425255.2024.2353762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 05/07/2024] [Indexed: 05/14/2024]
Abstract
INTRODUCTION To prevent mother-to-child transmission (PMTCT) of the human immunodeficiency virus (HIV) during pregnancy, the appropriate dosing regimens of antiretroviral (ARV) drugs need to be determined. Reliable data about pharmacokinetic (PK) characteristics of ARVs from randomized clinical trials (RCTs) are lacking, and post-marketing observational studies may offer valuable, but sometimes insufficient data, especially in pregnant people living with HIV (PLWHIV). This review article is focused PK and toxicological considerations affecting ARV dosing in pregnant PLWHIV. AREAS COVERED In our search, we included studies focused on PKs of ARVs in pregnancy available on PubMed, abstracts from recent global conferences and data from modeling studies. There are no significant changes in PKs of nucleoside/nucleotide reverse transcriptase inhibitors and non-nucleoside reverse transcriptase inhibitors throughout pregnancy. In contrast, the PKs of PIs and INSTIs are more variable, especially in the second and third trimesters. EXPERT OPINION Pregnant women are left out of RCTs. To the greatest extent possible, future research should include pregnant persons in RCTs, including PK studies, strictly considering maternal and fetal safety. Alternative innovative approaches/models need to be developed to obtain reliable data about rational pharmacotherapy of ARVs in the effective PMTCT of HIV, with maximum safety.
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Affiliation(s)
- Zoran Todorović
- Faculty of Medicine, Department of Pharmacology, Clinical Pharmacology and Toxicology, University of Belgrade, Belgrade, Serbia
| | - Gordana Dragović
- Faculty of Medicine, Department of Pharmacology, Clinical Pharmacology and Toxicology, University of Belgrade, Belgrade, Serbia
| | - Relja Lukić
- Faculty of Medicine, Obstetrics and Gynaecology Clinic GAK "Narodni Front", University of Belgrade, Belgrade, Serbia
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Westberg SM, Arellano R, Cieri-Hutcherson NE, Heinrich NT, Herman AM, Lodise NM, McBane S, Ofili TU, O'Grady N, Sankey KH. Pharmacotherapy of Chronic Neuropsychiatric Conditions During Pregnancy. Nurs Womens Health 2024; 28:227-241. [PMID: 38702041 DOI: 10.1016/j.nwh.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 12/08/2023] [Accepted: 03/28/2024] [Indexed: 05/06/2024]
Abstract
Many pregnant persons will experience neuropsychiatric conditions during pregnancy, including migraine, attention deficit disorder, depression, and anxiety. Treatment of each of these conditions requires shared decision-making among the individual, family, and health care team. Although medications may include risk, the benefits often outweigh the potential fetal risks. In this article, we review pharmacologic treatment options for each of these conditions and appropriate use in pregnancy to maintain the stability of conditions and to optimize maternal and fetal outcomes.
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Thunbo MØ, Vendelbo JH, Witte DR, Larsen A, Pedersen LH. Use of medication in pregnancy on the rise: Study on 1.4 million Danish pregnancies from 1998 to 2018. Acta Obstet Gynecol Scand 2024; 103:1210-1223. [PMID: 38491733 PMCID: PMC11103131 DOI: 10.1111/aogs.14805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 01/02/2024] [Accepted: 01/30/2024] [Indexed: 03/18/2024]
Abstract
INTRODUCTION Maternal demographics have evolved, and more women than ever enter pregnancy with preexisting comorbidity and with potentially complex medication exposure, including polypharmacy (concomitant intake of multiple medications). This study aims to describe the evolution of medication use in pregnancy in Denmark from 1998 to 2018 with special focus on polypharmacy, patterns of use, and underlying demographics. MATERIAL AND METHODS A Danish nationwide historical registry study based on all clinically recognized pregnancies with a gestation ≥10 weeks between 1998 and 2018. Medication use was estimated by redemption of prescriptions during pregnancy. RESULTS Among a total of 1 402 327 clinically recognized pregnancies, redemption of at least one prescription medication during pregnancy increased from 56.9% in 1998 to 63.3% in 2018, coinciding with an increased use of polypharmacy (from 24.8% in 1998 to 35.2% in 2018). The prevalence of pregnant women who used medications for chronic conditions increased more than the prevalence of women treated for occasional or short-time conditions. Redemption of one or multiple prescription medications during pregnancy was mostly seen among pregnant women ≥35 years of age. However, pregnant women <25 years old exhibited the largest increase in medication use during the study period. CONCLUSIONS Medication use in general, and polypharmacy in particular, increased from 1998 to 2008, possibly as the result of an increased prevalence of pregnant women with chronic conditions requiring pharmacological treatment. Notably, a marked maternal age-based discrepancy in usage pattern was observed, highlighting the need for further research in this area. The rise in the prevalence of polypharmacy during pregnancy underscores the need for pharmacovigilance to monitor adverse effects. Future studies should investigate the patterns of polypharmacy and the accompanying maternal and fetal risks.
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Affiliation(s)
| | | | - Daniel R. Witte
- Department of Public HealthAarhus UniversityAarhusDenmark
- Steno Diabetes Center AarhusAarhus University HospitalAarhusDenmark
| | - Agnete Larsen
- Department of BiomedicineAarhus UniversityAarhusDenmark
| | - Lars Henning Pedersen
- Department of Clinical MedicineAarhus UniversityAarhusDenmark
- Department of BiomedicineAarhus UniversityAarhusDenmark
- Department of Obstetrics and GynecologyAarhus University HospitalAarhusDenmark
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Koni AA, Qashoa H, Musa AA, Masri M, Hazem W, Taha S, Daifallah A, Al-Jabi SW, Abushanab AS, Zyoud SH. Knowledge and practice of community pharmacists regarding the safety of drugs during pregnancy: a cross-sectional study from a developing country. BMC Pregnancy Childbirth 2024; 24:189. [PMID: 38468217 PMCID: PMC10926555 DOI: 10.1186/s12884-024-06393-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 03/04/2024] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND Drug use during pregnancy can cause unfavorable fetal and maternal outcomes. Information sharing is essential for pharmacists' role within intricate, modern healthcare systems. Community pharmacists (CPs) have demonstrated unsatisfactory knowledge across various pharmacological domains in most developing countries. This study aimed to explore the knowledge and practices of CPs regarding medications and herb safety during pregnancy. METHODS A cross-sectional study was conducted in a developing country using a self-administered questionnaire. A sample of CPs working in the northern governorates of the West Bank was selected by convenience sampling. The questionnaire included questions on sociodemographic characteristics, practices and knowledge. Descriptive and inferential statistics were calculated using the Statistical Package for the Social Sciences (SPSS) to analyze the data. RESULTS A total of 207 questionnaires were completed. Most respondents had only a bachelor's degree (89.9%) but did not participate in continuous professional development (CPD) (71.0%). Almost one-third of the CP workload involved dispensing drugs to pregnant women. The majority of the participants reported that they inquire about pregnancy status (59.9%), refer to scientific sources (82.6%), and contact a prescribing physician (51.2%) in cases of uncertainty. A higher knowledge score was associated with receiving a master's degree and CPD programs. Most CPs identified folic acid, paracetamol and amoxicillin as safe, while tetracycline, isotretinoin, enalapril, pseudoephedrine and ibuprofen were among the drugs mostly reported as unsafe. Castor oil, Senna, St. John's wort and ginseng were the most frequently reported herbs as unsafe. CONCLUSIONS Despite the gaps in knowledge about herb pharmacology, CPs demonstrated acceptable knowledge and practice regarding drug safety during pregnancy. CPD is recommended for addressing gaps in knowledge and practice. Future research evaluating knowledge and practice may benefit from developing a specific, accurate, validated instrument.
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Affiliation(s)
- Amer A Koni
- Department of Clinical and Community Pharmacy, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine
- Division of Clinical Pharmacy, Department of Hematology and Oncology, An-Najah National University Hospital, Nablus, 44839, Palestine
| | - Hamzah Qashoa
- Department of Clinical and Community Pharmacy, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine
| | - Abeer Abo Musa
- Department of Clinical and Community Pharmacy, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine
| | - Maen Masri
- Department of Clinical and Community Pharmacy, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine
| | - Walaa Hazem
- Department of Clinical and Community Pharmacy, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine
| | - Sari Taha
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine
| | - Aiman Daifallah
- Department of Clinical and Community Pharmacy, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine
| | - Samah W Al-Jabi
- Department of Clinical and Community Pharmacy, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine
| | - Amani S Abushanab
- Department of Clinical and Community Pharmacy, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine
| | - Sa'ed H Zyoud
- Department of Clinical and Community Pharmacy, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine.
- Poison Control and Drug Information Center (PCDIC), Faculty of Medicine and Health Sciences, An- Najah National University, Nablus, 44839, Palestine.
- Clinical Research Center, An-Najah National University Hospital, Nablus, 44839, Palestine.
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Wisner KL, Avram MJ, George AL, Abramova TV, Yang A, Caritis SN, Costantine MM, Stika CS. Concentrations of Fluoxetine Enantiomers Decline During Pregnancy and Increase After Birth. J Clin Psychopharmacol 2024; 44:100-106. [PMID: 38421920 PMCID: PMC10906734 DOI: 10.1097/jcp.0000000000001821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
RATIONALE Few studies of the effect of the dynamic physiologic changes during pregnancy on plasma concentrations of fluoxetine (FLX) have been published. OBJECTIVES We determined the change in concentration to dose (C/D) ratios of R- and S-FLX and R- and S-norfluoxetine monthly during pregnancy and postpartum, assessed their relationships to cytochrome P450 (CYP) 2D6 and CYP2C9 metabolizer phenotypes, and evaluated the course of their depressive and anxiety symptoms. METHODS In this observational study, 10 FLX-treated pregnant individuals provided blood samples at steady state every 4 weeks during pregnancy and once postpartum for measurement of plasma FLX and norfluoxetine enantiomer concentrations. Participants were genotyped for variants in CYP2C9 and CYP2D6 using commercial assays with Taqman probes. At each assessment, depressive and anxiety symptoms were quantified. RESULTS The C/D ratios of all FLX and norfluoxetine enantiomers, and the active moiety, decreased steadily through pregnancy and rose after birth. In the final trimester, the mean C/D ratio of the active moiety was 24.9% lower compared with the mean nonpregnant, 12-week postpartum C/D ratio. One individual with CYP2D6 ultrarapid metabolizer status was prescribed the highest FLX dose among participants. In these treated individuals, the mean depressive and anxiety symptoms remained in the mild range across the perinatal period. CONCLUSIONS These data do not support a recommendation for routine plasma concentration monitoring or CYP2D6 pharmacogenetic testing for pregnant people treated with FLX; however, monitoring for symptom relapse is recommended because of declining plasma drug concentrations.
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Affiliation(s)
- Katherine L. Wisner
- Developing Brain Institute, Children’s National Hospital, 111 Michigan Ave. NW, Washington, DC 20001. This work was conducted while Dr. Wisner was at Northwestern University Feinberg School of Medicine
- Department of Obstetrics and Gynecology, Northwestern University’s Feinberg School of Medicine, 250 E Superior Street, Suite 03-2303; Chicago, IL 60611, USA
| | - Michael J. Avram
- Department of Anesthesiology, Northwestern University Feinberg School of Medicine, 251 East Huron Street, Chicago, IL, 60611 USA
| | - Alfred L. George
- Department of Pharmacology, Northwestern University Feinberg School of Medicine, 320 East Superior Street, Chicago, IL 60611 USA
| | - Tatiana V. Abramova
- Department of Pharmacology, Northwestern University Feinberg School of Medicine, 320 East Superior Street, Chicago, IL 60611 USA
| | - Amy Yang
- AY Analytics, 20 Melrose St, Westmont, IL 60559 USA (contractual statistical service to Northwestern University Feinberg School of Medicine)
| | - Steve N. Caritis
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh, Magee Womens Hospital, 300 Halket St, Pittsburgh, PA 15213 USA
| | - Maged M. Costantine
- Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, 410 W 10 Ave, Columbus, OH 43210 USA
| | - Catherine S. Stika
- Department of Obstetrics and Gynecology, Northwestern University’s Feinberg School of Medicine, 250 E Superior Street, Suite 03-2303; Chicago, IL 60611, USA
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11
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Liu X, Wang W, Chen J, Chen D, Tao Y, Ouyang D. PBPK/PD Modeling of Nifedipine for Precision Medicine in Pregnant Women: Enhancing Clinical Decision-Making for Optimal Drug Therapy. Pharm Res 2024; 41:63-75. [PMID: 38049651 DOI: 10.1007/s11095-023-03638-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 11/24/2023] [Indexed: 12/06/2023]
Abstract
OBJECTIVE This study aims to develop physiologically based pharmacokinetic and pharmacodynamic (PBPK/PD) predictive models for nifedipine in pregnant women, enhancing precision medicine and reducing adverse reactions for both mothers and infants. METHODS A PBPK/PD model was constructed using PK-Sim, MoBi, and MATLAB software, integrating literature and pregnancy-specific physiological information. The process involved: (1) establishing and validating a PBPK model for serum clearance after intravenous administration in non-pregnant individuals, (2) establishing and validating a PBPK model for serum clearance after oral administration in non-pregnant individuals, (3) constructing and validating a PBPK model for enzyme clearance after oral administration in non-pregnant individuals, and (4) adjusting the PBPK model structure and enzyme parameters according to pregnant women and validating it in oral administration. (5) PK/PD model was explored through MATLAB, and the PBPK and PK/PD models were integrated to form the PBPK/PD model. RESULTS The Nifedipine PBPK model's predictive accuracy was confirmed by non-pregnant and pregnant validation studies. The developed PBPK/PD model accurately predicted maximum antihypertensive effects for clinical doses of 5, 10, and 20 mg. The model suggested peak effect at 0.86 h post-administration, achieving blood pressure reductions of 5.4 mmHg, 14.3 mmHg, and 21.3 mmHg, respectively. This model provides guidance for tailored dosing in pregnancy-induced hypertension based on targeted blood pressure reduction. CONCLUSION Based on available literature data, the PBPK/PD model of Nifedipine in pregnancy demonstrated good predictive performance. It will help optimize individualized dosing of Nifedipine, improve treatment outcomes, and minimize the risk of adverse reactions in mothers and infants.
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Affiliation(s)
- Xinyang Liu
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences (ICMS)/FHS, University of Macau, Avenida da Universidade, Taipa, Macau, China
- Department of Pharmacy, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, 450000, China
| | - Wei Wang
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences (ICMS)/FHS, University of Macau, Avenida da Universidade, Taipa, Macau, China
| | - Jingsi Chen
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510150, China
- Key Laboratories for Major Obstetric Diseases of Guangdong Province, Guangzhou, 510150, China
| | - Dunjin Chen
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510150, China
- Key Laboratories for Major Obstetric Diseases of Guangdong Province, Guangzhou, 510150, China
| | - Yong Tao
- Department of Ophthalmology, Beijing Chaoyang Hospital, Capital Medical University, No. 8, South Road of Worker's Stadium, Chaoyang District, Beijing, 100020, China
| | - Defang Ouyang
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences (ICMS)/FHS, University of Macau, Avenida da Universidade, Taipa, Macau, China.
- Department of Public Health and Medicinal Administration, Faculty of Health Sciences (FHS), University of Macau, Macau, China.
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12
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Agarwal A, Murkey SP, Pandit P, Jaiswal A, Agrawal S. Navigating the Complexity: A Comprehensive Review of Managing Pregnancy in Complete Heart Block Cases. Cureus 2023; 15:e50977. [PMID: 38259400 PMCID: PMC10801392 DOI: 10.7759/cureus.50977] [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: 11/21/2023] [Accepted: 12/22/2023] [Indexed: 01/24/2024] Open
Abstract
This review explores the comprehensive management of pregnancy in cases of complete heart block, a cardiac condition characterized by the dissociation between atrial and ventricular conduction. The review begins with a thorough examination of preconception counseling, emphasizing the assessment of maternal health, the evaluation of cardiac function, and the identification of potential risks. Subsequently, the medical management section delves into using beta-blockers, pacemakers, and antiarrhythmic drugs to monitor cardiac function during pregnancy and adjust medication regimens. Obstetric considerations highlight the importance of antenatal care, fetal monitoring, and thoughtful delivery planning, including the choice between vaginal delivery and cesarean section. The section on complications underscores the risks of arrhythmias, heart failure, premature birth, and neonatal cardiac issues. Looking ahead, the future directions and research section explores ongoing studies in genetics, pharmacology, and technological innovations, envisioning potential advancements in pacing technology and personalized medicine approaches. The conclusion synthesizes key findings, offering recommendations for clinical practice and reflecting on the challenges and opportunities inherent in managing pregnancy in complete heart block cases. The multidisciplinary approach emerges as paramount, with collaborative efforts paving the way for improved patient outcomes and advancements in the field.
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Affiliation(s)
- Akash Agarwal
- Surgery, Jawaharlal Nehru Medical College, Wardha, IND
| | | | - Pranam Pandit
- Medicine, Jawaharlal Nehru Medical College, Wardha, IND
| | - Arpita Jaiswal
- Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Wardha, IND
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13
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Hughes J. Pharmacokinetics and Safety of Group A and B Anti-Tuberculosis Drugs Used in Treatment of Rifampicin-Resistant Tuberculosis during Pregnancy and Post-Partum: A Narrative Review. Pathogens 2023; 12:1385. [PMID: 38133270 PMCID: PMC10745846 DOI: 10.3390/pathogens12121385] [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: 10/03/2023] [Revised: 11/06/2023] [Accepted: 11/14/2023] [Indexed: 12/23/2023] Open
Abstract
Recommendations for treatment of rifampicin-resistant tuberculosis (RR-TB) during pregnancy and post-partum now include Group A and B antituberculosis drugs. While pharmacokinetic data for most of these drugs among adults receiving treatment for RR-TB are limited, the data from pregnant patients and their infants are extremely scarce. Existing data suggest that fluoroquinolones, bedaquiline, clofazimine and terizidone may be used safely in pregnancy. Pharmacokinetic exposures, particularly between trimesters, are potentially sub-optimal; however, there is currently no evidence to support dose adjustment during pregnancy. Linezolid poses a potentially serious toxicity risk, particularly as exposures appear to be high in the later stages of pregnancy and post-partum following extended use, but this should be considered alongside the benefits of this extremely effective drug in the treatment of this life-threatening disease. While plenty of questions remain regarding the exposure to Group A and B antituberculosis drugs through breastmilk, existing literature suggests minimal harm to the breastfed infant. Pregnant patients and their infants should be included in therapeutic trials and pharmacokinetic studies of effective antituberculosis drugs.
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Affiliation(s)
- Jennifer Hughes
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town 7500, South Africa
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14
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Tropea T, Mavichak W, Evangelinos A, Brennan-Richardson C, Cottrell EC, Myers JE, Johnstone ED, Brownbill P. Fetoplacental vascular effects of maternal adrenergic antihypertensive and cardioprotective medications in pregnancy. J Hypertens 2023; 41:1675-1687. [PMID: 37694528 PMCID: PMC10552840 DOI: 10.1097/hjh.0000000000003532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 06/07/2023] [Accepted: 07/24/2023] [Indexed: 09/12/2023]
Abstract
Maternal cardiovascular diseases, including hypertension and cardiac conditions, are associated with poor fetal outcomes. A range of adrenergic antihypertensive and cardioprotective medications are often prescribed to pregnant women to reduce major maternal complications during pregnancy. Although these treatments are not considered teratogenic, they may have detrimental effects on fetal growth and development, as they cross the fetoplacental barrier, and may contribute to placental vascular dysregulation. Medication risk assessment sheets do not include specific advice to clinicians and women regarding the safety of these therapies for use in pregnancy and the potential off-target effects of adrenergic medications on fetal growth have not been rigorously conducted. Little is known of their effects on the fetoplacental vasculature. There is also a dearth of knowledge on adrenergic receptor activation and signalling within the endothelium and vascular smooth muscle cells of the human placenta, a vital organ in the maintenance of adequate blood flow to satisfy fetal growth and development. The fetoplacental circulation, absent of sympathetic innervation, and unique in its reliance on endocrine, paracrine and autocrine influence in the regulation of vascular tone, appears vulnerable to dysregulation by adrenergic antihypertensive and cardioprotective medications compared with the adult peripheral circulation. This semi-systematic review focuses on fetoplacental vascular expression of adrenergic receptors, associated cell signalling mechanisms and predictive consequences of receptor activation/deactivation by antihypertensive and cardioprotective medications.
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Affiliation(s)
- Teresa Tropea
- Maternal & Fetal Health Research Centre, Division of Developmental Biology & Medicine, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester
- St Mary's Hospital, Manchester University Hospital NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Weerawaroon Mavichak
- Maternal & Fetal Health Research Centre, Division of Developmental Biology & Medicine, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester
- St Mary's Hospital, Manchester University Hospital NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Angelos Evangelinos
- Maternal & Fetal Health Research Centre, Division of Developmental Biology & Medicine, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester
- St Mary's Hospital, Manchester University Hospital NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Charlotte Brennan-Richardson
- Maternal & Fetal Health Research Centre, Division of Developmental Biology & Medicine, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester
- St Mary's Hospital, Manchester University Hospital NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Elizabeth C. Cottrell
- Maternal & Fetal Health Research Centre, Division of Developmental Biology & Medicine, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester
- St Mary's Hospital, Manchester University Hospital NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Jenny E. Myers
- Maternal & Fetal Health Research Centre, Division of Developmental Biology & Medicine, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester
- St Mary's Hospital, Manchester University Hospital NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Edward D. Johnstone
- Maternal & Fetal Health Research Centre, Division of Developmental Biology & Medicine, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester
- St Mary's Hospital, Manchester University Hospital NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Paul Brownbill
- Maternal & Fetal Health Research Centre, Division of Developmental Biology & Medicine, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester
- St Mary's Hospital, Manchester University Hospital NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
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15
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Zitoun N, Campbell MK, Matsui D, Garcia-Bournissen F. Prospective evaluation of pregnancy outcomes after gestational exposure to prazosin. Br J Clin Pharmacol 2023; 89:3324-3329. [PMID: 37323115 DOI: 10.1111/bcp.15829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 05/12/2023] [Accepted: 05/31/2023] [Indexed: 06/17/2023] Open
Abstract
AIMS Prazosin is an antihypertensive medication which can be used to help with post-traumatic stress disorder (PTSD) symptoms. Little data is currently available on its safety in pregnancy. The aim of this study was to assess the fetal and pregnancy safety associated with prazosin exposures in early pregnancy. METHODS Subjects were 11 patients who took prazosin during pregnancy and were counselled at the FRAME clinic in London Health Sciences Centre (Ontario, Canada) between 1 January 2000 and 31 December 2021. Data on their other exposures and pregnancy outcomes were collected from medical records and through telephone questionnaires. RESULTS It was found that 6/11 (54.5%) subjects did not report any adverse outcomes and experienced uneventful pregnancies. There were two miscarriages. Birthweights were within the normal range for the remaining nine pregnancies. Adverse events reported were consistent with background population expectation, including: one postpartum haemorrhage, one case of preeclampsia, one preterm birth, two NICU admissions, and two caesarean sections. CONCLUSIONS For these 11 subjects, pregnancy outcomes after exposure to prazosin were consistent with typical outcomes from unexposed pregnancies. More data are needed to conclude that prazosin is safe for use in pregnant subjects. However, the lack of adverse effects above baseline is reassuring to future patients who may be unintentionally exposed to prazosin while pregnant. Therefore, this study contributes valuable data towards monitoring safety of prazosin in pregnancy.
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Affiliation(s)
- Natalie Zitoun
- Department of Epidemiology & Biostatistics, University of Western Ontario, London, ON, Canada
| | - M Karen Campbell
- Department of Epidemiology & Biostatistics, University of Western Ontario, London, ON, Canada
- Department of Pediatrics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
- Department of Obstetrics & Gynecology, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
- Children's Health Research Institute, London, ON, Canada
- Lawson Health Research Institute, London, ON, Canada
| | - Doreen Matsui
- Department of Pediatrics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Facundo Garcia-Bournissen
- Department of Epidemiology & Biostatistics, University of Western Ontario, London, ON, Canada
- Department of Pediatrics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
- Children's Health Research Institute, London, ON, Canada
- Lawson Health Research Institute, London, ON, Canada
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16
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Mohammad FK, Mohammed AA, Garmavy HM, Rashid HM. Association of Reduced Maternal Plasma Cholinesterase Activity With Preeclampsia: A Meta-Analysis. Cureus 2023; 15:e47220. [PMID: 38022101 PMCID: PMC10653552 DOI: 10.7759/cureus.47220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2023] [Indexed: 12/01/2023] Open
Abstract
Blood butyrylcholinesterase (BChE) activity has been found to decrease during pregnancy and reportedly decrease even more in preeclampsia (PE). The purpose of the present meta-analysis was to answer a specific question of whether BChE activity (in the plasma, serum, or whole blood) is reduced in pregnant women suffering from PE compared to those with normal pregnancy. The meta-analysis included 15 studies with 20 records of BChE activity in 608 women compared to 569 healthy pregnant (control) ones. The studies were subjected to quality assessment using the Newcastle-Ottawa Scale (NOS). Using the Meta-Essentials software program 1.5, the one-group random effects model and forest plot revealed that the percentage of BChE activity in pregnant women with PE was 84.84% of the control value, with a standard error of 4.09 and 95% C.I. of 76.28, 93.41, indicating a significant 15.16% reduction in BChE activity in comparison to healthy pregnancy. No significant heterogeneity was seen in the analyzed data and the funnel plot did show publication bias. Subgroup (mild, severe, and unclassified PE) forest plot analysis revealed that the % BChE activities in PE compared to respective healthy pregnancies were 96.28%, 97.08%, and 76.62%, respectively with no heterogeneity. The median NOS score of the 15 studies included in the meta-analysis was 7, ranging from 5 to 8 (medium to high quality), and the forest plot showed an effect size of 0.735. This meta-analysis shows that BChE activity is reduced in PE compared with normal pregnancy and its value as a biomarker warrants further clinical studies.
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Affiliation(s)
- Fouad K Mohammad
- Department of Physiology, Biochemistry and Pharmacology, College of Veterinary Medicine, University of Mosul, Mosul, IRQ
| | - Ammar A Mohammed
- Department of Pharmacology, College of Pharmacy, University of Duhok, Duhok, IRQ
| | - Hishyar M Garmavy
- Department of Pharmacology, College of Pharmacy, University of Duhok, Duhok, IRQ
| | - Hussein M Rashid
- Department of Pharmacology, College of Pharmacy, University of Duhok, Duhok, IRQ
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17
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Misra A, Porras MP, Rajendran A, Contreras J, Scott NS. Cardio-Obstetrics: A Focused Review. Curr Cardiol Rep 2023; 25:1065-1073. [PMID: 37540401 DOI: 10.1007/s11886-023-01928-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/18/2023] [Indexed: 08/05/2023]
Abstract
PURPOSE OF REVIEW Cardiovascular disease is the leading cause of maternal mortality in the USA. All cardiovascular care providers should have a foundational knowledge on the management of pregnant individuals with heart disease. This focused review touches on several key cardio-obstetric themes. RECENT FINDINGS Many individuals with cardiovascular disease can safely undergo pregnancy, but should have counseling preconception to optimize cardiac status. There are several cardiovascular conditions that are high risk for maternal mortality and morbidity. These individuals should be adequately counseled preconception and offered reliable birth control. The approach to a high-risk pregnant patient with cardiac disease is best managed by a multidisciplinary team to address potential maternal and fetal complications. Identification of at risk individuals can be estimated preconception with several risk scores. The development of risk scores to stratify and identify those at elevated risk during pregnancy is an area of continued research and development.
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Affiliation(s)
- Amrit Misra
- Department of Cardiology, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Aardra Rajendran
- Department of Internal Medicine, John Hopkins University, Baltimore, MD, USA
| | - Johanna Contreras
- Department of Cardiology, Division of Advanced Heart Failure and Transplant, Icahn School of Medicine, Mount Sinai, New York City, NY, USA
| | - Nandita S Scott
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Yawkey 5B, Boston, MA, 02114, USA.
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18
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Popova NM, Slepnev AA, Abalenikhina YV, Shchulkin AV, Rokunov ED, Yakusheva EN. [Quantitative assessment of breast cancer resistance protein during pregnancy in rabbits]. BIOMEDITSINSKAIA KHIMIIA 2023; 69:72-77. [PMID: 36857429 DOI: 10.18097/pbmc20236901072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
Breast cancer resistance protein (BCRP,ABCG2) is an efflux transporter protein that transports various substrates from the cell to the extracellular space or organ cavities. The aim of this study was a complex assessment of the amount of BCRP during pregnancy in rabbits. The amount of BCRP in samples of the rabbit jejunum, liver, kidney, cerebral cortex, and placenta was determined by enzyme immunoassay, and in human hepatocellular carcinoma (HepG2) cells by the Western blot. To study the mechanisms involved in control of the dynamic BCRP levels during pregnancy, serum concentrations of sex hormones were investigated by radioimmunoassay and relative amounts of constitutive androstane receptor (CAR) and pregnane X receptor (PXR) in these organs were evaluated using the Western blot method. The putative role of CAR and PXR in regulation of the BCRP level by progesterone was evaluated in vitro experiments on HepG2 cells. It was found that amount of BCRP in the jejunum of pregnant rabbits was higher than in the placenta, liver, kidneys, and cerebral cortex. An increase in the amount of BCRP in the liver of rabbits was noted on the 21st day of pregnancy and a tendency to the increase was also detected on the 28th day; in the kidney and cerebral cortex increased BCRP levels were detected on the 28th day and 14th day of pregnancy, respectively, as compared with non-pregnant females. In vitro experiments with HepG2 cells have shown that the increase in the BCRP level is determined by the activating effect of progesterone on PXR.
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Affiliation(s)
- N M Popova
- Ryazan State Medical University, Ryazan, Russia
| | - A A Slepnev
- Ryazan State Medical University, Ryazan, Russia
| | | | | | - E D Rokunov
- Ryazan State Medical University, Ryazan, Russia
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19
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Sportiello L, Capuano A. It is the time to change the paradigms of pregnant and breastfeeding women in clinical research! Front Pharmacol 2023; 14:1113557. [PMID: 36909199 PMCID: PMC9996249 DOI: 10.3389/fphar.2023.1113557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 01/30/2023] [Indexed: 02/25/2023] Open
Affiliation(s)
- Liberata Sportiello
- Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, University of Campania "Luigi Vanvitelli", Naples, Italy.,Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Annalisa Capuano
- Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, University of Campania "Luigi Vanvitelli", Naples, Italy.,Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
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20
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Stika CS, Wisner KL, George AL, Avram MJ, Zumpf K, Rasmussen-Torvik LJ, Mesches GA, Caritis SN, Venkataramanan R, Costantine MM, West HA, Clark S, Ciolino JD. Changes in Sertraline Plasma Concentrations Across Pregnancy and Postpartum. Clin Pharmacol Ther 2022; 112:1280-1290. [PMID: 36094046 DOI: 10.1002/cpt.2746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 09/05/2022] [Indexed: 01/31/2023]
Abstract
Major depressive disorder (MDD) is a common disorder in pregnancy. Although sertraline is the most frequently prescribed antidepressant for pregnant people in the United States, limited information about its pharmacokinetics in pregnancy is available. Our objectives were to characterize plasma sertraline concentration to dose (C/D) ratios across pregnancy and postpartum and investigate the effect of pharmacogenetic variability on sertraline elimination. We performed a prospective observational cohort study in people with a singleton pregnancy ≤ 18 weeks gestation and a lifetime diagnosis of MDD at the 3 Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)-funded Obstetrical-Fetal Pharmacology Research Center sites. Subjects (N = 47) were receiving maintenance sertraline therapy and chose to continue it during pregnancy. Blood samples were obtained 24-hours postdose every 4 weeks across pregnancy and twice postpartum for measurement of plasma concentrations of sertraline and desmethylsertraline. Overall mean sertraline C/D ratios were decreased at study onset and remained consistently low until after delivery. During the last 4 weeks of pregnancy the mean sertraline C/D ratio (95% confidence interval (CI)), 0.25 (95% CI, 0.19, 0.3) ng/mL/dose (mg/day), was smaller than the mean ratio at ≥ 8 weeks after delivery, 0.32 (95% CI, 0.27, 0.37) ng/mL/dose (mg/day), a 22% difference. Mean sertraline/desmethylsertraline ratios were highest after birth, which confirmed increased sertraline elimination during pregnancy. Sertraline C/D ratios in participants with functional CYP2C19 activity did not change significantly during pregnancy, whereas ratios in participants with poor or intermediate CYP2C19 activity decreased by 51%. Exploratory pharmacogenomic analysis indicated that pregnant people with poor or intermediate CYP2C19 activity are at risk for subtherapeutic sertraline concentrations during pregnancy.
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Affiliation(s)
- Catherine S Stika
- Department of Obstetrics and Gynecology, Northwestern University's Feinberg School of Medicine, Chicago, Illinois, USA
| | - Katherine L Wisner
- Department of Obstetrics and Gynecology, Northwestern University's Feinberg School of Medicine, Chicago, Illinois, USA.,Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Alfred L George
- Department of Pharmacology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Michael J Avram
- Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Katelyn Zumpf
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Laura J Rasmussen-Torvik
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Gabrielle A Mesches
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Steve N Caritis
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh, Magee Womens Hospital, Pittsburgh, Pennsylvania, USA
| | - Raman Venkataramanan
- Department of Pharmaceutical Sciences, University of Pittsburgh School of Pharmacy, Pittsburgh, Pennsylvania, USA.,Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Maged M Costantine
- Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Holly A West
- Department of OB/GYN, University of Texas Medical Branch, Galveston, Texas, USA
| | - Shannon Clark
- Department of OB/GYN, University of Texas Medical Branch, Galveston, Texas, USA
| | - Jody D Ciolino
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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21
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Bruno AM, Allshouse AA, Campbell HM, Branch DW, Lim MY, Silver RM, Metz TD. Weight-Based Compared With Fixed-Dose Enoxaparin Prophylaxis After Cesarean Delivery: A Randomized Controlled Trial. Obstet Gynecol 2022; 140:575-583. [PMID: 36075079 PMCID: PMC10473241 DOI: 10.1097/aog.0000000000004937] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 07/14/2022] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To evaluate fixed compared with weight-based enoxaparin dosing to achieve prophylactic anti-Xa levels after cesarean delivery. METHODS Individuals meeting institutional criteria for enoxaparin thromboprophylaxis after cesarean delivery were randomly allocated to fixed (40 mg daily for body mass index [BMI, calculated as weight in kilograms divided by height in meters squared] lower than 40; 40 mg every 12 hours for BMI 40 or higher) or weight-based (0.5 mg/kg every 12 hours) enoxaparin dosing. Enoxaparin was initiated during inpatient hospitalization and continued at discharge for 14 days. Those with contraindication to anticoagulation, plan for therapeutic anticoagulation, or known renal impairment were excluded. The trial was unmasked. The primary outcome was prophylactic (0.2-0.6 international units/mL) peak anti-Xa level 4-6 hours after at least the third enoxaparin dose (at steady state). Secondary outcomes included subprophylactic and supraprophylactic peaks, outpatient peak, and venous thromboembolism (VTE) and wound complications in the first 6 weeks postpartum. Sample size of 121 per group was planned. At interim analysis with 50% enrollment, the trial was stopped early for efficacy. Primary analyses followed intention-to-treat principle with worst-case imputation for missing outcomes. Secondary analyses were complete case. RESULTS From June 2020 to November 2021, 74 individuals were randomized to weight-based enoxaparin and 72 to fixed-dose enoxaparin. Those who received weight-based dosing were more likely to achieve prophylactic anti-Xa levels than those who received fixed dosing in primary analysis (49/74 [66%] vs 32/72 [44%], relative risk [RR] 1.49, 95% CI 1.10-2.02) and secondary analysis (49/60 [82%] vs 32/57 [56%], RR 1.45, 95% CI 1.12-1.88). Subprophylactic levels occurred more frequently with fixed dosing; supraprophylactic levels did not differ significantly by dosing. At the outpatient postoperative visit, 52% of participants (15/29) with weight-based dosing compared with 15% (5/33) with fixed dosing achieved prophylactic peak anti-Xa level (RR 3.41, 95% CI 1.42-8.24). There were no VTEs in either group. Wound complications occurred in five individuals (7%) with weight-based enoxaparin dosing compared with one individual (1%) with fixed enoxaparin dosing (RR 4.86, 95% 0.58-40.63). CONCLUSION Weight-based dosing was more effective than fixed enoxaparin dosing in achieving prophylactic peak anti-Xa levels after cesarean delivery. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, NCT04305756.
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Affiliation(s)
- Ann M. Bruno
- University of Utah Health, Salt Lake City, UT
- Intermountain Healthcare, Murray, UT
| | | | - Heather M. Campbell
- University of Utah Health, Salt Lake City, UT
- Intermountain Healthcare, Murray, UT
| | - D. Ware Branch
- University of Utah Health, Salt Lake City, UT
- Intermountain Healthcare, Murray, UT
| | - Ming Y. Lim
- University of Utah Health, Salt Lake City, UT
| | - Robert M. Silver
- University of Utah Health, Salt Lake City, UT
- Intermountain Healthcare, Murray, UT
| | - Torri D. Metz
- University of Utah Health, Salt Lake City, UT
- Intermountain Healthcare, Murray, UT
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22
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Federle L. Part
II
: Interactive case: Cardiovascular diseases in pregnancy. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2022. [DOI: 10.1002/jac5.1689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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23
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Court R, Gausi K, Mkhize B, Wiesner L, Waitt C, McIlleron H, Maartens G, Denti P, Loveday M. Bedaquiline exposure in pregnancy and breastfeeding in women with rifampicin-resistant tuberculosis. Br J Clin Pharmacol 2022; 88:3548-3558. [PMID: 35526837 PMCID: PMC9296589 DOI: 10.1111/bcp.15380] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 04/14/2022] [Accepted: 04/27/2022] [Indexed: 11/30/2022] Open
Abstract
AIMS We aimed to explore the effect of pregnancy on bedaquiline pharmacokinetics (PK) and describe bedaquiline exposure in the breast milk of mothers treated for rifampicin-resistant tuberculosis (TB), where there are no human data available. METHODS We performed a longitudinal PK study in pregnant women treated for rifampicin-resistant TB to explore the effect of pregnancy on bedaquiline exposure. Pharmacokinetic sampling was performed at 4 time-points over 6 hours in the third trimester, and again at approximately 6 weeks postpartum. We obtained serial breast milk samples from breastfeeding mothers, and a single plasma sample taken from breastfed and nonbreastfed infants to assess bedaquiline exposure. We used liquid chromatography-tandem mass spectrometry to perform the breast milk and plasma bedaquiline assays, and population PK modelling to interpret the bedaquiline concentrations. RESULTS We recruited 13 women, 6 of whom completed the ante- and postpartum PK sampling. All participants were HIV-positive on antiretroviral therapy. We observed lower ante- and postpartum bedaquiline exposures than reported in nonpregnant controls. Bedaquiline concentrations in breast milk were higher than maternal plasma (milk to maternal plasma ratio: 14:1). A single random plasma bedaquiline and M2 concentration was available in 4 infants (median age: 6.5 wk): concentrations in the 1 breastfed infant were similar to maternal plasma concentrations; concentrations in the 3 nonbreastfed infants were detectable but lower than maternal plasma concentrations. CONCLUSION We report low exposure of bedaquiline in pregnant women treated for rifampicin-resistant TB. Bedaquiline significantly accumulates in breast milk; breastfed infants receive mg/kg doses of bedaquiline equivalent to maternal doses.
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Affiliation(s)
- Richard Court
- Division of Clinical Pharmacology, Department of MedicineUniversity of Cape Town
- Wellcome Centre for Infectious Diseases Research in Africa (CIDRI‐Africa), Institute of Infectious Disease and Molecular MedicineUniversity of Cape TownCape Town
| | - Kamunkhwala Gausi
- Division of Clinical Pharmacology, Department of MedicineUniversity of Cape Town
| | - Buyisile Mkhize
- Division of Clinical Pharmacology, Department of MedicineUniversity of Cape Town
| | - Lubbe Wiesner
- Division of Clinical Pharmacology, Department of MedicineUniversity of Cape Town
| | - Catriona Waitt
- Department of Pharmacology and TherapeuticsUniversity of LiverpoolUK
| | - Helen McIlleron
- Division of Clinical Pharmacology, Department of MedicineUniversity of Cape Town
- Wellcome Centre for Infectious Diseases Research in Africa (CIDRI‐Africa), Institute of Infectious Disease and Molecular MedicineUniversity of Cape TownCape Town
| | - Gary Maartens
- Division of Clinical Pharmacology, Department of MedicineUniversity of Cape Town
- Wellcome Centre for Infectious Diseases Research in Africa (CIDRI‐Africa), Institute of Infectious Disease and Molecular MedicineUniversity of Cape TownCape Town
| | - Paolo Denti
- Division of Clinical Pharmacology, Department of MedicineUniversity of Cape Town
| | - Marian Loveday
- HIV Prevention Research Unit, South African Medical Research CouncilKwaZulu‐NatalSouth Africa
- CAPRISA‐MRC HIV‐TB Pathogenesis and Treatment Research UnitUniversity of KwaZulu‐NatalSouth Africa
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24
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Beghin D. [Impact of pregnancy on drug pharmacokinetics: What implication in clinical practice?]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2022; 50:422-425. [PMID: 35219913 DOI: 10.1016/j.gofs.2022.02.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 02/10/2022] [Indexed: 06/14/2023]
Abstract
Physiological changes that occur during pregnancy in the maternal body can lead to alterations in the response to drugs in the mother. Pregnancy modifies the volume of distribution of drugs, their binding to plasma proteins, the activity of their metabolizing enzymes, and their elimination. However, to date, due to the dynamic and complex processes involved, adjustments to the dosage regimen during pregnancy remain impossible to standardize. Knowledge of these modifications will help to better understand the possible loss of drug efficacy during pregnancy, as well as anticipating the clinical and plasma monitoring of drugs with a low therapeutic margin.
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Affiliation(s)
- D Beghin
- Centre de référence sur les agents tératogènes (CRAT), DMU ESPRIT (épidémiologie et biostatistique, santé publique, pharmacie, pharmacologie, recherche, information médicale, thérapeutique et médicaments), GHU AP-HP Sorbonne université, site Trousseau 26, avenue Dr Netter, 75571 Paris cedex 12, France.
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25
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Ramírez-Lozada T, Loranca-García MC, Fuentes-Venado CE, Rodríguez-Cerdeira C, Ocharan-Hernández E, Soriano-Ursúa MA, Farfán-García ED, Chávez-Gutiérrez E, Ramírez-Magaña X, Robledo-Cayetano M, Loza-Mejía MA, Santa-Olalla IAG, Torres-Paez OU, Pinto-Almazán R, Martínez-Herrera E. Does the Fetus Limit Antibiotic Treatment in Pregnant Patients with COVID-19? Antibiotics (Basel) 2022; 11:antibiotics11020252. [PMID: 35203854 PMCID: PMC8868538 DOI: 10.3390/antibiotics11020252] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 02/04/2022] [Accepted: 02/08/2022] [Indexed: 02/07/2023] Open
Abstract
During pregnancy, there is a state of immune tolerance that predisposes them to viral infection, causing maternal-fetal vulnerability to the adverse effects of COVID-19. Bacterial coinfections significantly increase the mortality rate for COVID-19. However, it is known that all drugs, including antibiotics, will enter the fetal circulation in a variable degree despite the role of the placenta as a protective barrier and can cause teratogenesis or other malformations depending on the timing of exposure to the drug. Also, it is important to consider the impact of the indiscriminate use of antibiotics during pregnancy can alter both the maternal and fetal-neonatal microbiota, generating future repercussions in both. In the present study, the literature for treating bacterial coinfections in pregnant women with COVID-19 is reviewed. In turn, we present the findings in 50 pregnant women hospitalized diagnosed with SARS-CoV-2 without previous treatment with antibiotics; moreover, a bacteriological culture of sample types was performed. Seven pregnant women had coinfection with Staphylococcus haemolyticus, Staphylococcus epidermidis, Streptococcus agalactiae, Escherichia coli ESBL +, biotype 1 and 2, Acinetobacter jahnsonii, Enterococcus faecium, and Clostridium difficile. When performing the antibiogram, resistance to multiple drugs was found, such as macrolides, aminoglycosides, sulfa, dihydrofolate reductase inhibitors, beta-lactams, etc. The purpose of this study was to generate more scientific evidence on the better use of antibiotics in these patients. Because of this, it is important to perform an antibiogram to prevent abuse of empirical antibiotic treatment with antibiotics in pregnant women diagnosed with SARS-CoV-2.
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Affiliation(s)
- Tito Ramírez-Lozada
- Servicio de Ginecología y Obstetricia, Hospital Regional de Alta Especialidad de Ixtapaluca, Ixtapaluca 56530, Mexico; (T.R.-L.); (X.R.-M.)
| | - María Concepción Loranca-García
- Hospital General de Zona No. 53, Los Reyes, Instituto Mexicano del Seguro Social (IMSS), Carr Federal México-Puebla Km 17.5, Villa de la Paz, Rincón de los Reyes, Los Reyes Acaquilpan 56400, Mexico;
| | | | - Carmen Rodríguez-Cerdeira
- Efficiency, Quality, and Costs in Health Services Research Group (EFISALUD), Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, 36213 Vigo, Spain;
- Dermatology Department, Hospital Vithas Ntra. Sra. de Fátima, 36206 Vigo, Spain
- Campus Universitario, University of Vigo, 36310 Vigo, Spain
| | - Esther Ocharan-Hernández
- Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, Mexico City 11340, Mexico; (E.O.-H.); (M.A.S.-U.); (E.D.F.-G.)
| | - Marvin A. Soriano-Ursúa
- Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, Mexico City 11340, Mexico; (E.O.-H.); (M.A.S.-U.); (E.D.F.-G.)
| | - Eunice D. Farfán-García
- Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, Mexico City 11340, Mexico; (E.O.-H.); (M.A.S.-U.); (E.D.F.-G.)
| | - Edwin Chávez-Gutiérrez
- Doctorado en Ciencias en Biomedicina y Biotecnología Molecular, Escuela Nacional de Ciencias Biológicas, IPN, Mexico City 07738, Mexico;
- Unidad de Investigación, Hospital Regional de Alta Especialidad de Ixtapaluca, Estado de Mexico 56530, Mexico; (M.R.-C.); (O.U.T.-P.)
| | - Xóchitl Ramírez-Magaña
- Servicio de Ginecología y Obstetricia, Hospital Regional de Alta Especialidad de Ixtapaluca, Ixtapaluca 56530, Mexico; (T.R.-L.); (X.R.-M.)
| | - Maura Robledo-Cayetano
- Unidad de Investigación, Hospital Regional de Alta Especialidad de Ixtapaluca, Estado de Mexico 56530, Mexico; (M.R.-C.); (O.U.T.-P.)
| | - Marco A. Loza-Mejía
- Design, Isolation, and Synthesis of Bioactive Molecules Research Group, Chemical Sciences School, Universidad La Salle-México, Benjamín Franklin 45, Mexico City 06140, Mexico;
| | | | - Oscar Uriel Torres-Paez
- Unidad de Investigación, Hospital Regional de Alta Especialidad de Ixtapaluca, Estado de Mexico 56530, Mexico; (M.R.-C.); (O.U.T.-P.)
| | - Rodolfo Pinto-Almazán
- Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, Mexico City 11340, Mexico; (E.O.-H.); (M.A.S.-U.); (E.D.F.-G.)
- Non-Communicable Disease Research Group, Facultad Mexicana de Medicina, Universidad La Salle-México, Las Fuentes 17, Tlalpan Centro I, Tlalpan, Mexico City 14000, Mexico
- Correspondence: (R.P.-A.); (E.M.-H.)
| | - Erick Martínez-Herrera
- Efficiency, Quality, and Costs in Health Services Research Group (EFISALUD), Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, 36213 Vigo, Spain;
- Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, Mexico City 11340, Mexico; (E.O.-H.); (M.A.S.-U.); (E.D.F.-G.)
- Correspondence: (R.P.-A.); (E.M.-H.)
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26
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Bukkems VE, Necsoi C, Tenorio CH, Garcia C, Alejandre IA, Weiss F, Lambert JS, van Hulzen A, Richel O, Te Brake LHM, van der Meulen E, Burger D, Konopnicki D, Colbers A. Tenofovir alafenamide plasma concentrations are reduced in pregnant women living with HIV: data from the PANNA Network. Clin Infect Dis 2021; 75:623-629. [PMID: 34864950 PMCID: PMC9464066 DOI: 10.1093/cid/ciab1010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Tenofovir alafenamide (TAF), a prodrug of tenofovir (TFV), is included in the majority of the recommended first-line antiretroviral regimens for patients living with HIV, but there are limited data on TAF use in pregnant women. We aimed to examine the plasma pharmacokinetics of TAF and TFV in pregnant women from Europe. METHODS Pregnant women living with HIV were included from treatment centers across Europe, and intensive pharmacokinetic sampling in the third trimester and postpartum was performed. Pharmacokinetic parameters of TAF and TFV were determined with noncompartmental analysis. The proportion of women with a TAF AUCtau below the target of 53.1 ng*h/mL was determined. Clinical efficacy and safety outcome parameters were reported. RESULTS In total, 20 pregnant women living with HIV were included. At the third trimester, geometric mean TAF AUClast and Cmax were decreased by 46% and 52%, respectively, compared with postpartum. TFV AUC0-24h, Cmax, and Ctrough decreased by 33%, 30% and 34%, respectively. The proportion of women with a TAF AUClast <53.1 ng*h/mL was 6% at third trimester and 0% postpartum. One out of 20 women had a viral load >50 copies/mL at third trimester and no mother-to-child transmission occurred. CONCLUSIONS TAF plasma concentrations were reduced by about half in women living with HIV during third trimester of pregnancy, but remained above the predefined efficacy target in the majority of the pregnant women. TFV concentrations were reduced by approximately 30% during third trimester. Despite the observed exposure decrease, high virologic efficacy was observed in this study.
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Affiliation(s)
- Vera E Bukkems
- Department of Pharmacy, Radboud Institute for Health Sciences (RIHS), Radboud university medical center, Nijmegen, the Netherlands
| | - Coca Necsoi
- Saint-Pierre University Hospital, Brussels, Belgium
| | | | - Coral Garcia
- Hospital Universtario Virgen de las Nieves, Granada, Spain
| | - Irene Alba Alejandre
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Germany
| | - Fabian Weiss
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Germany
| | - John S Lambert
- Mater Misericordiae University Hospital, Dublin, Ireland.,Rotunda hospitals, Dublin, Ireland.,UCD school of medicine and medical science, Dublin, Ireland
| | - Astrid van Hulzen
- Department of internal medicine, Isala Hospital, Zwolle, the Netherlands
| | - Olivier Richel
- Department of internal medicine, Radboud university medical center, Nijmegen, the Netherlands
| | - Lindsey H M Te Brake
- Department of Pharmacy, Radboud Institute for Health Sciences (RIHS), Radboud university medical center, Nijmegen, the Netherlands
| | - Eric van der Meulen
- Department of Pharmacy, Radboud Institute for Health Sciences (RIHS), Radboud university medical center, Nijmegen, the Netherlands
| | - David Burger
- Department of Pharmacy, Radboud Institute for Health Sciences (RIHS), Radboud university medical center, Nijmegen, the Netherlands
| | | | - Angela Colbers
- Department of Pharmacy, Radboud Institute for Health Sciences (RIHS), Radboud university medical center, Nijmegen, the Netherlands
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27
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A Case of a Perinatal Woman on Methadone Maintenance Who Developed Postpartum Torsades de Pointes: Importance of Perinatal Changes in Drug Metabolism. J Clin Psychopharmacol 2021; 41:484-487. [PMID: 34155161 DOI: 10.1097/jcp.0000000000001426] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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28
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Gausi K, Wiesner L, Norman J, Wallis CL, Onyango‐Makumbi C, Chipato T, Haas DW, Browning R, Chakhtoura N, Montepiedra G, Aaron L, McCarthy K, Bradford S, Vhembo T, Stranix‐Chibanda L, Masheto GR, Violari A, Mmbaga BT, Aurpibul L, Bhosale R, Nevrekhar N, Rouzier V, Kabugho E, Mutambanengwe M, Chanaiwa V, Nyati M, Mhembere T, Tongprasert F, Hesseling A, Shin K, Zimmer B, Costello D, Jean‐Philippe P, Sterling TR, Theron G, Weinberg A, Gupta A, Denti P. Pharmacokinetics and Drug-Drug Interactions of Isoniazid and Efavirenz in Pregnant Women Living With HIV in High TB Incidence Settings: Importance of Genotyping. Clin Pharmacol Ther 2021; 109:1034-1044. [PMID: 32909316 PMCID: PMC8048881 DOI: 10.1002/cpt.2044] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 08/30/2020] [Indexed: 01/11/2023]
Abstract
The World Health Organization guidelines recommend that individuals living with HIV receive ≥ 6 months of isoniazid preventive therapy, including pregnant women. Yet, plasma isoniazid exposure during pregnancy, in the antiretroviral therapy era, has not been well-described. We investigated pregnancy-induced and pharmacogenetic-associated pharmacokinetic changes and drug-drug interactions between isoniazid and efavirenz in pregnant women. Eight hundred forty-seven women received isoniazid for 28 weeks, either during pregnancy or at 12 weeks postpartum, and 786 women received efavirenz. After adjusting for NAT2 and CYP2B6 genotype and weight, pregnancy increased isoniazid and efavirenz clearance by 26% and 15%, respectively. Isoniazid decreased efavirenz clearance by 7% in CYP2B6 normal metabolizers and 13% in slow and intermediate metabolizers. Overall, both isoniazid and efavirenz exposures were reduced during pregnancy, but the main determinants of drug concentration were NAT2 and CYP2B6 genotypes, which resulted in a five-fold difference for both drugs between rapid and slow metabolizers.
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Affiliation(s)
- Kamunkhwala Gausi
- Division of Clinical PharmacologyDepartment of MedicineUniversity of Cape TownCape TownSouth Africa
| | - Lubbe Wiesner
- Division of Clinical PharmacologyDepartment of MedicineUniversity of Cape TownCape TownSouth Africa
| | - Jennifer Norman
- Division of Clinical PharmacologyDepartment of MedicineUniversity of Cape TownCape TownSouth Africa
| | | | | | - Tsungai Chipato
- Department of Obstetrics and GynaecologyUniversity of Zimbabwe College of Health SciencesHarareZimbabwe
| | - David W. Haas
- Departments of Medicine, Pharmacology, Pathology, Microbiology, and ImmunologyVanderbilt University School of MedicineNashvilleTennesseeUSA,Department of Internal MedicineMeharry Medical CollegeNashvilleTennesseeUSA
| | - Renee Browning
- Division of AIDSNational Institute of Allergy and Infectious DiseasesNational Institutes of HealthBethesdaMarylandUSA
| | - Nahida Chakhtoura
- National Institutes of Health (NIH), Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)BethesdaMarylandUSA
| | - Grace Montepiedra
- Center for Biostatistics in AIDS ResearchHarvard T. H. Chan School of Public HealthBostonMassachusettsUSA
| | - Lisa Aaron
- Center for Biostatistics in AIDS ResearchHarvard T. H. Chan School of Public HealthBostonMassachusettsUSA
| | | | | | - Tichaona Vhembo
- Department of Obstetrics and GynaecologyUniversity of Zimbabwe College of Health SciencesHarareZimbabwe
| | - Lynda Stranix‐Chibanda
- Department of Obstetrics and GynaecologyUniversity of Zimbabwe College of Health SciencesHarareZimbabwe
| | | | - Avy Violari
- The Perinatal HIV Research UnitUniversity of the WitwatersrandJohannesburgSouth Africa
| | | | - Linda Aurpibul
- Research Institute for Health SciencesChiang Mai UniversityChiang MaiThailand
| | | | - Neetal Nevrekhar
- Byramjee Jeejeebhoy Government College–Johns Hopkins Clinical Research SitePuneIndia
| | - Vanessa Rouzier
- Weill Cornell Center for Global Health New YorkNew YorkNew YorkUSA,Centres GHESKIOPort‐au‐PrinceHaiti
| | | | - Mercy Mutambanengwe
- University of Zimbabwe College of Health Sciences Clinical Trials Research CentreHarareZimbabwe
| | - Vongai Chanaiwa
- University of Zimbabwe College of Health Sciences Clinical Trials Research CentreHarareZimbabwe
| | - Mandisa Nyati
- Perinatal HIV Research UnitUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Tsungai Mhembere
- University of Zimbabwe College of Health Sciences Clinical Trials Research CentreHarareZimbabwe
| | - Fuanglada Tongprasert
- Department of Obstetrics and GynecologyFaculty of MedicineChiang Mai UniversityChiang MaiThailand
| | - Anneke Hesseling
- Department of Paediatrics and Child HealthThe Desmond Tutu TB CenterStellenbosch UniversityTygerbergSouth Africa
| | - Katherine Shin
- Division of AIDSNational Institute of Allergy and Infectious DiseasesNational Institutes of HealthBethesdaMarylandUSA
| | | | | | - Patrick Jean‐Philippe
- Division of AIDSNational Institute of Allergy and Infectious DiseasesNational Institutes of HealthBethesdaMarylandUSA
| | - Timothy R. Sterling
- Vanderbilt Tuberculosis CenterVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Gerhard Theron
- Department of Obstetrics and GynaecologyStellenbosch UniversityCape TownSouth Africa
| | - Adriana Weinberg
- University of Colorado Denver Anschutz Medical CampusAuroraColoradoUSA
| | - Amita Gupta
- Johns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Paolo Denti
- Division of Clinical PharmacologyDepartment of MedicineUniversity of Cape TownCape TownSouth Africa
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Arya V, Venkatakrishnan K. Role of Physiologically Based Pharmacokinetic Modeling and Simulation in Enabling Model-Informed Development of Drugs and Biotherapeutics. J Clin Pharmacol 2020; 60 Suppl 1:S7-S11. [PMID: 33205427 DOI: 10.1002/jcph.1770] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 10/05/2020] [Indexed: 12/14/2022]
Affiliation(s)
- Vikram Arya
- Division of Infectious Disease Pharmacology (DIDP), Office of Clinical Pharmacology (OCP), Office of Translational Sciences (OTS), Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | - Karthik Venkatakrishnan
- EMD Serono Research and Development Institute, Inc. (a business of Merck KGaA, Darmstadt, Germany), Billerica, Massachusetts, USA
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Zafeiri A, Mitchell RT, Hay DC, Fowler PA. Over-the-counter analgesics during pregnancy: a comprehensive review of global prevalence and offspring safety. Hum Reprod Update 2020; 27:67-95. [PMID: 33118024 DOI: 10.1093/humupd/dmaa042] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 08/16/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Analgesia during pregnancy is often necessary. Due to their widespread availability, many mothers opt to use over-the-counter (OTC) analgesics. Those analgesic compounds and their metabolites can readily cross the placenta and reach the developing foetus. Evidence for safety or associations with adverse health outcomes is conflicting, limiting definitive decision-making for healthcare professionals. OBJECTIVE AND RATIONALE This review provides a detailed and objective overview of research in this field. We consider the global prevalence of OTC analgesia during pregnancy, explain the current mechanistic understanding of how analgesic compounds cross the placenta and reach the foetus, and review current research on exposure associations with offspring health outcomes. SEARCH METHODS A comprehensive English language literature search was conducted using PubMed and Scopus databases. Different combinations of key search terms were used including 'over-the-counter/non-prescription analgesics', 'pregnancy', 'self-medication', 'paracetamol', 'acetaminophen', 'diclofenac', 'aspirin', 'ibuprofen', 'in utero exposure', 'placenta drug transport', 'placental transporters', 'placenta drug metabolism' and 'offspring outcomes'. OUTCOMES This article examines the evidence of foetal exposure to OTC analgesia, starting from different routes of exposure to evidence, or the lack thereof, linking maternal consumption to offspring ill health. There is a very high prevalence of maternal consumption of OTC analgesics globally, which is increasing sharply. The choice of analgesia selected by pregnant women differs across populations. Location was also observed to have an effect on prevalence of use, with more developed countries reporting the highest consumption rates. Some of the literature focuses on the association of in utero exposure at different pregnancy trimesters and the development of neurodevelopmental, cardiovascular, respiratory and reproductive defects. This is in contrast to other studies which report no associations. WIDER IMPLICATIONS The high prevalence and the challenges of reporting exact consumption rates make OTC analgesia during pregnancy a pressing reproductive health issue globally. Even though some healthcare policy-making authorities have declared the consumption of some OTC analgesics for most stages of pregnancy to be safe, such decisions are often based on partial review of literature. Our comprehensive review of current evidence highlights that important knowledge gaps still exist. Those areas require further research in order to provide pregnant mothers with clear guidance with regard to OTC analgesic use during pregnancy.
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Affiliation(s)
- Aikaterini Zafeiri
- Institute of Medical Sciences, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, UK
| | - Rod T Mitchell
- MRC Centre for Reproductive Health, University of Edinburgh, The Queen's Medical Research Institute, Edinburgh, UK
| | - David C Hay
- MRC Centre for Regenerative Medicine, Institute of Regeneration and Repair, University of Edinburgh, Edinburgh, UK
| | - Paul A Fowler
- Institute of Medical Sciences, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, UK
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Pereira KV, Giacomeli R, Gomes de Gomes M, Haas SE. The challenge of using nanotherapy during pregnancy: Technological aspects and biomedical implications. Placenta 2020; 100:75-80. [PMID: 32862059 PMCID: PMC7431318 DOI: 10.1016/j.placenta.2020.08.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 08/05/2020] [Indexed: 01/08/2023]
Abstract
During the period of pregnancy, several processes and physiological adaptations occur in the body and metabolism of pregnant woman. These physiological adaptations in pregnant woman end up leading to a suppression in immune system favoring obstetric complications to the mother, fetus and placental tissue. An effective pharmacological therapy for these complications is still a challenge, since some drugs during pregnancy can have deleterious and teratogenic effects. An emerging alternative to pharmacological therapy during pregnancy is drugs encapsulated in nanoparticles (NP), recent area called nano-obstetrics. NP have the advantage of drug targeting and reduction of side effects. Then, maternal, placental or fetal uptake can be expected, depending on the characteristics of NP. Inorganic NP, crossing placental barrier effectively, but have several nanotoxicological effects. While organic NP appear to have a better targeting capacity and have few toxicological effects, but the studies are still scarce. Thus, in this review, were examined questions related to use and impact of physicochemical aspects of inorganic and organic NP during pregnancy.
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Affiliation(s)
- Kelle Velasques Pereira
- Postgraduate Program in Pharmaceutical Sciences, Federal University of Santa Maria, UFSM, Av. Roraima n.1000, 97105-900, Santa Maria, RS, Brazil
| | - Renata Giacomeli
- Postgraduate Program in Pharmaceutical Sciences, Federal University of Pampa, UNIPAMPA, Campus Uruguaiana, BR 472, Km 7, 97500-970, Uruguaiana, RS, Brazil
| | - Marcelo Gomes de Gomes
- Postgraduate Program in Pharmaceutical Sciences, Federal University of Pampa, UNIPAMPA, Campus Uruguaiana, BR 472, Km 7, 97500-970, Uruguaiana, RS, Brazil
| | - Sandra Elisa Haas
- Postgraduate Program in Pharmaceutical Sciences, Federal University of Pampa, UNIPAMPA, Campus Uruguaiana, BR 472, Km 7, 97500-970, Uruguaiana, RS, Brazil; Postgraduate Program in Pharmaceutical Sciences, Federal University of Santa Maria, UFSM, Av. Roraima n.1000, 97105-900, Santa Maria, RS, Brazil.
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Abduljalil K, Badhan RKS. Drug dosing during pregnancy-opportunities for physiologically based pharmacokinetic models. J Pharmacokinet Pharmacodyn 2020; 47:319-340. [PMID: 32592111 DOI: 10.1007/s10928-020-09698-w] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 06/20/2020] [Indexed: 12/15/2022]
Abstract
Drugs can have harmful effects on the embryo or the fetus at any point during pregnancy. Not all the damaging effects of intrauterine exposure to drugs are obvious at birth, some may only manifest later in life. Thus, drugs should be prescribed in pregnancy only if the expected benefit to the mother is thought to be greater than the risk to the fetus. Dosing of drugs during pregnancy is often empirically determined and based upon evidence from studies of non-pregnant subjects, which may lead to suboptimal dosing, particularly during the third trimester. This review collates examples of drugs with known recommendations for dose adjustment during pregnancy, in addition to providing an example of the potential use of PBPK models in dose adjustment recommendation during pregnancy within the context of drug-drug interactions. For many drugs, such as antidepressants and antiretroviral drugs, dose adjustment has been recommended based on pharmacokinetic studies demonstrating a reduction in drug concentrations. However, there is relatively limited (and sometimes inconsistent) information regarding the clinical impact of these pharmacokinetic changes during pregnancy and the effect of subsequent dose adjustments. Examples of using pregnancy PBPK models to predict feto-maternal drug exposures and their applications to facilitate and guide dose assessment throughout gestation are discussed.
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Affiliation(s)
- Khaled Abduljalil
- Certara UK Limited, Simcyp Division, Level 2-Acero, 1 Concourse Way, Sheffield, S1 2BJ, UK.
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Abstract
The effects of the many biochemical and physiologic changes of pregnancy on the dose-response relationship of drugs administered to pregnant women are poorly understood. The dose-response relationship is affected by pharmacokinetics, or what the body does to a drug, and pharmacodynamics, or what a drug does to the body. Insights into the potential effects of the changes of pregnancy on one aspect of the dose-response relationship of a drug can be obtained by studying the pharmacokinetics of the drug in the various stages of pregnancy and the postpartum period. There are several available approaches to studying pharmacokinetic changes in pregnancy. Single trough screening studies can provide qualitative estimates of elimination clearance, which with the dosing rate determines the steady-state drug concentration, throughout pregnancy and into the postpartum period. Population pharmacokinetic studies such as two stage pharmacokinetic studies and studies using a nonlinear mixed effects pharmacokinetic modeling approach can characterize pharmacokinetic changes more rigorously.
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