1
|
Almadi MA, Lu Y, Alali AA, Barkun AN. Peptic ulcer disease. Lancet 2024:S0140-6736(24)00155-7. [PMID: 38885678 DOI: 10.1016/s0140-6736(24)00155-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 09/22/2023] [Accepted: 01/24/2024] [Indexed: 06/20/2024]
Abstract
Annual prevalence estimates of peptic ulcer disease range between 0·12% and 1·5%. Peptic ulcer disease is usually attributable to Helicobacter pylori infection, intake of some medications (such as aspirin and non-steroidal anti-inflammatory medications), or being critically ill (stress-related), or it can be idiopathic. The clinical presentation is usually uncomplicated, with peptic ulcer disease management based on eradicating H pylori if present, the use of acid-suppressing medications-most often proton pump inhibitors (PPIs)-or addressing complications, such as with early endoscopy and high-dose PPIs for peptic ulcer bleeding. Special considerations apply to patients on antiplatelet and antithrombotic agents. H pylori treatment has evolved, with the choice of regimen dictated by local antibiotic resistance patterns. Indications for primary and secondary prophylaxis vary across societies; most suggest PPIs for patients at highest risk of developing a peptic ulcer, its complications, or its recurrence. Additional research areas include the use of potassium-competitive acid blockers and H pylori vaccination; the optimal approach for patients at risk of stress ulcer bleeding requires more robust determinations of optimal patient selection and treatment selection, if any. Appropriate continuation of PPI use outweighs most possible side-effects if given for approved indications, while de-prescribing should be trialled when a definitive indication is no longer present.
Collapse
Affiliation(s)
- Majid A Almadi
- Division of Gastroenterology, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia; Division of Gastroenterology, The McGill University Health Center, Montréal General Hospital, McGill University, Montréal, QC, Canada
| | - Yidan Lu
- Division of Gastroenterology, The McGill University Health Center, Montréal General Hospital, McGill University, Montréal, QC, Canada
| | - Ali A Alali
- Department of Medicine, Faculty of Medicine, Kuwait University, Jabriyah, Kuwait
| | - Alan N Barkun
- Division of Gastroenterology, The McGill University Health Center, Montréal General Hospital, McGill University, Montréal, QC, Canada; Division of Clinical Epidemiology, The McGill University Health Center, Montréal General Hospital, McGill University, Montréal, QC, Canada.
| |
Collapse
|
2
|
Chiang YT, Seow KM, Chen KH. The Pathophysiological, Genetic, and Hormonal Changes in Preeclampsia: A Systematic Review of the Molecular Mechanisms. Int J Mol Sci 2024; 25:4532. [PMID: 38674114 PMCID: PMC11050545 DOI: 10.3390/ijms25084532] [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: 03/19/2024] [Revised: 04/12/2024] [Accepted: 04/18/2024] [Indexed: 04/28/2024] Open
Abstract
Preeclampsia, a serious complication of pregnancy, involves intricate molecular and cellular mechanisms. Fetal microchimerism, where fetal cells persist within maternal tissues and in circulation, acts as a mechanistic link between placental dysfunction and maternal complications in the two-stage model of preeclampsia. Hormones, complements, and cytokines play pivotal roles in the pathophysiology, influencing immune responses, arterial remodeling, and endothelial function. Also, soluble HLA-G, involved in maternal-fetal immune tolerance, is reduced in preeclampsia. Hypoxia-inducible factor 1-alpha (Hif-α) dysregulation leads to placental abnormalities and preeclampsia-like symptoms. Alterations in matrix metalloproteinases (MMPs), endothelins (ETs), chemokines, and cytokines contribute to defective trophoblast invasion, endothelial dysfunction, and inflammation. Preeclampsia's genetic complexity includes circRNAs, miRNAs, and lncRNAs. CircRNA_06354 is linked to early-onset preeclampsia by influencing trophoblast invasion via the hsa-miR-92a-3p/VEGF-A pathway. The dysregulation of C19MC, especially miR-519d and miR-517-5p, affects trophoblast function. Additionally, lncRNAs like IGFBP1 and EGFR-AS1, along with protein-coding genes, impact trophoblast regulation and angiogenesis, influencing both preeclampsia and fetal growth. Besides aberrations in CD31+ cells, other potential biomarkers such as MMPs, soluble HLA-G, and hCG hold promise for predicting preeclampsia and its complications. Therapeutic interventions targeting factors such as peroxisome PPAR-γ and endothelin receptors show potential in mitigating preeclampsia-related complications. In conclusion, preeclampsia is a complex disorder with a multifactorial etiology and pathogenesis. Fetal microchimerism, hormones, complements, and cytokines contribute to placental and endothelial dysfunction with inflammation. Identifying novel biomarkers and therapeutic targets offers promise for early diagnosis and effective management, ultimately reducing maternal and fetal morbidity and mortality. However, further research is warranted to translate these findings into clinical practice and enhance outcomes for at-risk women.
Collapse
Affiliation(s)
- Yi-Ting Chiang
- Department of Medical Education, Taipei Tzu-Chi Hospital, The Buddhist Tzu-Chi Medical Foundation, Taipei 231, Taiwan;
| | - Kok-Min Seow
- Department of Obstetrics and Gynecology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei 111, Taiwan;
- Department of Obstetrics and Gynecology, National Yang-Ming Chiao-Tung University, Taipei 112, Taiwan
| | - Kuo-Hu Chen
- Department of Obstetrics and Gynecology, Taipei Tzu-Chi Hospital, The Buddhist Tzu-Chi Medical Foundation, Taipei 231, Taiwan
- School of Medicine, Tzu-Chi University, Hualien 970, Taiwan
| |
Collapse
|
3
|
Röjler L, Uchida AM, Garber JJ, Stephansson O, Söderling J, Roelstraete B, Ludvigsson JF. Pregnancy Outcomes in Females with Eosinophilic Esophagitis: A Nationwide Population-Based Study. Inflamm Intest Dis 2023; 8:143-152. [PMID: 38115912 PMCID: PMC10727518 DOI: 10.1159/000534412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 09/27/2023] [Indexed: 12/21/2023] Open
Abstract
Introduction Eosinophilic esophagitis (EoE) is a chronic, allergic inflammatory disease of the esophagus. It has a peak incidence in the 2nd and 3rd decades of life. Despite this, little is known about pregnancy outcomes in patients with EoE. Methods Using a validated histopathologic and nationwide population-based cohort for the diagnosis of EoE, we examined maternal and fetal outcomes, with preterm birth as the primary outcome, in females with EoE compared to matched controls. Odds ratios (ORs) were calculated using logistic regression. Results Between 1992 and 2016, we identified 19 females with EoE who gave birth to 23 children (reference births: n = 115). There was 1 (4.3%) preterm birth in the EoE cohort versus 8 (7.0%) in the reference cohort (OR = 0.60; 95% CI = 0.07-5.14). Secondary fetal outcomes included stillbirth, neonatal death, small for gestational age, low birth weight (LBW), and low Apgar score. Of these, LBW (<2,500 g) in patients with EoE compared to controls correlated to an OR of 12.42 (95% CI = 1.26-122.42); however, this finding was based on very low numbers. The remaining fetal outcomes were not significantly different between females with EoE and controls. Secondary pregnancy and maternal outcomes including induction of labor, instrumental delivery, gestational diabetes, or pre-eclampsia were not significantly different between patients with EoE and controls. Discussion/Conclusion Overall in this nationwide cohort study, we did not find increased association of preterm birth in patients with EoE.
Collapse
Affiliation(s)
- Lovisa Röjler
- Department of Pediatrics, Örebro University Hospital, Örebro, Sweden
| | - Amiko M. Uchida
- Division of Gastroenterology, Hepatology and Nutrition, University of Utah School of Medicine, Salt Lake City, UT, USA
- Gastrointestinal Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - John J. Garber
- Gastrointestinal Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Olof Stephansson
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Jonas Söderling
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Bjorn Roelstraete
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Jonas F. Ludvigsson
- Department of Pediatrics, Örebro University Hospital, Örebro, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Celiac Disease Center, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA
| |
Collapse
|
4
|
Dutta AK, Jain A, Jearth V, Mahajan R, Panigrahi MK, Sharma V, Goenka MK, Kochhar R, Makharia G, Reddy DN, Kirubakaran R, Ahuja V, Berry N, Bhat N, Dutta U, Ghoshal UC, Jain A, Jalihal U, Jayanthi V, Kumar A, Nijhawan S, Poddar U, Ramesh GN, Singh SP, Zargar S, Bhatia S. Guidelines on optimizing the use of proton pump inhibitors: PPI stewardship. Indian J Gastroenterol 2023; 42:601-628. [PMID: 37698821 DOI: 10.1007/s12664-023-01428-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 07/10/2023] [Indexed: 09/13/2023]
Abstract
Proton pump inhibitors (PPIs) have been available for over three decades and are among the most commonly prescribed medications. They are effective in treating a variety of gastric acid-related disorders. They are freely available and based on current evidence, use of PPIs for inappropriate indications and duration appears to be common. Over the years, concerns have been raised on the safety of PPIs as they have been associated with several adverse effects. Hence, there is a need for PPI stewardship to promote the use of PPIs for appropriate indication and duration. With this objective, the Indian Society of Gastroenterology has formulated guidelines on the rational use of PPIs. The guidelines were developed using a modified Delphi process. This paper presents these guidelines in detail, including the statements, review of literature, level of evidence and recommendations. This would help the clinicians in optimizing the use of PPIs in their practice and promote PPI stewardship.
Collapse
Affiliation(s)
- Amit Kumar Dutta
- Department of Gastroenterology, Christian Medical College and Hospital, Vellore, 632 004, India.
| | | | - Vaneet Jearth
- Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | - Ramit Mahajan
- Dayanand Medical College and Hospital, Ludhiana, 141 001, India
| | | | - Vishal Sharma
- Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | | | | | - Govind Makharia
- All India Institute of Medical Sciences, New Delhi, 110 029, India
| | | | - Richard Kirubakaran
- Center of Biostatistics and Evidence Based Medicine, Vellore, 632 004, India
| | - Vineet Ahuja
- All India Institute of Medical Sciences, New Delhi, 110 029, India
| | - Neha Berry
- BLK Institute of Digestive and Liver Disease, New Delhi, 201 012, India
| | - Naresh Bhat
- Aster CMI Hospital, Bengaluru, 560 092, India
| | - Usha Dutta
- Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | - Uday Chand Ghoshal
- Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, 226 014, India
| | - Ajay Jain
- Choithram Hospital and Research Center, Indore, 452 014, India
| | | | - V Jayanthi
- Sri Ramachandra Medical College, Chennai, 600 116, India
| | - Ajay Kumar
- Institute of Digestive and Liver Diseases, BLK - Max Superspeciality Hospital, New Delhi, 201 012, India
| | | | - Ujjal Poddar
- Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, 226 014, India
| | | | - Shivram P Singh
- Kalinga Gastroenterology Foundation, Cuttack, 753 001, India
| | - Showkat Zargar
- Department of Gastroenterology, Sher-i-Kashmir Institute of Medical Sciences, Kashmir, 190 011, India
| | - Shobna Bhatia
- Sir H N Reliance Foundation Hospital, Mumbai, 400 004, India
| |
Collapse
|
5
|
Peron A, Ripoche E, Picot C, Ajiji P, Cucherat M, Cottin J. Use of proton pump inhibitors during pregnancy: A systematic review and meta-analysis of congenital malformations. Reprod Toxicol 2023; 119:108419. [PMID: 37269915 DOI: 10.1016/j.reprotox.2023.108419] [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: 12/30/2022] [Revised: 05/14/2023] [Accepted: 05/31/2023] [Indexed: 06/05/2023]
Abstract
Use of proton pump inhibitors (PPI) are common among pregnant women to relieve gastrointestinal symptoms. The number of exposed pregnancies is therefore considerable, and a recent meta-analysis (MA) from 2020 raised concern about their teratogenicity. The aim of the study was to provide a MA of the risk of major congenital malformations (MCM) after PPI exposure during the first trimester of pregnancy. A systematic review and random-effects model approach were performed using a collaborative WEB-based meta-analysis platform (metaPreg.org) with a registered protocol (osf.io/u4gva). The primary outcome was the incidence of overall MCM. The secondary outcomes of interest were specific MCM reported by at least three studies. All comparative studies assessing these outcomes in PPI exposed pregnancies were searched from inception to April 2022. From the 211 initially identified studies, 11 were included in the MA. The pooled odds ratio (OR) for the primary outcome showed no significant results based on 5 618 exposed pregnancies (OR 1.10, 95% CI [0.95;1.26]; I²=0%). Similarly, no result was significant for the secondary outcomes. The total exposed sample size ranged from 3 161-5 085; OR ranged between 0.60 and 1.92; heterogeneity was between 0% and 23%. Based on the results of the present MA, first trimester PPI exposure was not associated with a significantly increased risk of overall or specific MCM. However, this MA included only observational studies which are prone to bias and there were insufficient data to evaluate PPI at a substance level. Future studies are needed to address this concern.
Collapse
Affiliation(s)
- Audrey Peron
- Service Hospitalo-Universitaire de Pharmaco-Toxicologie, Hospices Civils de Lyon, Lyon, France.
| | - Emmanuelle Ripoche
- Adverse Events and Incidents Department-Surveillance Division, Agence nationale de sécurité du médicament et des produits de santé (ANSM), Saint Denis, France
| | - Cyndie Picot
- Service Hospitalo-Universitaire de Pharmaco-Toxicologie, Hospices Civils de Lyon, Lyon, France
| | - Priscilla Ajiji
- Adverse Events and Incidents Department-Surveillance Division, Agence nationale de sécurité du médicament et des produits de santé (ANSM), Saint Denis, France; EA 7379, Faculté de Santé, Université Paris-Est Créteil, France
| | - Michel Cucherat
- Service Hospitalo-Universitaire de Pharmaco-Toxicologie, Hospices Civils de Lyon, Lyon, France; CNRS-Université Lyon 1, UMR5558 - Laboratoire de Biométrie & biologie évolutive, Département de biostatistiques & modélisation pour la santé et l'environnement-Equipe Evaluation et modélisation des effets des médicaments, Lyon, France
| | - Judith Cottin
- Service Hospitalo-Universitaire de Pharmaco-Toxicologie, Hospices Civils de Lyon, Lyon, France
| |
Collapse
|
6
|
S2k-Leitlinie Gastroösophageale Refluxkrankheit und eosinophile Ösophagitis der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) – März 2023 – AWMF-Registernummer: 021–013. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2023; 61:862-933. [PMID: 37494073 DOI: 10.1055/a-2060-1069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
|
7
|
Liu BD, Starkey M, Virani A, Pichette SL, Fass S, Song G. Review article: Functional dyspepsia and pregnancy-Effects and management in a special population. Aliment Pharmacol Ther 2023; 57:1375-1396. [PMID: 37129241 DOI: 10.1111/apt.17534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 01/23/2023] [Accepted: 04/17/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND Around 10% of Americans meet the Rome IV criteria for functional dyspepsia (FD), with a significantly higher rate in women. FD also has a higher prevalence in women below the age of 50, suggesting that women who are affected are likely to be of reproductive age. Unfortunately, there is a lack of research or evidence-based guidelines on managing FD in pregnancy. AIMS AND METHODS To address this issue, we aimed to perform a systematic review of the interactions between FD and pregnancy and managing pre-existing FD in the peripartum and post-partum phases using current lifestyle, pharmacological, non-pharmacological and alternative medicine interventions. RESULTS Due to the lack of Rome IV FD-specific data in pregnancy, we instead performed a narrative review on how existing FD interventions could be extrapolated to the pregnant population. Where possible we use the highest level of available evidence or official guidelines to answer these questions, which often involves synthesising treatment and safety evidence of these interventions in other diseases during pregnancy. Finally, we highlight current substantial knowledge gaps requiring further research for the safe management of a pregnant patient with pre-existing FD. CONCLUSIONS Overall, despite the paucity of knowledge of treating FD during pregnancy, providers can mitigate this uncertainty by planning ahead with the patient. Patients should ideally minimise treatment until after breastfeeding. However, interdisciplinary resources are available to ensure that minimal-risk interventions are maximised, while interventions with more risks, if necessary, are justifiable by both the patient and the care team. Future investigations should continue to elicit the mechanistic relationship between FD and pregnancy while cautiously expanding prospective research on promising and safe therapies in pregnant patients with pre-existing FD.
Collapse
Affiliation(s)
- Benjamin D Liu
- Department of Medicine, Case Western Reserve University/Metrohealth Medical Center, Cleveland, Ohio, USA
| | - Morgan Starkey
- Department of Medicine, Case Western Reserve University/Metrohealth Medical Center, Cleveland, Ohio, USA
| | - Aleena Virani
- Department of Medicine, University of Western Ontario, London, Ontario, Canada
| | - Sandra L Pichette
- Department of Obstetrics and Gynecology, Case Western Reserve University/Metrohealth Medical Center, Cleveland, Ohio, USA
| | - Shira Fass
- Department of Psychiatry, Case Western Reserve University/MetroHealth Medical Center, Cleveland, Ohio, USA
| | - Gengqing Song
- Division of Gastroenterology and Hepatology, Case Western Reserve University/MetroHealth Medical Center, Cleveland, Ohio, USA
| |
Collapse
|
8
|
Vatish M, Powys VR, Cerdeira AS. Novel therapeutic and diagnostic approaches for preeclampsia. Curr Opin Nephrol Hypertens 2023; 32:124-133. [PMID: 36683536 DOI: 10.1097/mnh.0000000000000870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
PURPOSE OF REVIEW This review will summarize recent findings relating to the diagnostic approach to preeclampsia and current avenues of research aimed at modifying the underlying disease process. RECENT FINDINGS Growing international consensus supports a broad preeclampsia definition that incorporates maternal end-organ and uteroplacental dysfunction. Recent evidence demonstrates that this definition better identifies women and babies at risk of adverse outcomes compared to the traditional definition of hypertension and proteinuria. Multiple studies have demonstrated the usefulness and cost-effectiveness of angiogenic biomarkers such as soluble fms-like tyrosine kinase-1 and placental growth factor as a clinical adjunct to diagnose and predict severity of preeclampsia associated outcomes. Current novel therapeutic approaches to preeclampsia target pathogenic pathways (e.g. antiangiogenesis) or downstream effects such as oxidative stress and nitric oxide. Recent findings relating to these promising candidates are discussed. Multicenter clinical trials are needed to evaluate their effectiveness and ability to improve fetal and maternal outcomes. SUMMARY We provide an updated framework of the current approaches to define and diagnose preeclampsia. Disease modifying therapies (in particular, targeting the angiogenic pathway) are being developed for the first time and promise to revolutionize the way we manage preeclampsia.
Collapse
Affiliation(s)
- Manu Vatish
- Nuffield Department of Women's Health and Reproductive Research, University of Oxford, Oxford
| | | | - Ana Sofia Cerdeira
- Nuffield Department of Women's Health and Reproductive Research, University of Oxford, Oxford
| |
Collapse
|
9
|
Choi A, Noh Y, Jeong HE, Choi EY, Man KKC, Han JY, Kim HS, Yon DK, Shin JY. Association Between Proton Pump Inhibitor Use During Early Pregnancy and Risk of Congenital Malformations. JAMA Netw Open 2023; 6:e2250366. [PMID: 36626173 PMCID: PMC9856708 DOI: 10.1001/jamanetworkopen.2022.50366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
IMPORTANCE Proton pump inhibitors (PPIs) are increasingly used during pregnancy; however, several observational studies have raised concerns about an increased risk of specific types of congenital malformations. OBJECTIVE To examine the association between PPI exposure during early pregnancy and the risk of congenital malformations. DESIGN, SETTING, AND PARTICIPANTS This population-based cohort study used data from the National Health Insurance Service-National Health Information Database of South Korea (2010-2020); sibling-controlled analyses were conducted to account for familial factors. A total of 2 696 216 pregnancies in women aged 19 to 44 years between June 1, 2011, and December 31, 2019, and their live-born infants were identified. Pregnant women who were exposed to known teratogens or who delivered infants with chromosomal abnormalities or genetic syndromes were excluded. Data on participant race and ethnicity were not collected because the National Health Information Database does not report this information. EXPOSURES Proton pump inhibitor use during the first trimester. MAIN OUTCOMES AND MEASURES Primary outcomes were major congenital malformations, congenital heart defects, cleft palate, hydrocephalus, and hypospadias. The subtypes of major congenital malformations and congenital heart defects were evaluated as exploratory outcomes. Propensity score fine stratification was used to control for potential confounders, and a weighted generalized linear model was used to estimate relative risks with 95% CIs. RESULTS Of 2 696 216 pregnancies (mean [SD] maternal age, 32.1 [4.2] years), 40 540 (1.5%; mean [SD] age, 32.4 [4.6] years) were exposed to PPIs during the first trimester. The absolute risk of major congenital malformations was 396.7 per 10 000 infants in PPI-exposed pregnancies and 323.4 per 10 000 infants in unexposed pregnancies. The propensity score-adjusted relative risks were 1.07 (95% CI, 1.02-1.13) for major congenital malformations, 1.09 (95% CI, 1.01-1.17) for congenital heart defects, 1.02 (95% CI, 0.72-1.43) for cleft palate, 0.94 (95% CI, 0.54-1.63) for hydrocephalus, and 0.77 (95% CI, 0.51-1.17) for hypospadias. In the sibling-controlled analyses, no associations were observed between PPI use and primary outcomes, including major congenital malformations (odds ratio, 1.05; 95% CI, 0.91-1.22) and congenital heart defects (odds ratio, 1.07; 95% CI, 0.88-1.30). A range of sensitivity analyses revealed results that were similar to the main findings. CONCLUSIONS AND RELEVANCE In this cohort study, the use of PPIs during early pregnancy was not associated with a substantial increase in the risk of congenital malformations, although small increased risks were observed for major congenital malformations and congenital heart defects; findings from sibling-controlled analyses revealed that PPIs were unlikely to be major teratogens. These findings may help guide clinicians and patients in decision-making about PPI use in the first trimester.
Collapse
Affiliation(s)
- Ahhyung Choi
- School of Pharmacy, Sungkyunkwan University, Suwon, South Korea
| | - Yunha Noh
- School of Pharmacy, Sungkyunkwan University, Suwon, South Korea
- Department of Biohealth Regulatory Science, Sungkyunkwan University, Suwon, South Korea
| | - Han Eol Jeong
- School of Pharmacy, Sungkyunkwan University, Suwon, South Korea
- Department of Biohealth Regulatory Science, Sungkyunkwan University, Suwon, South Korea
| | - Eun-Young Choi
- School of Pharmacy, Sungkyunkwan University, Suwon, South Korea
| | - Kenneth K. C. Man
- Research Department of Practice and Policy, University College London School of Pharmacy, London, United Kingdom
- Centre for Medicines Optimisation Research and Education, University College London Hospitals NHS Foundation Trust, London, United Kingdom
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong
| | - Jung Yeol Han
- Korean Mothersafe Counselling Center, Department of Obstetrics and Gynecology, Inje University Ilsan Paik Hospital, Goyang, South Korea
| | - Hyun-Soo Kim
- Division of Gastroenterology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, South Korea
| | - Dong Keon Yon
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Ju-Young Shin
- School of Pharmacy, Sungkyunkwan University, Suwon, South Korea
- Department of Biohealth Regulatory Science, Sungkyunkwan University, Suwon, South Korea
- Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, South Korea
| |
Collapse
|
10
|
White ND. Drug-Induced Microbiome Changes: Considerations in Pregnancy. Am J Lifestyle Med 2023; 17:50-53. [PMID: 36636397 PMCID: PMC9830251 DOI: 10.1177/15598276221130259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
During pregnancy, the maternal microbiome is associated with both the health of the mother as well as the developing fetus. Several classes of drugs are known to influence the microbiome and their use in pregnancy may impact maternal/fetal outcomes and long-term health of offspring. The drug-microbiome interactions of antibiotics, proton pump inhibitors, laxatives, metformin, and probiotics will be described, along with considerations for use of these agents in pregnancy.
Collapse
Affiliation(s)
- Nicole D. White
- School of Pharmacy and Health Professions, Creighton University, Omaha, NE, USA (NDW)
| |
Collapse
|
11
|
Breddels EM, Simin J, Fornes R, Lilja Engstrand H, Engstrand L, Bruyndonckx R, Brusselaers N. Population-based cohort study: proton pump inhibitor use during pregnancy in Sweden and the risk of maternal and neonatal adverse events. BMC Med 2022; 20:492. [PMID: 36539798 PMCID: PMC9768950 DOI: 10.1186/s12916-022-02673-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 11/21/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Approximately half of all women suffer from heartburn at some stage during pregnancy. The most effective treatment is proton pump inhibitors, but the safety of use during pregnancy cannot be guaranteed. This study aimed to elucidate the effect of proton pump inhibitors on the risk of pre-eclampsia, gestational diabetes mellitus, preterm birth, an Apgar score at 5 min below 7, and a child being small or large for its gestational age. METHODS This Swedish population-based study included 1,089,514 live singleton deliveries between July 2006 and December 2016 in Sweden. Multiple logistic regression was used to model the outcomes as a function of the covariates. Results were presented as odds ratios with 95% confidence intervals. RESULTS In 1.4% of all pregnancies, the mother used proton pump inhibitors in the period from 3 months before the last menstrual period up to delivery. The use of proton pump inhibitors was associated with higher odds of pre-eclampsia (odds ratio = 1.19, 1.10-1.29), gestational diabetes mellitus (odds ratio = 1.29, 1.16-1.43), preterm birth (odds ratio = 1.23, 1.14-1.32), and small for gestational age (odds ratio = 1.27, 1.16-1.40) and lower odds of large for gestational age (odds ratio = 0.84, 0.77-0.91). No significant association was found with a low Apgar score 5 min after birth. CONCLUSIONS Proton pump inhibitor use was associated with a higher risk of pre-eclampsia, gestational diabetes, preterm birth, and being born small for gestational age.
Collapse
Affiliation(s)
- Esmee M Breddels
- I-BioStat, Data Science Institute, Hasselt University, Hasselt, Belgium.,Centre for Translational Microbiome Research, Department of Microbiology Tumor and Cell Biology, Karolinska Institutet, Biomedicum A8, Solnavägen 9, 17165, Stockholm, Sweden
| | - Johanna Simin
- Centre for Translational Microbiome Research, Department of Microbiology Tumor and Cell Biology, Karolinska Institutet, Biomedicum A8, Solnavägen 9, 17165, Stockholm, Sweden
| | - Romina Fornes
- Centre for Translational Microbiome Research, Department of Microbiology Tumor and Cell Biology, Karolinska Institutet, Biomedicum A8, Solnavägen 9, 17165, Stockholm, Sweden
| | - Helene Lilja Engstrand
- Department of Women's and Children's Health, Karolinska University Hospital, Stockholm, Sweden
| | - Lars Engstrand
- Centre for Translational Microbiome Research, Department of Microbiology Tumor and Cell Biology, Karolinska Institutet, Biomedicum A8, Solnavägen 9, 17165, Stockholm, Sweden
| | - Robin Bruyndonckx
- I-BioStat, Data Science Institute, Hasselt University, Hasselt, Belgium
| | - Nele Brusselaers
- Centre for Translational Microbiome Research, Department of Microbiology Tumor and Cell Biology, Karolinska Institutet, Biomedicum A8, Solnavägen 9, 17165, Stockholm, Sweden. .,Global Health Institute, Antwerp University, Antwerp, Belgium.
| |
Collapse
|
12
|
Dunbar K, Yadlapati R, Konda V. Heartburn, Nausea, and Vomiting During Pregnancy. Am J Gastroenterol 2022; 117:10-15. [PMID: 36194028 PMCID: PMC10782592 DOI: 10.14309/ajg.0000000000001958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 06/30/2022] [Indexed: 12/11/2022]
Affiliation(s)
- Kerry Dunbar
- Division of Gastroenterology and Hepatology, Department of Medicine, Dallas VA Medical Center and University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Rena Yadlapati
- Division of Gastroenterology, University of California San Diego, La Jolla, California, USA
| | - Vani Konda
- Baylor Scott and White Center for Esophageal Diseases, Department of Gastroenterology, Baylor University Medical Center, Dallas, Texas, USA
| |
Collapse
|
13
|
Altuwaijri M. Evidence-based treatment recommendations for gastroesophageal reflux disease during pregnancy: A review. Medicine (Baltimore) 2022; 101:e30487. [PMID: 36107559 PMCID: PMC9439837 DOI: 10.1097/md.0000000000030487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Gastroesophageal reflux disease (GERD) occurs in approximately two-thirds of all pregnancies. Around 25% of pregnant women experience heartburn daily. Symptomatic GERD usually presents in the first trimester and progresses throughout pregnancy. The treatment goal is to alleviate heartburn and regurgitation without jeopardizing the pregnancy or its outcome. An English language electronic literature search of MEDLINE, EMBASE, and Cochrane Reviews was undertaken to identify randomized controlled trials, observational studies, management recommendations and reviews of GERD and its treatment during pregnancy. The search period was defined by the date of inception of each database. The treatment in a pregnant GERD patient should follow the step-up approach, starting with lifestyle modification as the first step. If heartburn is severe, medication should be started after consultation with a physician (Recommendation Grade C). The preferred choice of antacids is calcium-containing antacids (Recommendation Grade A). If symptoms persist with antacids Sucralfate can be introduced at a 1g oral tablet, 3 times daily (Recommendation Grade C). Followed by histamine-2 receptor antagonist (Recommendation Grade B). Inadequate control while on histamine-2 receptor antagonist and antacid may mandate a step-up to proton pump inhibitors along with antacids as rescue medication for breakthrough GERD (Recommendation Grade C). This article presented the treatment recommendations for pregnant women with typical GERD, based on the best available evidence.
Collapse
Affiliation(s)
- Mansour Altuwaijri
- Division of Gastroenterology, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- *Correspondence: Mansour Altuwaijri, Division of Gastroenterology, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia (e-mail: )
| |
Collapse
|
14
|
de Alwis N, Fato BR, Beard S, Binder NK, Kaitu’u-Lino TJ, Onda K, Hannan NJ. Assessment of the Proton Pump Inhibitor, Esomeprazole Magnesium Hydrate and Trihydrate, on Pathophysiological Markers of Preeclampsia in Preclinical Human Models of Disease. Int J Mol Sci 2022; 23:ijms23179533. [PMID: 36076929 PMCID: PMC9455231 DOI: 10.3390/ijms23179533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 08/17/2022] [Accepted: 08/20/2022] [Indexed: 12/02/2022] Open
Abstract
Previously, we demonstrated that the proton pump inhibitor, esomeprazole magnesium hydrate (MH), could have potential as a repurposed treatment against preeclampsia, a serious obstetric condition. In this study we investigate the difference in the preclinical effectiveness between 100 µM of esomeprazole MH and its hydration isomer, esomeprazole magnesium trihydrate (MTH). Here, we found that both treatments reduced secretion of sFLT-1 (anti-angiogenic factor) from primary cytotrophoblast, but only esomeprazole MH reduced sFLT-1 secretion from primary human umbilical vein endothelial cells (assessed via ELISA). Both drugs could mitigate expression of the endothelial dysfunction markers, vascular cell adhesion molecule-1 and endothelin-1 (via qPCR). Neither esomeprazole MH nor MTH quenched cytotrophoblast reactive oxygen species production in response to sodium azide (ROS assay). Finally, using wire myography, we demonstrated that both compounds were able to induce vasodilation of human omental arteries at 100 µM. Esomeprazole is safe to use in pregnancy and a candidate treatment for preeclampsia. Using primary human tissues and cells, we validated that esomeprazole is effective in enhancing vascular relaxation, and can reduce key factors associated with preeclampsia, including sFLT-1 and endothelial dysfunction. However, esomeprazole MH was more efficacious than esomeprazole MTH in our in vitro studies.
Collapse
Affiliation(s)
- Natasha de Alwis
- Therapeutics Discovery and Vascular Function Group, Department of Obstetrics and Gynaecology, Mercy Hospital for Women, University of Melbourne, Heidelberg, VIC 3084, Australia
| | - Bianca R. Fato
- Therapeutics Discovery and Vascular Function Group, Department of Obstetrics and Gynaecology, Mercy Hospital for Women, University of Melbourne, Heidelberg, VIC 3084, Australia
| | - Sally Beard
- Therapeutics Discovery and Vascular Function Group, Department of Obstetrics and Gynaecology, Mercy Hospital for Women, University of Melbourne, Heidelberg, VIC 3084, Australia
| | - Natalie K. Binder
- Therapeutics Discovery and Vascular Function Group, Department of Obstetrics and Gynaecology, Mercy Hospital for Women, University of Melbourne, Heidelberg, VIC 3084, Australia
| | - Tu’uhevaha J. Kaitu’u-Lino
- Diagnostics Discovery and Reverse Translation in Pregnancy Group, Department of Obstetrics and Gynaecology, Mercy Hospital for Women, University of Melbourne, Heidelberg, VIC 3084, Australia
| | - Kenji Onda
- Department of Clinical Pharmacology, Tokyo University of Pharmacy and Life Sciences, Hachioji, Tokyo 192-0392, Japan
| | - Natalie J. Hannan
- Therapeutics Discovery and Vascular Function Group, Department of Obstetrics and Gynaecology, Mercy Hospital for Women, University of Melbourne, Heidelberg, VIC 3084, Australia
- Correspondence: ; Tel.: +61-3-8458-4371
| |
Collapse
|
15
|
Hussain S, Singh A, Antony B, Klugarová J, Murad MH, Jayraj AS, Langaufová A, Klugar M. Proton Pump Inhibitors Use and Risk of Preeclampsia: A Meta-Analysis. J Clin Med 2022; 11:jcm11164675. [PMID: 36012913 PMCID: PMC9410414 DOI: 10.3390/jcm11164675] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 07/21/2022] [Accepted: 07/25/2022] [Indexed: 12/17/2022] Open
Abstract
Evidence from preclinical studies suggests a preventive effect of proton pump inhibitors (PPIs) in preeclampsia. Recently, several epidemiological studies have described a conflicting association between the use of PPIs during pregnancy and preeclampsia risk. This study aimed to evaluate the association between PPI use and the risk of preeclampsia. We searched databases, including MEDLINE, Embase, Scopus, Web of Science Core Collection, Emcare, CINAHL, and the relevant grey literature from inception until 13 September 2021. Studies reporting the preeclampsia risk with the use of PPIs were eligible for inclusion. Literature screening, data extraction, and the risk of bias assessment were performed independently by two investigators. Random-effect meta-analysis was performed to generate relative risks (RR) and 95% confidence intervals (CI). The risk of preeclampsia and preterm preeclampsia among women receiving PPIs during pregnancy were the primary outcomes of interest. This meta-analysis comprised three studies involving 4,877,565 pregnant women, of whom 119,017 were PPI users. The included studies were judged to have a low risk of bias. The risk of preeclampsia among pregnant women who received PPIs anytime during pregnancy was significantly increased (RR 1.27 (95% CI: 1.23–1.31)), although the increase was trivial in absolute terms (2 per 1000). The subgroup analysis revealed that the risk was increased in each of the three trimesters. The risk of preterm preeclampsia among pregnant women receiving PPIs anytime during pregnancy was not significantly increased (RR 1.04 (95% CI: 0.70–1.55)). The certainty evaluated by GRADE in these estimates was low. PPI use may be associated with a trivial increase in the risk of preeclampsia in pregnant women. There is no evidence supporting that PPI use decreases the risk of preeclampsia or preterm preeclampsia.
Collapse
Affiliation(s)
- Salman Hussain
- Czech National Centre for Evidence-Based Healthcare and Knowledge Translation (Cochrane Czech Republic, Czech EBHC: JBI Centre of Excellence, Masaryk University GRADE Centre), Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic, Kamenice 5, 62500 Brno, Czech Republic
- Correspondence: (S.H.); (M.K.)
| | - Ambrish Singh
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool St, Hobart, TAS 7000, Australia
| | - Benny Antony
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool St, Hobart, TAS 7000, Australia
| | - Jitka Klugarová
- Czech National Centre for Evidence-Based Healthcare and Knowledge Translation (Cochrane Czech Republic, Czech EBHC: JBI Centre of Excellence, Masaryk University GRADE Centre), Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic, Kamenice 5, 62500 Brno, Czech Republic
| | - M. Hassan Murad
- Division of Public Health, Infectious Diseases and Occupational Medicine, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA
| | - Aarthi S. Jayraj
- Department of Obstetrics & Gynaecology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Alena Langaufová
- Czech National Centre for Evidence-Based Healthcare and Knowledge Translation (Cochrane Czech Republic, Czech EBHC: JBI Centre of Excellence, Masaryk University GRADE Centre), Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic, Kamenice 5, 62500 Brno, Czech Republic
| | - Miloslav Klugar
- Czech National Centre for Evidence-Based Healthcare and Knowledge Translation (Cochrane Czech Republic, Czech EBHC: JBI Centre of Excellence, Masaryk University GRADE Centre), Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic, Kamenice 5, 62500 Brno, Czech Republic
- Correspondence: (S.H.); (M.K.)
| |
Collapse
|
16
|
de Alwis N, Binder NK, Mangwiro YTM, Beard S, Pritchard N, Kadife E, Fato BR, Keenan E, Brownfoot FC, Kaitu’u-Lino TJ, Hannan NJ. Actions of Esomeprazole on the Maternal Vasculature in Lean and Obese Pregnant Mice with Impaired Nitric Oxide Synthesis: A Model of Preeclampsia. Int J Mol Sci 2022; 23:ijms23158185. [PMID: 35897759 PMCID: PMC9330120 DOI: 10.3390/ijms23158185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 07/20/2022] [Accepted: 07/21/2022] [Indexed: 01/09/2023] Open
Abstract
Preeclampsia is a devastating, multisystem disorder of pregnancy. It has no cure except delivery, which if premature can impart significant neonatal morbidity. Efforts to repurpose pregnancy-safe therapeutics for the treatment of preeclampsia have led to the assessment of the proton pump inhibitor, esomeprazole. Preclinically, esomeprazole reduced placental secretion of anti-angiogenic sFlt-1, improved endothelial dysfunction, promoted vasorelaxation, and reduced maternal hypertension in a mouse model. Our understanding of the precise mechanisms through which esomeprazole works to reduce endothelial dysfunction and enhance vasoreactivity is limited. Evidence from earlier studies suggested esomeprazole might work via the nitric oxide pathway, upregulating endothelial nitric oxide synthase (eNOS). Here, we investigated the effect of esomeprazole in a mouse model of L-NAME-induced hypertension (decreased eNOS activity). We further antagonised the model by addition of diet-induced obesity, which is relevant to both preeclampsia and the nitric oxide pathway. Esomeprazole did not decrease blood pressure in this model, nor were there any alterations in vasoreactivity or changes in foetal outcomes in lean mice. We observed similar findings in the obese mouse cohort, except esomeprazole treatment enhanced ex vivo acetylcholine-induced vasorelaxation. As acetylcholine induces nitric oxide production, these findings hint at a function for esomeprazole in the nitric oxide pathway.
Collapse
Affiliation(s)
- Natasha de Alwis
- Therapeutics Discovery & Vascular Function Group, Department of Obstetrics and Gynaecology, The University of Melbourne, Mercy Hospital for Women, Heidelberg, VIC 3084, Australia; (N.d.A.); (N.K.B.); (Y.T.M.M.); (S.B.); (B.R.F.)
- Mercy Perinatal, Mercy Hospital for Women, Heidelberg, VIC 3084, Australia; (N.P.); (E.K.); (E.K.); (F.C.B.); (T.J.K.-L.)
| | - Natalie K. Binder
- Therapeutics Discovery & Vascular Function Group, Department of Obstetrics and Gynaecology, The University of Melbourne, Mercy Hospital for Women, Heidelberg, VIC 3084, Australia; (N.d.A.); (N.K.B.); (Y.T.M.M.); (S.B.); (B.R.F.)
- Mercy Perinatal, Mercy Hospital for Women, Heidelberg, VIC 3084, Australia; (N.P.); (E.K.); (E.K.); (F.C.B.); (T.J.K.-L.)
| | - Yeukai T. M. Mangwiro
- Therapeutics Discovery & Vascular Function Group, Department of Obstetrics and Gynaecology, The University of Melbourne, Mercy Hospital for Women, Heidelberg, VIC 3084, Australia; (N.d.A.); (N.K.B.); (Y.T.M.M.); (S.B.); (B.R.F.)
| | - Sally Beard
- Therapeutics Discovery & Vascular Function Group, Department of Obstetrics and Gynaecology, The University of Melbourne, Mercy Hospital for Women, Heidelberg, VIC 3084, Australia; (N.d.A.); (N.K.B.); (Y.T.M.M.); (S.B.); (B.R.F.)
- Mercy Perinatal, Mercy Hospital for Women, Heidelberg, VIC 3084, Australia; (N.P.); (E.K.); (E.K.); (F.C.B.); (T.J.K.-L.)
| | - Natasha Pritchard
- Mercy Perinatal, Mercy Hospital for Women, Heidelberg, VIC 3084, Australia; (N.P.); (E.K.); (E.K.); (F.C.B.); (T.J.K.-L.)
| | - Elif Kadife
- Mercy Perinatal, Mercy Hospital for Women, Heidelberg, VIC 3084, Australia; (N.P.); (E.K.); (E.K.); (F.C.B.); (T.J.K.-L.)
- Obstetrics Diagnostics and Therapeutics Group, Department of Obstetrics and Gynaecology, The University of Melbourne, Mercy Hospital for Women, Heidelberg, VIC 3084, Australia
| | - Bianca R. Fato
- Therapeutics Discovery & Vascular Function Group, Department of Obstetrics and Gynaecology, The University of Melbourne, Mercy Hospital for Women, Heidelberg, VIC 3084, Australia; (N.d.A.); (N.K.B.); (Y.T.M.M.); (S.B.); (B.R.F.)
- Mercy Perinatal, Mercy Hospital for Women, Heidelberg, VIC 3084, Australia; (N.P.); (E.K.); (E.K.); (F.C.B.); (T.J.K.-L.)
| | - Emerson Keenan
- Mercy Perinatal, Mercy Hospital for Women, Heidelberg, VIC 3084, Australia; (N.P.); (E.K.); (E.K.); (F.C.B.); (T.J.K.-L.)
- Obstetrics Diagnostics and Therapeutics Group, Department of Obstetrics and Gynaecology, The University of Melbourne, Mercy Hospital for Women, Heidelberg, VIC 3084, Australia
| | - Fiona C. Brownfoot
- Mercy Perinatal, Mercy Hospital for Women, Heidelberg, VIC 3084, Australia; (N.P.); (E.K.); (E.K.); (F.C.B.); (T.J.K.-L.)
- Obstetrics Diagnostics and Therapeutics Group, Department of Obstetrics and Gynaecology, The University of Melbourne, Mercy Hospital for Women, Heidelberg, VIC 3084, Australia
| | - Tu’uhevaha J. Kaitu’u-Lino
- Mercy Perinatal, Mercy Hospital for Women, Heidelberg, VIC 3084, Australia; (N.P.); (E.K.); (E.K.); (F.C.B.); (T.J.K.-L.)
- Diagnostics Discovery and Reverse Translation in Pregnancy, The University of Melbourne, Mercy Hospital for Women, Heidelberg, VIC 3084, Australia
| | - Natalie J. Hannan
- Therapeutics Discovery & Vascular Function Group, Department of Obstetrics and Gynaecology, The University of Melbourne, Mercy Hospital for Women, Heidelberg, VIC 3084, Australia; (N.d.A.); (N.K.B.); (Y.T.M.M.); (S.B.); (B.R.F.)
- Mercy Perinatal, Mercy Hospital for Women, Heidelberg, VIC 3084, Australia; (N.P.); (E.K.); (E.K.); (F.C.B.); (T.J.K.-L.)
- Correspondence: ; Tel.: +61-3-8458-4371; Fax: +61-3-8458-4380
| |
Collapse
|
17
|
de Alwis N, Beard S, Binder NK, Pritchard N, Tong S, Kaitu'u-Lino TJ, Hannan NJ. Placental DAAM2 is unaltered in preeclampsia, but upregulated by treatment with proton pump inhibitors. Pregnancy Hypertens 2022; 30:13-20. [DOI: 10.1016/j.preghy.2022.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 07/21/2022] [Accepted: 07/25/2022] [Indexed: 11/24/2022]
|
18
|
Ali RAR, Hassan J, Egan LJ. Review of recent evidence on the management of heartburn in pregnant and breastfeeding women. BMC Gastroenterol 2022; 22:219. [PMID: 35508989 PMCID: PMC9066781 DOI: 10.1186/s12876-022-02287-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 04/19/2022] [Indexed: 12/03/2022] Open
Abstract
Gastroesophageal reflux disease (GERD) is one the most common medical complaints in pregnant women. Some women continue to experience GERD symptoms after delivery. Effective management of GERD symptoms is important to improve productivity and quality of life. Management of heartburn in pregnant and breastfeeding women involves lifestyle modifications, dietary modifications, non-pharmaceutical remedies and pharmaceutical drugs. For most patients, lifestyle/dietary modifications are helpful in reducing GERD symptoms. For patients who require a more intense intervention, various types of pharmaceutical drugs are available. However, the suitability of each treatment for use during pregnancy and lactation must be taken into consideration. This article explores the reported efficacy and safety of these treatment options in pregnant and breastfeeding women. Recommended treatment algorithm in pregnant and breastfeeding women have been developed.
Collapse
Affiliation(s)
- Raja Affendi Raja Ali
- Gastroenterology Unit, Department of Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia. .,GUT Research Group, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia.
| | - Jamiyah Hassan
- Faculty of Medicine and Hospital, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
| | - Laurence J Egan
- Department of Clinical Pharmacology, Galway University Hospital, The National University of Ireland, Galway, Ireland
| |
Collapse
|
19
|
Tong S, Kaitu’u-Lino TJ, Hastie R, Brownfoot F, Cluver C, Hannan N. Pravastatin, proton-pump inhibitors, metformin, micronutrients, and biologics: new horizons for the prevention or treatment of preeclampsia. Am J Obstet Gynecol 2022; 226:S1157-S1170. [PMID: 32946849 DOI: 10.1016/j.ajog.2020.09.014] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 08/25/2020] [Accepted: 09/10/2020] [Indexed: 12/14/2022]
Abstract
There has been increasing research momentum to identify new therapeutic agents for the prevention or treatment of preeclampsia, drugs that can affect the underlying disease pathophysiology. Molecular targets of candidate treatments include oxidative stress, antiangiogenic factors, and the angiotensin, nitric oxide, and proinflammatory pathways. The proposed treatments undergoing preclinical and clinical trial evaluation are thought to act on placental or endothelial disease or both. Most have adopted the pragmatic strategy of repurposing drugs. Of all the therapeutic agents proposed, pravastatin has received the most interest. There are preclinical studies showing that it has pleiotropic actions that favorably impact on multiple molecular targets and can resolve a preeclampsia phenotype in many animal models. An early phase clinical trial suggests that it may have therapeutic activity. Several large prevention trials are planned or ongoing and, when completed, could definitively address whether pravastatin can prevent preeclampsia. Proton-pump inhibitors, metformin, and sulfasalazine are other drugs with preclinical evidence of multiple molecular actions that could resolve the pathophysiology of preeclampsia. These agents are also currently being evaluated in clinical trials. There have been many recent preclinical studies identifying the potential of numerous natural compounds to treat preeclampsia, such as plant extracts and micronutrients that have potent anti-inflammatory or antioxidant activity. Recent preclinical studies have also proposed novel molecular-targeted strategies, such as monoclonal antibodies targeting tumor necrosis factor alpha, placental growth factor, and short interfering RNA technology, to silence the gene expression of soluble fms-like tyrosine kinase-1 or angiotensinogen. Other treatment approaches that have transitioned to human trials (ranging from single-arm to phase III trials that have been completed or are ongoing) include folic acid, nitric oxide donors (such as L-arginine), recombinant antithrombin III, digoxin immune antigen-binding fragment, and melatonin. There have been case series showing the removal of circulating soluble fms-like tyrosine kinase-1 may help stabilize the disease and prolong pregnancy. Interestingly, there are case reports suggesting that monoclonal antibody eculizumab (complement inhibitor) may have therapeutic potential. If new agents are discovered that are proven to be effective in preventing or treating preeclampsia, the potential to improve global maternal and perinatal health will be significant.
Collapse
|
20
|
Tan J, Xiong Y, Qi Y, Liu C, Huang S, Yao G, Sun W, Qian Y, Ye L, Xu Q, Liu H, Lee AH, Thabane L, Sun X. Data Resource Profile: Xiamen registry of pregnant women and offspring (REPRESENT): a population-based, long-term follow-up database linking four major healthcare data platforms. Int J Epidemiol 2021; 50:27-28. [PMID: 33367681 PMCID: PMC7938502 DOI: 10.1093/ije/dyaa161] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2020] [Indexed: 02/05/2023] Open
Affiliation(s)
- Jing Tan
- Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, Chengdu, China.,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada; Biostatistics Unit, St Joseph's Healthcare-Hamilton, Hamilton, Canada
| | - Yiquan Xiong
- Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, Chengdu, China
| | - Yana Qi
- Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, Chengdu, China
| | - Chunrong Liu
- Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, Chengdu, China
| | - Shiyao Huang
- Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, Chengdu, China
| | | | - Wei Sun
- Xiamen Health Commission, Xiamen, China
| | | | - Lishan Ye
- Xiamen Health and Medical Big Data Center, Xiamen, China
| | - Qiushi Xu
- Xiamen Health and Medical Big Data Center, Xiamen, China
| | - Hui Liu
- Xiamen Health and Medical Big Data Center, Xiamen, China
| | - Andy H Lee
- School of Public Health, Curtin University, Perth, Australia
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada; Biostatistics Unit, St Joseph's Healthcare-Hamilton, Hamilton, Canada
| | - Xin Sun
- Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, Chengdu, China
| |
Collapse
|
21
|
Nakai T, Kitada A, Fukui S, Okada M. Risk of adverse pregnancy outcomes in Japanese systemic lupus erythematosus patients with prior severe organ manifestations: A single-center retrospective analysis. Lupus 2021; 30:1415-1426. [PMID: 34013819 DOI: 10.1177/09612033211016074] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Systemic lupus erythematosus (SLE) increases the incidence of adverse pregnancy outcomes (APOs). Nevertheless, most of the data on SLE pregnancies were derived from database studies in which details of the pregnancies were unavailable, and no consensus exists on the risk of APO in patients with prior severe organ manifestations. METHODS SLE patients followed by rheumatologists and gynecologists throughout pregnancy at our institute were retrospectively identified, and their data between April 2003 and December 2020 were reviewed from electronic records. We assigned patients based on the presence of prior severe organ manifestation (renal/neurological manifestation, prior treatment with methylprednisolone pulse therapy/prednisolone 1 mg/kg/day/biological or cytotoxic therapy) and compared the incidence of overall and serious APO (maternal death, pregnancy loss, preterm birth <32 weeks, birthweight <1500 g, Apgar score <7 at 5 min and birth defect). RESULTS This study included 34 pregnancies in 32 patients; 23 pregnancies in 22 patients were classified as SLE with prior severe organ manifestation. There was no statistical difference in the incidence of overall APO between the two groups (52.2% vs 45.5%, P = 1). Among patients with prior severe organ manifestation, 17.4% had serious APO. A detailed electronic health record search revealed specific causes of APO in all pregnancies with serious APO, except the presence of prior severe organ manifestation. CONCLUSION The incidence of overall APO in SLE patients was not affected by prior severe organ manifestation. Although the incidence of serious APOs increased in patients with previous severe organ manifestation, there were other risk factors for poor pregnancy outcomes besides prior lupus severity. Therefore, proper management by rheumatologists and gynecologists may enable patients with prior severe organ manifestation to safely deliver healthy babies.
Collapse
Affiliation(s)
- Takehiro Nakai
- Immuno-Rheumatology Center, St. Luke's International Hospital, Tokyo, Japan
| | - Ayako Kitada
- Immuno-Rheumatology Center, St. Luke's International Hospital, Tokyo, Japan
| | - Sho Fukui
- Immuno-Rheumatology Center, St. Luke's International Hospital, Tokyo, Japan
| | - Masato Okada
- Immuno-Rheumatology Center, St. Luke's International Hospital, Tokyo, Japan
| |
Collapse
|
22
|
Abstract
IMPORTANCE Gastroesophageal reflux disease (GERD) is defined by recurrent and troublesome heartburn and regurgitation or GERD-specific complications and affects approximately 20% of the adult population in high-income countries. OBSERVATIONS GERD can influence patients' health-related quality of life and is associated with an increased risk of esophagitis, esophageal strictures, Barrett esophagus, and esophageal adenocarcinoma. Obesity, tobacco smoking, and genetic predisposition increase the risk of developing GERD. Typical GERD symptoms are often sufficient to determine the diagnosis, but less common symptoms and signs, such as dysphagia and chronic cough, may occur. Patients with typical GERD symptoms can be medicated empirically with a proton pump inhibitor (PPI). Among patients who do not respond to such treatment or if the diagnosis is unclear, endoscopy, esophageal manometry, and esophageal pH monitoring are recommended. Patients with GERD symptoms combined with warning symptoms of malignancy (eg, dysphagia, weight loss, bleeding) and those with other main risk factors for esophageal adenocarcinoma, such as older age, male sex, and obesity, should undergo endoscopy. Lifestyle changes, medication, and surgery are the main treatment options for GERD. Weight loss and smoking cessation are often useful. Medication with a PPI is the most common treatment, and after initial full-dose therapy, which usually is omeprazole 20 mg once daily, the aim is to use the lowest effective dose. Observational studies have suggested several adverse effects after long-term PPI, but these findings need to be confirmed before influencing clinical decision making. Surgery with laparoscopic fundoplication is an invasive treatment alternative in select patients after thorough and objective assessments, particularly if they are young and healthy. Endoscopic and less invasive surgical techniques are emerging, which may reduce the use of long-term PPI and fundoplication, but the long-term safety and efficacy remain to be scientifically established. CONCLUSIONS AND RELEVANCE The clinical management of GERD influences the lives of many individuals and is responsible for substantial consumption of health care and societal resources. Treatments include lifestyle modification, PPI medication, and laparoscopic fundoplication. New endoscopic and less invasive surgical procedures are evolving. PPI use remains the dominant treatment, but long-term therapy requires follow-up and reevaluation for potential adverse effects.
Collapse
Affiliation(s)
- John Maret-Ouda
- Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, and Karolinska University Hospital, Stockholm, Sweden
- Centre for Clinical Research Sormland, Uppsala University, Eskilstuna, Sweden
| | - Sheraz R Markar
- Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, and Karolinska University Hospital, Stockholm, Sweden
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Jesper Lagergren
- Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, and Karolinska University Hospital, Stockholm, Sweden
- School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom
| |
Collapse
|
23
|
Novel approaches to combat preeclampsia: from new drugs to innovative delivery. Placenta 2020; 102:10-16. [PMID: 32980138 DOI: 10.1016/j.placenta.2020.08.022] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 08/30/2020] [Accepted: 08/31/2020] [Indexed: 12/22/2022]
Abstract
Preeclampsia is a complex disease affecting 2-8% of pregnancies worldwide. It poses significant risk of maternal and perinatal morbidity and mortality. Despite the rising research interest to discover new therapeutic approaches to prevent and treat preeclampsia, options remain limited. Identifying the important pathological stages in the progression of this disease allows us to evaluate effective candidate therapeutics. Three important stages in the pathophysiology are: 1) placental hypoxia and oxidative stress, 2) excess release of anti-angiogenic and pro-inflammatory factors, and 3) widespread systemic endothelial dysfunction and vasoconstriction. Repurposing drugs already safe for use in pregnancy is an attractive option for discovery of novel therapeutics. There are many drugs currently being assessed to treat preeclampsia, including proton pump inhibitors (PPIs), metformin, statins, sulfasalazine, sofalcone, resveratrol, melatonin, and sildenafil citrate. These drugs show positive effects in preclinical studies, targeting placental and endothelial dysfunction. However, using novel therapeutics can raise safety concerns for the developing fetus. Therefore, innovative targeted delivery systems are being developed to safely administer these therapeutics directly to the placenta and/or endothelium. These include nanoparticle delivery systems, developed and used by the oncology field, now being adapted for obstetrics. This technology is currently being assessed in animal models and shows promise for treating preeclampsia. Combining effective therapeutics with targeted drug delivery could be the future of preeclampsia treatment.
Collapse
|
24
|
Saito J, Yakuwa N, Sandaiji N, Kawasaki H, Kaneko K, Suzuki T, Yamatani A, Sago H, Murashima A. Esomeprazole During Pregnancy and Lactation: Esomeprazole Levels in Maternal Serum, Cord Blood, Breast Milk, and the Infant's Serum. Breastfeed Med 2020; 15:598-601. [PMID: 32635742 DOI: 10.1089/bfm.2020.0175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Background: Esomeprazole is the S-isomer of omeprazole and is used to treat stomach acid-related diseases. Most data regarding the safety of esomeprazole during pregnancy are derived from studies on omeprazole, and the data characterizing esomeprazole transfer across the placenta and excretion into breast milk are limited. In this report, we discuss the safety of esomeprazole with reference to drug concentrations in maternal and neonatal blood and breast milk. Materials and Methods: After the patient provided informed consent, esomeprazole concentrations in maternal serum, breast milk, cord blood, and infant's serum were measured after 10 mg of maternal oral esomeprazole administration. Case Report: A 34-year-old female diagnosed with rheumatoid arthritis received esomeprazole before and during pregnancy and lactation. The esomeprazole concentration in cord blood was 40% of the level in maternal serum. At 12 hours after delivery (23.2 hours after dose), omeprazole was not detected in the infant's serum. In breast milk, esomeprazole concentrations at 0.7, 4.0, and 8.2 hours after the last dose were 10.5, 19.6, and 3.0 ng/mL, respectively, and esomeprazole was not detected at 10 hours after maternal administration. The calculated daily infant dose of esomeprazole through breast milk was 0.003 mg/[kg·day]. The infant demonstrated normal developmental progress and no detectable drug-related adverse effects. Discussion and Conclusions: Exposure to esomeprazole through placenta and breast milk was not clinically relevant in the infant. Further studies are needed to evaluate any harmful effects after exposure to esomeprazole in utero or during breastfeeding after esomeprazole treatment.
Collapse
Affiliation(s)
- Jumpei Saito
- Department of Pharmacy, National Center for Child Health and Development, Tokyo, Japan
| | - Naho Yakuwa
- Japan Drug Information Institute in Pregnancy, National Center for Child Health and Development, Tokyo, Japan
| | - Noriko Sandaiji
- Department of Pharmacy, National Center for Child Health and Development, Tokyo, Japan
| | - Hiroyo Kawasaki
- Department of Pharmacy, National Center for Child Health and Development, Tokyo, Japan
| | - Kayoko Kaneko
- Division of Maternal Medicine, Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Tomo Suzuki
- Division of Obstetrics, Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Akimasa Yamatani
- Department of Pharmacy, National Center for Child Health and Development, Tokyo, Japan
| | - Haruhiko Sago
- Division of Obstetrics, Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Atsuko Murashima
- Japan Drug Information Institute in Pregnancy, National Center for Child Health and Development, Tokyo, Japan.,Division of Maternal Medicine, Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| |
Collapse
|
25
|
Binder NK, Brownfoot FC, Beard S, Cannon P, Nguyen TV, Tong S, Kaitu'u-Lino TJ, Hannan NJ. Esomeprazole and sulfasalazine in combination additively reduce sFlt-1 secretion and diminish endothelial dysfunction: potential for a combination treatment for preeclampsia. Pregnancy Hypertens 2020; 22:86-92. [PMID: 32758704 DOI: 10.1016/j.preghy.2020.07.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 07/09/2020] [Accepted: 07/23/2020] [Indexed: 12/19/2022]
Abstract
Development and repurposing of therapies that show promise in the prevention or treatment of preeclampsia would be a major advance for the obstetrics field. We recently identified esomeprazole and sulfasalazine as potential candidates for the treatment of preeclampsia. Both reduce placental and endothelial secretion of sFlt-1 and sENG and mitigate endothelial dysfunction in vitro. Here we assessed whether esomeprazole and sulfasalazine in combination would additively attenuate the elevated release of anti-angiogenic factors and markers of endothelial dysfunction, key characteristics of preeclampsia. Primary placental tissue and cells, and primary endothelial cells were treated with esomeprazole and sulfasalazine alone and in combination. We assessed secretion of sFlt-1 and sENG and performed in vitro assays of endothelial dysfunction. Combining esomeprazole and sulfasalazine in lower concentrations caused an additive reduction in sFlt-1 secretion in primary cytotrophoblasts, placental explants and endothelial cells. No additive reduction was observed in sENG secretion when esomeprazole and sulfasalazine were combined. Together, esomeprazole and sulfasalazine additively reduced TNF-α-induced VCAM and ET-1 mRNA expression, and monocyte adhesion to endothelial cells. In conclusion, combining esomeprazole and sulfasalazine additively reduced secretion of sFlt-1 and markers of endothelial dysfunction. Combined administration of esomeprazole and sulfasalazine may provide a more effective treatment or prevention for preeclampsia compared to either as single agents.
Collapse
Affiliation(s)
- Natalie K Binder
- Translational Obstetrics Group, Department of Obstetrics and Gynaecology, University of Melbourne and Mercy Hospital for Women, Australia; Therapeutics Discovery and Vascular Function, Department of Obstetrics and Gynaecology, University of Melbourne and Mercy Hospital for Women, Australia; Mercy Perinatal 163 Studley Rd, Heidelberg 3084, Victoria, Australia
| | - Fiona C Brownfoot
- Translational Obstetrics Group, Department of Obstetrics and Gynaecology, University of Melbourne and Mercy Hospital for Women, Australia; Mercy Perinatal 163 Studley Rd, Heidelberg 3084, Victoria, Australia
| | - Sally Beard
- Translational Obstetrics Group, Department of Obstetrics and Gynaecology, University of Melbourne and Mercy Hospital for Women, Australia; Therapeutics Discovery and Vascular Function, Department of Obstetrics and Gynaecology, University of Melbourne and Mercy Hospital for Women, Australia; Mercy Perinatal 163 Studley Rd, Heidelberg 3084, Victoria, Australia
| | - Ping Cannon
- Translational Obstetrics Group, Department of Obstetrics and Gynaecology, University of Melbourne and Mercy Hospital for Women, Australia; Diagnostics Discovery and Reverse Translation, Department of Obstetrics and Gynaecology, University of Melbourne and Mercy Hospital for Women, Australia; Mercy Perinatal 163 Studley Rd, Heidelberg 3084, Victoria, Australia
| | - Tuong V Nguyen
- Translational Obstetrics Group, Department of Obstetrics and Gynaecology, University of Melbourne and Mercy Hospital for Women, Australia; Diagnostics Discovery and Reverse Translation, Department of Obstetrics and Gynaecology, University of Melbourne and Mercy Hospital for Women, Australia; Mercy Perinatal 163 Studley Rd, Heidelberg 3084, Victoria, Australia
| | - Stephen Tong
- Translational Obstetrics Group, Department of Obstetrics and Gynaecology, University of Melbourne and Mercy Hospital for Women, Australia; Mercy Perinatal 163 Studley Rd, Heidelberg 3084, Victoria, Australia
| | - Tu'uhevaha J Kaitu'u-Lino
- Translational Obstetrics Group, Department of Obstetrics and Gynaecology, University of Melbourne and Mercy Hospital for Women, Australia; Diagnostics Discovery and Reverse Translation, Department of Obstetrics and Gynaecology, University of Melbourne and Mercy Hospital for Women, Australia; Mercy Perinatal 163 Studley Rd, Heidelberg 3084, Victoria, Australia
| | - Natalie J Hannan
- Translational Obstetrics Group, Department of Obstetrics and Gynaecology, University of Melbourne and Mercy Hospital for Women, Australia; Therapeutics Discovery and Vascular Function, Department of Obstetrics and Gynaecology, University of Melbourne and Mercy Hospital for Women, Australia; Mercy Perinatal 163 Studley Rd, Heidelberg 3084, Victoria, Australia.
| |
Collapse
|
26
|
|
27
|
Abstract
PURPOSE OF REVIEW To review the rationale and biological plausibility and discuss the current research on novel interventions for the prevention of preeclampsia. RECENT FINDINGS Preeclampsia affects up to 8% of pregnancies worldwide and remains a major cause of maternal and neonatal morbidity and mortality. Multiple medications have been investigated or repurposed as potential effective interventions for preeclampsia prevention. Aspirin is currently the only drug for which there is some evidence of benefit for preeclampsia prevention, and its use is recommended by professional societies for pregnancies at risk. Statins have shown promise for prevention of preeclampsia in animal models and human pilot studies, without any trend or concerns for safety signals or teratogenicity. The use of metformin has also gained popularity in experimental studies, but observations from randomized clinical trials were not consistent on its utility as a possible intervention for preeclampsia prevention. While initial studies evaluating esomeprazole were promising, randomized trials failed to show benefit. Contemporary research shows exciting new opportunities for prophylactic treatment for preeclampsia, to prevent this debilitating and life-threatening disease.
Collapse
Affiliation(s)
- Marwan Ma'ayeh
- Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, The Ohio State University College of Medicine, 395 W 12th Avenue, Columbus, OH, 43210, USA. Marwan.Ma'
| | - Kara M Rood
- Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, The Ohio State University College of Medicine, 395 W 12th Avenue, Columbus, OH, 43210, USA
| | - Douglas Kniss
- Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, The Ohio State University College of Medicine, 395 W 12th Avenue, Columbus, OH, 43210, USA
| | - Maged M Costantine
- Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, The Ohio State University College of Medicine, 395 W 12th Avenue, Columbus, OH, 43210, USA
| |
Collapse
|
28
|
Li CM, Zhernakova A, Engstrand L, Wijmenga C, Brusselaers N. Systematic review with meta-analysis: the risks of proton pump inhibitors during pregnancy. Aliment Pharmacol Ther 2020; 51:410-420. [PMID: 31909512 DOI: 10.1111/apt.15610] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 10/14/2019] [Accepted: 11/23/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND There have been safety concerns considering long-term proton pump inhibitor (PPI) use, also during pregnancy. AIMS To assess the risk of adverse neonatal outcomes associated with maternal intake of PPIs by means of systematic review and meta-analysis. METHODS The systematic search included PubMed, Web of Science, Cochrane Database and Embase (inception until June 2019). All studies reporting ≥1 adverse pregnancy outcome comparing PPI users to non-users. Histamine-2 receptor antagonists (H2RA) were also compared to both non-users and PPI users. Outcomes included congenital malformations, abortion, stillbirth, neonatal death, preterm birth, small for gestational age and low birth weight. Pooled odds ratios (OR) and 95% confidence intervals (CI) were obtained by random-effects modelling. PROSPERO study-protocol: CRD42018103320. RESULTS In total, 26 observational studies (20 cohort, 6 case-control studies) were identified, of which 19 assessed PPIs and 12 H2RA. PPI use was associated with an increased risk of congenital malformations (OR 1.28, 95% CI 1.09-1.52), especially in case-control studies (OR 2.04, 1.46-2.86). No associations were found between H2RA and congenital malformations. No significant associations were found between PPI use and abortions, stillbirth, neonatal death, preterm birth and low-birth weight, although H2RA use may be associated with an increased risk of preterm birth (OR 1.25, 95% CI 1.02-1.56). Although statistical heterogeneity and the risk of bias were overall low, clinical heterogeneity, information and selection bias may be present in the individual studies. CONCLUSIONS This meta-analysis suggests an association between maternal PPI use and congenital malformations in humans, yet power was insufficient to assess specific malformations and drugs.
Collapse
Affiliation(s)
- Cheng Mei Li
- Centre for Translational Microbiome Research, Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden.,Science for Life Laboratory, Stockholm, Sweden.,Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Alexandra Zhernakova
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Lars Engstrand
- Centre for Translational Microbiome Research, Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden.,Science for Life Laboratory, Stockholm, Sweden
| | - Cisca Wijmenga
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Nele Brusselaers
- Centre for Translational Microbiome Research, Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden.,Science for Life Laboratory, Stockholm, Sweden
| |
Collapse
|
29
|
Thélin CS, Richter JE. Review article: the management of heartburn during pregnancy and lactation. Aliment Pharmacol Ther 2020; 51:421-434. [PMID: 31950535 DOI: 10.1111/apt.15611] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 10/15/2019] [Accepted: 11/24/2019] [Indexed: 12/09/2022]
Abstract
BACKGROUND Gestational reflux is common, affecting up to 80% of pregnant women. Most symptoms will abate during lactation. During both of these periods, interventions used to relieve symptoms focus on a "step-up" methodology with progressive intensification of treatment. This begins with lifestyle modifications. AIM To provide guidance in the treatment of reflux in pregnancy and lactation, as well as briefly summarising the pathogenesis, clinical presentation and diagnostic workup. METHODS A comprehensive search, using online databases PubMed and MEDLINE, along with relevant manuscripts published in English between 1966 and 2019 was used. All abstracts were screened, potentially relevant articles were researched, and bibliographies were reviewed. RESULTS Only a small percentage of relevant drugs are contraindicated for use in pregnancy or while breastfeeding. However, not all drug agents have been extensively evaluated in pregnant women or during the breastfeeding period. Antacids, alginates, and sucralfate are the first-line therapeutic agents. If symptoms persist, any of the H2 RAs can be used except for nizatidine (due to foetal teratogenicity or harm in animal studies). PPIs are reserved for women with intractable symptoms or complicated GERD; all are FDA category B drugs, except for omeprazole, which is a category C drug. CONCLUSIONS The management of heartburn during pregnancy and lactation begins with lifestyle modifications. In situations where disease severity increases, medical providers must discuss risks and benefits of these medicines with the patient in detail.
Collapse
Affiliation(s)
- Camille S Thélin
- Division of Digestive Diseases & Nutrition, Department of Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Joel E Richter
- Joy Culverhouse Center for Swallowing Disorders, Division of Digestive Diseases & Nutrition, Department of Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| |
Collapse
|
30
|
Ellfolk M, Tornio A, Niemi M, Leinonen MK, Lahesmaa-Korpinen AM, Malm H. Placental transporter-mediated drug interactions and offspring congenital anomalies. Br J Clin Pharmacol 2020; 86:868-879. [PMID: 31823387 PMCID: PMC7163376 DOI: 10.1111/bcp.14191] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 11/14/2019] [Accepted: 11/26/2019] [Indexed: 01/16/2023] Open
Abstract
Aims P‐glycoprotein (P‐gp) and breast cancer resistance protein (BCRP) are efflux transporters expressed in the placenta, limiting their substrates from reaching the foetus. Our aim was to investigate if concomitant prenatal exposure to several substrates or inhibitors of these transporters increases the risk of congenital anomalies. Methods The national Drugs and Pregnancy database, years 1996–2014, was utilized in this population‐based birth cohort study. In the database, the Medical Birth Register, the Register on Induced Abortions, the Malformation register and the Register on Reimbursed Drug Purchases have been linked. The University of Washington Metabolism and Transport Drug Interaction Database was used to identify substrates and inhibitors of P‐gp and BCRP. We included singleton pregnancies ending in birth or elective termination of pregnancy due to foetal anomaly. Known teratogens were excluded. We identified women exposed 1 month before pregnancy or during the first trimester to P‐gp/BCRP polytherapy (n = 21 186); P‐gp/breast cancer resistance protein monotherapy (n = 97 906); non‐P‐gp/BCRP polytherapy (n = 78 636); and unexposed (n = 728 870). We investigated the association between the exposure groups and major congenital anomalies using logistic regression adjusting for several confounders. Results The prevalence of congenital anomalies was higher in the P‐gp/BCRP polytherapy group (5.5%) compared to the P‐gp/BCRP monotherapy (4.7%, OR 1.13; 95% CI 1.05–1.21), the non‐P‐gp/BCRP polytherapy (4.9%, OR 1.14; 95% CI 1.06–1.22), and to the unexposed groups (4.2%, OR 1.23; 95% CI 1.15–1.31). Conclusion The results suggest a role of placental transporter‐mediated drug interactions in teratogenesis.
Collapse
Affiliation(s)
- Maria Ellfolk
- Teratology Information, Department of Emergency Medicine Services, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Aleksi Tornio
- Department of Clinical Pharmacology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Individualized Drug Therapy Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Mikko Niemi
- Department of Clinical Pharmacology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Individualized Drug Therapy Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Maarit K Leinonen
- Information Services Department, Unit of Statistics and Registers, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Anna-Maria Lahesmaa-Korpinen
- Information Services Department, Unit of Statistics and Registers, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Heli Malm
- Teratology Information, Department of Emergency Medicine Services, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Department of Clinical Pharmacology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Individualized Drug Therapy Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Department of Child Psychiatry, University of Turku, Turku, Finland
| |
Collapse
|
31
|
Hastie R, Bergman L, Cluver CA, Wikman A, Hannan NJ, Walker SP, Wikström AK, Tong S, Hesselman S. Proton Pump Inhibitors and Preeclampsia Risk Among 157 720 Women. Hypertension 2019; 73:1097-1103. [PMID: 30827143 DOI: 10.1161/hypertensionaha.118.12547] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Preeclampsia is a hypertensive disorder of pregnancy with a high rate of maternal and neonatal morbidity and mortality. The only definite treatment is delivery. Preclinical investigations have identified proton pump inhibitors (PPIs), which are commonly used to treat reflux during pregnancy, as a potential treatment for preeclampsia. The aim of this study was to determine the association between PPI use during pregnancy and preeclampsia risk in a population-based register cohort. Using the Swedish Pregnancy Register, we conducted a cohort study of nulliparous pregnant women delivering from January 2013 to July 2017. Associations between PPI use and preeclampsia were investigated using logistic regression analyses with risk estimates presented as crude and adjusted odds ratios (aOR) with 95% CI. Of 157 720 nulliparous pregnant women, 6051 (3.8%) reported PPI use during pregnancy. PPI use during any point of pregnancy was associated with an increased risk of overall preeclampsia (aOR of 1.17; 95% CI, 1.04-1.32) and preeclampsia at term (aOR of 1.20; 95% CI, 1.04-1.39). However, PPI use recorded after 28 gestational weeks was associated with a reduced risk of preterm (delivery <37 weeks) preeclampsia (aOR of 0.63; 95% CI, 0.41-0.96) and early (delivery <34 weeks) preeclampsia (aOR of 0.41; 95% CI, 0.20-0.82). These findings highlight the heterogeneity of this disease, with a potential role PPIs for preventing preterm preeclampsia when used in close proximity to disease onset. Targeting PPI use to women at greatest risk of preterm preeclampsia may help prevent this severe form of disease.
Collapse
Affiliation(s)
- Roxanne Hastie
- From the Mercy Perinatal, Mercy Hospital for Women, Melbourne, Australia (R,H., N.J.H., S.P.W., S.T.)
- Translational Obstetrics Group, Department of Obstetrics and Gynaecology, University of Melbourne, Heidelberg, Australia (R.H., C.A.C., N.J.H., S.T.)
- Department of Women's and Children's Health, Uppsala University, Sweden (R.H., L.B., A.W., A.-K.W., S.H.)
| | - Lina Bergman
- Department of Women's and Children's Health, Uppsala University, Sweden (R.H., L.B., A.W., A.-K.W., S.H.)
- Center for Clinical Research (L.B., S.H.), Uppsala University, Falun, Sweden
- Department of Obstetrics and Gynaecology, Stellenbosch University, Cape Town, South Africa (L.B., C.A.C.)
| | - Catherin A Cluver
- Translational Obstetrics Group, Department of Obstetrics and Gynaecology, University of Melbourne, Heidelberg, Australia (R.H., C.A.C., N.J.H., S.T.)
- Department of Obstetrics and Gynaecology, Stellenbosch University, Cape Town, South Africa (L.B., C.A.C.)
| | - Anna Wikman
- Department of Women's and Children's Health, Uppsala University, Sweden (R.H., L.B., A.W., A.-K.W., S.H.)
| | - Natalie J Hannan
- From the Mercy Perinatal, Mercy Hospital for Women, Melbourne, Australia (R,H., N.J.H., S.P.W., S.T.)
- Translational Obstetrics Group, Department of Obstetrics and Gynaecology, University of Melbourne, Heidelberg, Australia (R.H., C.A.C., N.J.H., S.T.)
| | - Susan P Walker
- From the Mercy Perinatal, Mercy Hospital for Women, Melbourne, Australia (R,H., N.J.H., S.P.W., S.T.)
| | - Anna-Karin Wikström
- Department of Women's and Children's Health, Uppsala University, Sweden (R.H., L.B., A.W., A.-K.W., S.H.)
| | - Stephen Tong
- From the Mercy Perinatal, Mercy Hospital for Women, Melbourne, Australia (R,H., N.J.H., S.P.W., S.T.)
- Translational Obstetrics Group, Department of Obstetrics and Gynaecology, University of Melbourne, Heidelberg, Australia (R.H., C.A.C., N.J.H., S.T.)
| | - Susanne Hesselman
- Department of Women's and Children's Health, Uppsala University, Sweden (R.H., L.B., A.W., A.-K.W., S.H.)
- Center for Clinical Research (L.B., S.H.), Uppsala University, Falun, Sweden
| |
Collapse
|
32
|
Hastie R, Brownfoot FC, Pritchard N, Hannan NJ, Cannon P, Nguyen V, Palmer K, Beard S, Tong S, Kaitu’u-Lino TJ. EGFR (Epidermal Growth Factor Receptor) Signaling and the Mitochondria Regulate sFlt-1 (Soluble FMS-Like Tyrosine Kinase-1) Secretion. Hypertension 2019; 73:659-670. [DOI: 10.1161/hypertensionaha.118.12300] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- Roxanne Hastie
- From the Translational Obstetrics Group, Department of Obstetrics and Gynecology, Mercy Hospital for Women, University of Melbourne, Heidelberg, Victoria, Australia (R.H., F.C.B., N.P., N.J.H., P.C., V.N., S.B., S.T., T.J.K.-L.)
- Mercy Perinatal, Research Department, Mercy Hospital for Women, Victoria, Australia (R.H., F.C.B., N.P., N.J.H., P.C., V.N., S.B., S.T., T.J.K.-L.)
| | - Fiona C. Brownfoot
- From the Translational Obstetrics Group, Department of Obstetrics and Gynecology, Mercy Hospital for Women, University of Melbourne, Heidelberg, Victoria, Australia (R.H., F.C.B., N.P., N.J.H., P.C., V.N., S.B., S.T., T.J.K.-L.)
- Mercy Perinatal, Research Department, Mercy Hospital for Women, Victoria, Australia (R.H., F.C.B., N.P., N.J.H., P.C., V.N., S.B., S.T., T.J.K.-L.)
| | - Natasha Pritchard
- From the Translational Obstetrics Group, Department of Obstetrics and Gynecology, Mercy Hospital for Women, University of Melbourne, Heidelberg, Victoria, Australia (R.H., F.C.B., N.P., N.J.H., P.C., V.N., S.B., S.T., T.J.K.-L.)
- Mercy Perinatal, Research Department, Mercy Hospital for Women, Victoria, Australia (R.H., F.C.B., N.P., N.J.H., P.C., V.N., S.B., S.T., T.J.K.-L.)
| | - Natalie J. Hannan
- From the Translational Obstetrics Group, Department of Obstetrics and Gynecology, Mercy Hospital for Women, University of Melbourne, Heidelberg, Victoria, Australia (R.H., F.C.B., N.P., N.J.H., P.C., V.N., S.B., S.T., T.J.K.-L.)
- Mercy Perinatal, Research Department, Mercy Hospital for Women, Victoria, Australia (R.H., F.C.B., N.P., N.J.H., P.C., V.N., S.B., S.T., T.J.K.-L.)
| | - Ping Cannon
- From the Translational Obstetrics Group, Department of Obstetrics and Gynecology, Mercy Hospital for Women, University of Melbourne, Heidelberg, Victoria, Australia (R.H., F.C.B., N.P., N.J.H., P.C., V.N., S.B., S.T., T.J.K.-L.)
- Mercy Perinatal, Research Department, Mercy Hospital for Women, Victoria, Australia (R.H., F.C.B., N.P., N.J.H., P.C., V.N., S.B., S.T., T.J.K.-L.)
| | - Vi Nguyen
- From the Translational Obstetrics Group, Department of Obstetrics and Gynecology, Mercy Hospital for Women, University of Melbourne, Heidelberg, Victoria, Australia (R.H., F.C.B., N.P., N.J.H., P.C., V.N., S.B., S.T., T.J.K.-L.)
- Mercy Perinatal, Research Department, Mercy Hospital for Women, Victoria, Australia (R.H., F.C.B., N.P., N.J.H., P.C., V.N., S.B., S.T., T.J.K.-L.)
| | - Kirsten Palmer
- Department of Obstetrics and Gynaecology, Monash University, Victoria, Australia (K.P.)
| | - Sally Beard
- From the Translational Obstetrics Group, Department of Obstetrics and Gynecology, Mercy Hospital for Women, University of Melbourne, Heidelberg, Victoria, Australia (R.H., F.C.B., N.P., N.J.H., P.C., V.N., S.B., S.T., T.J.K.-L.)
- Mercy Perinatal, Research Department, Mercy Hospital for Women, Victoria, Australia (R.H., F.C.B., N.P., N.J.H., P.C., V.N., S.B., S.T., T.J.K.-L.)
| | - Stephen Tong
- From the Translational Obstetrics Group, Department of Obstetrics and Gynecology, Mercy Hospital for Women, University of Melbourne, Heidelberg, Victoria, Australia (R.H., F.C.B., N.P., N.J.H., P.C., V.N., S.B., S.T., T.J.K.-L.)
- Mercy Perinatal, Research Department, Mercy Hospital for Women, Victoria, Australia (R.H., F.C.B., N.P., N.J.H., P.C., V.N., S.B., S.T., T.J.K.-L.)
| | - Tu’uhevaha J. Kaitu’u-Lino
- From the Translational Obstetrics Group, Department of Obstetrics and Gynecology, Mercy Hospital for Women, University of Melbourne, Heidelberg, Victoria, Australia (R.H., F.C.B., N.P., N.J.H., P.C., V.N., S.B., S.T., T.J.K.-L.)
- Mercy Perinatal, Research Department, Mercy Hospital for Women, Victoria, Australia (R.H., F.C.B., N.P., N.J.H., P.C., V.N., S.B., S.T., T.J.K.-L.)
| |
Collapse
|
33
|
Cox AG, Marshall SA, Palmer KR, Wallace EM. Current and emerging pharmacotherapy for emergency management of preeclampsia. Expert Opin Pharmacother 2019; 20:701-712. [PMID: 30707633 DOI: 10.1080/14656566.2019.1570134] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Preeclampsia is a disease specific to pregnancy characterised by new onset hypertension with maternal organ dysfunction and/or fetal growth restriction. It remains a major cause of maternal and perinatal morbidity and mortality. For fifty years, antihypertensives have been the mainstay of treating preeclampsia, reducing maternal morbidity and mortality. With increased knowledge of the mechanisms underlying the disease has come opportunities for novel therapies that complement antihypertensives by protecting the maternal vasculature. Areas covered: In this review, the authors consider, in detail, the antihypertensives commonly used today in the emergency care of women with severe preeclampsia. They also review less common anti-hypertensive agents and discuss the role of magnesium sulphate in the management of preeclampsia and the prevention of eclampsia. Finally, they explore novel therapeutics for the acute management of preeclampsia. Expert opinion: The rapid control of maternal hypertension will, and must, remain the mainstay of emergency treatment for women with severe preeclampsia. The role of magnesium sulphate as a primary prevention for eclampsia is context dependant and should not displace a focus on correcting blood pressure safely. The exploration of novel adjuvant therapies will likely allow us to prolong pregnancy longer and improve perinatal outcomes safely for the mother.
Collapse
Affiliation(s)
- Annie G Cox
- a Ritchie Centre, Department of Obstetrics and GynaecologySchool of Clinical Sciences , Monash University , Clayton , Australia.,b The Ritchie Centre , Hudson Institute of Medical Research , Clayton , Australia
| | - Sarah A Marshall
- a Ritchie Centre, Department of Obstetrics and GynaecologySchool of Clinical Sciences , Monash University , Clayton , Australia.,b The Ritchie Centre , Hudson Institute of Medical Research , Clayton , Australia
| | - Kirsten R Palmer
- a Ritchie Centre, Department of Obstetrics and GynaecologySchool of Clinical Sciences , Monash University , Clayton , Australia
| | - Euan M Wallace
- a Ritchie Centre, Department of Obstetrics and GynaecologySchool of Clinical Sciences , Monash University , Clayton , Australia.,b The Ritchie Centre , Hudson Institute of Medical Research , Clayton , Australia
| |
Collapse
|
34
|
Marshall SA, Cox AG, Parry LJ, Wallace EM. Targeting the vascular dysfunction: Potential treatments for preeclampsia. Microcirculation 2018; 26:e12522. [PMID: 30556222 DOI: 10.1111/micc.12522] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 11/22/2018] [Accepted: 12/10/2018] [Indexed: 12/18/2022]
Abstract
Preeclampsia is a pregnancy-specific disorder, primarily characterized by new-onset hypertension in combination with a variety of other maternal or fetal signs. The pathophysiological mechanisms underlying the disease are still not entirely clear. Systemic maternal vascular dysfunction underlies the clinical features of preeclampsia. It is a result of oxidative stress and the actions of excessive anti-angiogenic factors, such as soluble fms-like tyrosine kinase, soluble endoglin, and activin A, released by a dysfunctional placenta. The vascular dysfunction then leads to impaired regulation and secretion of relaxation factors and an increase in sensitivity/production of constrictors. This results in a more constricted vasculature rather than the relaxed vasodilated state associated with normal pregnancy. Currently, the only effective "treatment" for preeclampsia is delivery of the placenta and therefore the baby. Often, this means a preterm delivery to save the life of the mother, with all the attendant risks and burdens associated with fetal prematurity. To lessen this burden, there is a pressing need for more effective treatments that target the maternal vascular dysfunction that underlies the hypertension. This review details the vascular effects of key drugs undergoing clinical assessment as potential treatments for women with preeclampsia.
Collapse
Affiliation(s)
- Sarah A Marshall
- Departments of Obstetrics and Gynaecology and Medicine, School of Clinical Sciences, The Ritchie Centre, Monash University, Clayton, Victoria, Australia
| | - Annie G Cox
- Departments of Obstetrics and Gynaecology and Medicine, School of Clinical Sciences, The Ritchie Centre, Monash University, Clayton, Victoria, Australia
| | - Laura J Parry
- School of BioSciences, The University of Melbourne, Parkville, Victoria, Australia
| | - Euan M Wallace
- Departments of Obstetrics and Gynaecology and Medicine, School of Clinical Sciences, The Ritchie Centre, Monash University, Clayton, Victoria, Australia
| |
Collapse
|
35
|
Cluver CA, Hannan NJ, van Papendorp E, Hiscock R, Beard S, Mol BW, Theron GB, Hall DR, Decloedt EH, Stander M, Adams KT, Rensburg M, Schubert P, Walker SP, Tong S. Esomeprazole to treat women with preterm preeclampsia: a randomized placebo controlled trial. Am J Obstet Gynecol 2018; 219:388.e1-388.e17. [PMID: 30055127 DOI: 10.1016/j.ajog.2018.07.019] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 07/17/2018] [Accepted: 07/20/2018] [Indexed: 01/30/2023]
Abstract
BACKGROUND Preterm preeclampsia has a high rate of fetal death or disability. There is no treatment to slow the disease, except delivery. Preclinical studies have identified proton pump inhibitors as a possible treatment. OBJECTIVE The purpose of this study was to examine whether esomeprazole could prolong pregnancy in women who have received a diagnosis of preterm preeclampsia. STUDY DESIGN We performed a double-blind, randomized controlled trial at Tygerberg Hospital in South Africa. Women with preterm preeclampsia (gestational age 26 weeks+0 days to 31 weeks+6 days) were assigned randomly to 40-mg daily esomeprazole or placebo. The primary outcome was a prolongation of gestation of 5 days. Secondary outcomes were maternal and neonatal outcomes. We compared circulating markers of endothelial dysfunction that was associated with preeclampsia and performed pharmacokinetic studies. RESULTS Between January 2016 and April 2017, we recruited 120 participants. One participant was excluded because of incorrect randomization, which left 59 participants in the esomeprazole and 60 participants in the placebo group. Median gestational age at enrolment was 29+4 weeks gestation. There were no between-group differences in median time from randomization to delivery: 11.4 days (interquartile range, 3.6-19.7 days) in the esomeprazole group and 8.3 days (interquartile range, 3.8-19.6 days) in the placebo group (3 days longer in the esomeprazole arm; 95% confidence interval, -2.9-8.8; P=.31). There were no placental abruptions in the esomeprazole group and 6 (10%) in the placebo group (P=.01, P=.14 adjusted). There were no differences in other maternal or neonatal outcomes or markers of endothelial dysfunction. Esomeprazole and its metabolites were detected in maternal blood among those treated with esomeprazole, but only trace amounts in the umbilical cord blood. CONCLUSION Daily esomeprazole (40 mg) did not prolong gestation in pregnancies with preterm preeclampsia or decrease circulating soluble fms-like tyrosine kinase 1 concentrations. Higher levels in the maternal circulation may be needed for clinical effect.
Collapse
|
36
|
Gomes CF, Sousa M, Lourenço I, Martins D, Torres J. Gastrointestinal diseases during pregnancy: what does the gastroenterologist need to know? Ann Gastroenterol 2018; 31:385-394. [PMID: 29991883 PMCID: PMC6033757 DOI: 10.20524/aog.2018.0264] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 02/26/2018] [Indexed: 12/15/2022] Open
Abstract
Pregnancy is characterized by numerous physiological changes that may lead to a diversity of symptoms and frequently to gastrointestinal complaints, such as heartburn, nausea and vomiting, or constipation. Chronic gastrointestinal diseases require treatment maintenance during this period, raising the challenging question whether outcomes beneficial to the mother may be harmful for the fetus. In addition, certain diseases, such as acute fatty liver of pregnancy, only develop during pregnancy and may require urgent procedures, such as fetus delivery. Even though they are not present in our day-to-day practice, knowledge of pregnancy-related diseases is fundamental and collaboration between gastroenterologists and obstetricians is often necessary. Herein, we review pregnancy-related diseases and systematize the most appropriate treatment choices according to the recent literature and guidelines, so that the article can serve as a guide to the gastroenterologist regarding the medical approach to pregnancy-related gastrointestinal and liver diseases and their therapeutic management.
Collapse
Affiliation(s)
- Catarina Frias Gomes
- Surgical Department, Gastroenterology Division (Catarina Frias Gomes, Joana Torres), Hospital Beatriz Ângelo, Loures, Portugal
| | - Mónica Sousa
- Medicine Department, Internal Medicina Division (Mónica Sousa);), Hospital Beatriz Ângelo, Loures, Portugal
| | - Inês Lourenço
- Surgical Department, Gynaecology and Obstetrics Division (Inês Lourenço, Diana Martins), Hospital Beatriz Ângelo, Loures, Portugal
| | - Diana Martins
- Surgical Department, Gynaecology and Obstetrics Division (Inês Lourenço, Diana Martins), Hospital Beatriz Ângelo, Loures, Portugal
| | - Joana Torres
- Surgical Department, Gastroenterology Division (Catarina Frias Gomes, Joana Torres), Hospital Beatriz Ângelo, Loures, Portugal
| |
Collapse
|
37
|
Abstract
Hypomagnesaemia is common in pregnancy, particularly in developing countries and low-income communities. Despite the frequent therapeutic use of magnesium in pregnancy, and the evidence regarding the association of hypomagnesaemia with adverse pregnancy outcomes in animal studies, it remains unclear whether hypomagnesaemia is associated with complications in human pregnancy. Three case reports of pregnancies complicated by moderate-severe hypomagnesaemia are presented and magnesium physiology in pregnancy is discussed. The evidence as to whether hypomagnesaemia may represent a direct cause, a consequence of other disease processes or an epiphenomenon in adverse pregnancies outcomes is reviewed.
Collapse
Affiliation(s)
- Adam Morton
- Mater Hospital, Raymond Tce, Brisbane, Australia
| |
Collapse
|
38
|
Kaitu’u-Lino TJ, Brownfoot FC, Beard S, Cannon P, Hastie R, Nguyen TV, Binder NK, Tong S, Hannan NJ. Combining metformin and esomeprazole is additive in reducing sFlt-1 secretion and decreasing endothelial dysfunction - implications for treating preeclampsia. PLoS One 2018; 13:e0188845. [PMID: 29466360 PMCID: PMC5821305 DOI: 10.1371/journal.pone.0188845] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 11/14/2017] [Indexed: 01/12/2023] Open
Abstract
INTRODUCTION The discovery of new treatments that prevent or treat preeclampsia would be a major advance. Antiangiogenic factors soluble fms-like tyrosine kinase-1 (sFlt-1) and soluble endoglin (sENG) are secreted in excess from the placenta, causing hypertension, endothelial dysfunction, and multiorgan injury. We recently identified metformin and esomeprazole as potential treatments for preeclampsia. Both reduce placental and endothelial secretion of sFlt-1 and soluble endoglin, and reduce endothelial dysfunction. OBJECTIVES We set out to assess whether combining metformin and esomeprazole would additively reduce sFlt-1 and soluble endoglin secretion and reduce endothelial dysfunction (verses drug alone). Metformin and esomeprazole were added to primary placental cells and tissues, and endothelial cells and their effects on sFlt-1 and soluble endoglin secretion were assessed in vitro. Tumor necrosis factor-α (TNF-α) was added to endothelial cells to induce dysfunction in vitro. We examined the ability of metformin + esomeprazole to rescue TNF-α induced vascular cell adhesion molecule-1 (VCAM-1) and Endothelin-1 (ET-1) expression, leukocyte adhesion (markers of endothelial dysfunction). RESULTS Combining metformin and esomeprazole was additive at reducing sFlt-1 secretion and expression of sFlt-1 e15a mRNA isoform in primary cytotrophoblast, placental explants and endothelial cells. In contrast, no additive reduction in sENG was observed with combined metformin and esomeprazole. The low-dose combination of metformin + esomeprazole additively reduced TNF-α-induced VCAM-1 mRNA, but not VCAM-1 protein expression. There was no additive reduction when combining metformin and esomeprazole on TNF-α induced PBMC adhesion to endothelial cells. However, combining metformin and esomeprazole additively reduced ET-1 mRNA expression. CONCLUSIONS In conclusion combining metformin and esomeprazole additively reduced secretion of sFlt-1, and markers of endothelial dysfunction. The combination of metformin and esomeprazole may provide a more effective treatment or prevention for preeclampsia compared to either as single agents.
Collapse
Affiliation(s)
- Tu’uhevaha J. Kaitu’u-Lino
- Translational Obstetrics Group, The Department of Obstetrics and Gynaecology, University of Melbourne and Mercy Perinatal, Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Fiona C. Brownfoot
- Translational Obstetrics Group, The Department of Obstetrics and Gynaecology, University of Melbourne and Mercy Perinatal, Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Sally Beard
- Translational Obstetrics Group, The Department of Obstetrics and Gynaecology, University of Melbourne and Mercy Perinatal, Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Ping Cannon
- Translational Obstetrics Group, The Department of Obstetrics and Gynaecology, University of Melbourne and Mercy Perinatal, Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Roxanne Hastie
- Translational Obstetrics Group, The Department of Obstetrics and Gynaecology, University of Melbourne and Mercy Perinatal, Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Tuong V. Nguyen
- Translational Obstetrics Group, The Department of Obstetrics and Gynaecology, University of Melbourne and Mercy Perinatal, Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Natalie K. Binder
- Translational Obstetrics Group, The Department of Obstetrics and Gynaecology, University of Melbourne and Mercy Perinatal, Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Stephen Tong
- Translational Obstetrics Group, The Department of Obstetrics and Gynaecology, University of Melbourne and Mercy Perinatal, Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Natalie J. Hannan
- Translational Obstetrics Group, The Department of Obstetrics and Gynaecology, University of Melbourne and Mercy Perinatal, Mercy Hospital for Women, Heidelberg, Victoria, Australia
- * E-mail:
| |
Collapse
|
39
|
Brew BK, Almqvist C. Acid Suppressant Use in Pregnancy and Asthma in Offspring: Should We Be Worried? Pediatrics 2018; 141:peds.2017-3741. [PMID: 29326338 DOI: 10.1542/peds.2017-3741] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/14/2017] [Indexed: 11/24/2022] Open
Affiliation(s)
- Bronwyn K Brew
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; and
| | - Catarina Almqvist
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; and.,Pediatric Allergy and Pulmonology Unit, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| |
Collapse
|
40
|
Abstract
OBJECTIVES To review the evidence-based management of nausea and vomiting of pregnancy and hyperemesis gravidarum. EVIDENCE MEDLINE and Cochrane database searches were performed using the medical subject headings of treatment, nausea, vomiting, pregnancy, and hyperemesis gravidarum. The quality of evidence reported in these guidelines has been described using the Evaluation of Evidence criteria outlined in the Report of the Canadian Task Force on Preventative Health Care. BENEFITS Nausea and vomiting of pregnancy has a profound effect on women's health and quality of life during pregnancy as well as a financial impact on the health care system, and its early recognition and management is recommended. COST: Costs, including hospitalizations, additional office visits, and time lost from work, may be reduced if nausea and vomiting in pregnancy is treated early. RECOMMENDATIONS
Collapse
|
41
|
Ono Y, Shiozaki A, Yoneda N, Yoneda S, Yoshino O, Saito S. Effectiveness of Helicobacter pylori
eradication in pregnant women with idiopathic thrombocytopenic purpura. J Obstet Gynaecol Res 2017; 43:1212-1216. [DOI: 10.1111/jog.13341] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 02/05/2017] [Accepted: 02/25/2017] [Indexed: 01/15/2023]
Affiliation(s)
- Yosuke Ono
- Department of Obstetrics and Gynecology; University of Toyama; Sugitani Toyama Japan
| | - Arihiro Shiozaki
- Department of Obstetrics and Gynecology; University of Toyama; Sugitani Toyama Japan
| | - Noriko Yoneda
- Department of Obstetrics and Gynecology; University of Toyama; Sugitani Toyama Japan
| | - Satoshi Yoneda
- Department of Obstetrics and Gynecology; University of Toyama; Sugitani Toyama Japan
| | - Osamu Yoshino
- Department of Obstetrics and Gynecology; University of Toyama; Sugitani Toyama Japan
| | - Shigeru Saito
- Department of Obstetrics and Gynecology; University of Toyama; Sugitani Toyama Japan
| |
Collapse
|
42
|
Johnson DA, Katz PO, Armstrong D, Cohen H, Delaney BC, Howden CW, Katelaris P, Tutuian RI, Castell DO. The Safety of Appropriate Use of Over-the-Counter Proton Pump Inhibitors: An Evidence-Based Review and Delphi Consensus. Drugs 2017; 77:547-561. [PMID: 28233274 PMCID: PMC5357248 DOI: 10.1007/s40265-017-0712-6] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The availability of over-the-counter (OTC) proton pump inhibitors (PPIs) for the short-term (2 weeks) management of frequent heartburn (≥2 days/week) has increased markedly, yet evidence-based recommendations have not been developed. A panel of nine international experts in gastroesophageal reflux disease developed consensus statements regarding the risks and benefits of OTC PPIs using a modified Delphi process. Consensus (based on ≥80% approval) was reached through multiple rounds of remote voting and a final round of live voting. To identify relevant data, the available literature was searched and summarized. Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system terminology was used to rate the quality of evidence and strength of recommendations; consensus was based on ≥2/3 agreement. After 4 rounds of review, consensus was achieved for 18 statements. Notably, the available data did not directly reflect OTC use, but instead, prescription use; therefore, extrapolations to the OTC setting were often necessary. This limitation is regrettable, but it justifies performing this exercise to provide evidence-based expert opinion on a widely used class of drugs. The panel determined that using OTC PPIs according to label instructions is unlikely to mask the symptoms of esophageal or gastric cancer or adversely impact the natural history of related precursor conditions. OTC PPIs are not expected to substantially affect micronutrient absorption or bone mineral density or cause community-acquired pneumonia, Clostridium difficile infection, or cardiovascular adverse events. However, OTC PPI use may be associated with slightly increased risks for infectious diarrhea, certain idiosyncratic reactions, and cirrhosis-related spontaneous bacterial peritonitis. The available evidence does not suggest that OTC PPI use consistent with label instructions is associated with substantial health risks. To minimize potential risks, healthcare professionals and consumers must actively participate in decision making when managing reflux-related symptoms in the self-care setting.
Collapse
Affiliation(s)
- David A Johnson
- Department of Gastroenterology, Eastern Virginia Medical School, 885 Kempsville Rd, Suite 114, Norfolk, VA, 23505, USA.
| | - Philip O Katz
- Division of Gastroenterology, Einstein Medical Center, 5401 Old York Rd, Suite 363 Klein Building, Philadelphia, PA, 19141, USA.
| | - David Armstrong
- Division of Gastroenterology, McMaster University, HSC-3V3, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada
| | - Henry Cohen
- Department of Gastroenterology, National University of Uruguay, Av. Italia 2370, 11600, Montevideo, Uruguay
| | - Brendan C Delaney
- Department of Surgery and Cancer, Imperial College, Kensington, London, SW7 2AZ, UK
| | - Colin W Howden
- Division of Gastroenterology, University of Tennessee Health Science Center, 956 Court Avenue, Suite H210, Memphis, TN, 38163, USA
| | - Peter Katelaris
- Department of Gastroenterology, University of Sydney, Concord, Sydney, 2139, Australia
| | - Radu I Tutuian
- Department of Gastroenterology, University of Bern School of Medicine, Freiburgerstr 10, Bern, Switzerland
| | - Donald O Castell
- Division of Gastroenterology and Hepatology, Medical University of South Carolina, 11 Harleston Place, Charleston, SC, 29401, USA
| |
Collapse
|
43
|
|
44
|
Onda K, Tong S, Beard S, Binder N, Muto M, Senadheera SN, Parry L, Dilworth M, Renshall L, Brownfoot F, Hastie R, Tuohey L, Palmer K, Hirano T, Ikawa M, Kaitu'u-Lino T, Hannan NJ. Proton Pump Inhibitors Decrease Soluble fms-Like Tyrosine Kinase-1 and Soluble Endoglin Secretion, Decrease Hypertension, and Rescue Endothelial Dysfunction. Hypertension 2017; 69:457-468. [PMID: 28115513 DOI: 10.1161/hypertensionaha.116.08408] [Citation(s) in RCA: 102] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 09/28/2016] [Accepted: 12/12/2016] [Indexed: 01/30/2023]
Abstract
Preeclampsia is a severe complication of pregnancy. Antiangiogenic factors soluble fms-like tyrosine kinase-1 (sFlt-1) and soluble endoglin are secreted in excess from the placenta, causing hypertension, endothelial dysfunction, and multiorgan injury. Oxidative stress and vascular inflammation exacerbate the endothelial injury. A drug that can block these pathophysiological steps would be an attractive treatment option. Proton pump inhibitors (PPIs) are safe in pregnancy where they are prescribed for gastric reflux. We performed functional studies on primary human tissues and animal models to examine the effects of PPIs on sFlt-1 and soluble endoglin secretion, vessel dilatation, blood pressure, and endothelial dysfunction. PPIs decreased sFlt-1 and soluble endoglin secretion from trophoblast, placental explants from preeclamptic pregnancies, and endothelial cells. They also mitigated tumor necrosis factor-α-induced endothelial dysfunction: PPIs blocked endothelial vascular cell adhesion molecule-1 expression, leukocyte adhesion to endothelium, and disruption of endothelial tube formation. PPIs decreased endothelin-1 secretion and enhanced endothelial cell migration. Interestingly, the PPI esomeprazole vasodilated maternal blood vessels from normal pregnancies and cases of preterm preeclampsia, but its vasodilatory effects were lost when the vessels were denuded of their endothelium. Esomeprazole decreased blood pressure in a transgenic mouse model where human sFlt-1 was overexpressed in placenta. PPIs upregulated endogenous antioxidant defenses and decreased cytokine secretion from placental tissue and endothelial cells. We have found that PPIs decrease sFlt-1 and soluble endoglin secretion and endothelial dysfunction, dilate blood vessels, decrease blood pressure, and have antioxidant and anti-inflammatory properties. They have therapeutic potential for preeclampsia and other diseases where endothelial dysfunction is involved.
Collapse
Affiliation(s)
- Kenji Onda
- From the Translational Obstetrics Group, Department of Obstetrics and Gynaecology, Mercy Hospital for Women, University of Melbourne, Heidelberg, Victoria, Australia (K.O., S.T., S.B., N.B., F.B., R.H., L.T., K.P., T.K.-L., N.J.H.); Department of Clinical Pharmacology, Tokyo University of Pharmacy and Life Sciences, Hachioji, Japan (K.O., T.H.); Research Institute for Microbial Diseases, Osaka University, Japan (M.M., M.I.); School of Biosciences, University of Melbourne, Parkville, Victoria, Australia (S.N.S., L.P.); Maternal and Fetal Health Research Centre, Institute of Human Development, University of Manchester, United Kingdom (M.D., L.R.); St Mary's Hospital, Central Manchester University Hospitals NHS Trust, Manchester Academic Health Science Centre, United Kingdom (M.D., L.R.)
| | - Stephen Tong
- From the Translational Obstetrics Group, Department of Obstetrics and Gynaecology, Mercy Hospital for Women, University of Melbourne, Heidelberg, Victoria, Australia (K.O., S.T., S.B., N.B., F.B., R.H., L.T., K.P., T.K.-L., N.J.H.); Department of Clinical Pharmacology, Tokyo University of Pharmacy and Life Sciences, Hachioji, Japan (K.O., T.H.); Research Institute for Microbial Diseases, Osaka University, Japan (M.M., M.I.); School of Biosciences, University of Melbourne, Parkville, Victoria, Australia (S.N.S., L.P.); Maternal and Fetal Health Research Centre, Institute of Human Development, University of Manchester, United Kingdom (M.D., L.R.); St Mary's Hospital, Central Manchester University Hospitals NHS Trust, Manchester Academic Health Science Centre, United Kingdom (M.D., L.R.).
| | - Sally Beard
- From the Translational Obstetrics Group, Department of Obstetrics and Gynaecology, Mercy Hospital for Women, University of Melbourne, Heidelberg, Victoria, Australia (K.O., S.T., S.B., N.B., F.B., R.H., L.T., K.P., T.K.-L., N.J.H.); Department of Clinical Pharmacology, Tokyo University of Pharmacy and Life Sciences, Hachioji, Japan (K.O., T.H.); Research Institute for Microbial Diseases, Osaka University, Japan (M.M., M.I.); School of Biosciences, University of Melbourne, Parkville, Victoria, Australia (S.N.S., L.P.); Maternal and Fetal Health Research Centre, Institute of Human Development, University of Manchester, United Kingdom (M.D., L.R.); St Mary's Hospital, Central Manchester University Hospitals NHS Trust, Manchester Academic Health Science Centre, United Kingdom (M.D., L.R.)
| | - Natalie Binder
- From the Translational Obstetrics Group, Department of Obstetrics and Gynaecology, Mercy Hospital for Women, University of Melbourne, Heidelberg, Victoria, Australia (K.O., S.T., S.B., N.B., F.B., R.H., L.T., K.P., T.K.-L., N.J.H.); Department of Clinical Pharmacology, Tokyo University of Pharmacy and Life Sciences, Hachioji, Japan (K.O., T.H.); Research Institute for Microbial Diseases, Osaka University, Japan (M.M., M.I.); School of Biosciences, University of Melbourne, Parkville, Victoria, Australia (S.N.S., L.P.); Maternal and Fetal Health Research Centre, Institute of Human Development, University of Manchester, United Kingdom (M.D., L.R.); St Mary's Hospital, Central Manchester University Hospitals NHS Trust, Manchester Academic Health Science Centre, United Kingdom (M.D., L.R.)
| | - Masanaga Muto
- From the Translational Obstetrics Group, Department of Obstetrics and Gynaecology, Mercy Hospital for Women, University of Melbourne, Heidelberg, Victoria, Australia (K.O., S.T., S.B., N.B., F.B., R.H., L.T., K.P., T.K.-L., N.J.H.); Department of Clinical Pharmacology, Tokyo University of Pharmacy and Life Sciences, Hachioji, Japan (K.O., T.H.); Research Institute for Microbial Diseases, Osaka University, Japan (M.M., M.I.); School of Biosciences, University of Melbourne, Parkville, Victoria, Australia (S.N.S., L.P.); Maternal and Fetal Health Research Centre, Institute of Human Development, University of Manchester, United Kingdom (M.D., L.R.); St Mary's Hospital, Central Manchester University Hospitals NHS Trust, Manchester Academic Health Science Centre, United Kingdom (M.D., L.R.)
| | - Sevvandi N Senadheera
- From the Translational Obstetrics Group, Department of Obstetrics and Gynaecology, Mercy Hospital for Women, University of Melbourne, Heidelberg, Victoria, Australia (K.O., S.T., S.B., N.B., F.B., R.H., L.T., K.P., T.K.-L., N.J.H.); Department of Clinical Pharmacology, Tokyo University of Pharmacy and Life Sciences, Hachioji, Japan (K.O., T.H.); Research Institute for Microbial Diseases, Osaka University, Japan (M.M., M.I.); School of Biosciences, University of Melbourne, Parkville, Victoria, Australia (S.N.S., L.P.); Maternal and Fetal Health Research Centre, Institute of Human Development, University of Manchester, United Kingdom (M.D., L.R.); St Mary's Hospital, Central Manchester University Hospitals NHS Trust, Manchester Academic Health Science Centre, United Kingdom (M.D., L.R.)
| | - Laura Parry
- From the Translational Obstetrics Group, Department of Obstetrics and Gynaecology, Mercy Hospital for Women, University of Melbourne, Heidelberg, Victoria, Australia (K.O., S.T., S.B., N.B., F.B., R.H., L.T., K.P., T.K.-L., N.J.H.); Department of Clinical Pharmacology, Tokyo University of Pharmacy and Life Sciences, Hachioji, Japan (K.O., T.H.); Research Institute for Microbial Diseases, Osaka University, Japan (M.M., M.I.); School of Biosciences, University of Melbourne, Parkville, Victoria, Australia (S.N.S., L.P.); Maternal and Fetal Health Research Centre, Institute of Human Development, University of Manchester, United Kingdom (M.D., L.R.); St Mary's Hospital, Central Manchester University Hospitals NHS Trust, Manchester Academic Health Science Centre, United Kingdom (M.D., L.R.)
| | - Mark Dilworth
- From the Translational Obstetrics Group, Department of Obstetrics and Gynaecology, Mercy Hospital for Women, University of Melbourne, Heidelberg, Victoria, Australia (K.O., S.T., S.B., N.B., F.B., R.H., L.T., K.P., T.K.-L., N.J.H.); Department of Clinical Pharmacology, Tokyo University of Pharmacy and Life Sciences, Hachioji, Japan (K.O., T.H.); Research Institute for Microbial Diseases, Osaka University, Japan (M.M., M.I.); School of Biosciences, University of Melbourne, Parkville, Victoria, Australia (S.N.S., L.P.); Maternal and Fetal Health Research Centre, Institute of Human Development, University of Manchester, United Kingdom (M.D., L.R.); St Mary's Hospital, Central Manchester University Hospitals NHS Trust, Manchester Academic Health Science Centre, United Kingdom (M.D., L.R.)
| | - Lewis Renshall
- From the Translational Obstetrics Group, Department of Obstetrics and Gynaecology, Mercy Hospital for Women, University of Melbourne, Heidelberg, Victoria, Australia (K.O., S.T., S.B., N.B., F.B., R.H., L.T., K.P., T.K.-L., N.J.H.); Department of Clinical Pharmacology, Tokyo University of Pharmacy and Life Sciences, Hachioji, Japan (K.O., T.H.); Research Institute for Microbial Diseases, Osaka University, Japan (M.M., M.I.); School of Biosciences, University of Melbourne, Parkville, Victoria, Australia (S.N.S., L.P.); Maternal and Fetal Health Research Centre, Institute of Human Development, University of Manchester, United Kingdom (M.D., L.R.); St Mary's Hospital, Central Manchester University Hospitals NHS Trust, Manchester Academic Health Science Centre, United Kingdom (M.D., L.R.)
| | - Fiona Brownfoot
- From the Translational Obstetrics Group, Department of Obstetrics and Gynaecology, Mercy Hospital for Women, University of Melbourne, Heidelberg, Victoria, Australia (K.O., S.T., S.B., N.B., F.B., R.H., L.T., K.P., T.K.-L., N.J.H.); Department of Clinical Pharmacology, Tokyo University of Pharmacy and Life Sciences, Hachioji, Japan (K.O., T.H.); Research Institute for Microbial Diseases, Osaka University, Japan (M.M., M.I.); School of Biosciences, University of Melbourne, Parkville, Victoria, Australia (S.N.S., L.P.); Maternal and Fetal Health Research Centre, Institute of Human Development, University of Manchester, United Kingdom (M.D., L.R.); St Mary's Hospital, Central Manchester University Hospitals NHS Trust, Manchester Academic Health Science Centre, United Kingdom (M.D., L.R.)
| | - Roxanne Hastie
- From the Translational Obstetrics Group, Department of Obstetrics and Gynaecology, Mercy Hospital for Women, University of Melbourne, Heidelberg, Victoria, Australia (K.O., S.T., S.B., N.B., F.B., R.H., L.T., K.P., T.K.-L., N.J.H.); Department of Clinical Pharmacology, Tokyo University of Pharmacy and Life Sciences, Hachioji, Japan (K.O., T.H.); Research Institute for Microbial Diseases, Osaka University, Japan (M.M., M.I.); School of Biosciences, University of Melbourne, Parkville, Victoria, Australia (S.N.S., L.P.); Maternal and Fetal Health Research Centre, Institute of Human Development, University of Manchester, United Kingdom (M.D., L.R.); St Mary's Hospital, Central Manchester University Hospitals NHS Trust, Manchester Academic Health Science Centre, United Kingdom (M.D., L.R.)
| | - Laura Tuohey
- From the Translational Obstetrics Group, Department of Obstetrics and Gynaecology, Mercy Hospital for Women, University of Melbourne, Heidelberg, Victoria, Australia (K.O., S.T., S.B., N.B., F.B., R.H., L.T., K.P., T.K.-L., N.J.H.); Department of Clinical Pharmacology, Tokyo University of Pharmacy and Life Sciences, Hachioji, Japan (K.O., T.H.); Research Institute for Microbial Diseases, Osaka University, Japan (M.M., M.I.); School of Biosciences, University of Melbourne, Parkville, Victoria, Australia (S.N.S., L.P.); Maternal and Fetal Health Research Centre, Institute of Human Development, University of Manchester, United Kingdom (M.D., L.R.); St Mary's Hospital, Central Manchester University Hospitals NHS Trust, Manchester Academic Health Science Centre, United Kingdom (M.D., L.R.)
| | - Kirsten Palmer
- From the Translational Obstetrics Group, Department of Obstetrics and Gynaecology, Mercy Hospital for Women, University of Melbourne, Heidelberg, Victoria, Australia (K.O., S.T., S.B., N.B., F.B., R.H., L.T., K.P., T.K.-L., N.J.H.); Department of Clinical Pharmacology, Tokyo University of Pharmacy and Life Sciences, Hachioji, Japan (K.O., T.H.); Research Institute for Microbial Diseases, Osaka University, Japan (M.M., M.I.); School of Biosciences, University of Melbourne, Parkville, Victoria, Australia (S.N.S., L.P.); Maternal and Fetal Health Research Centre, Institute of Human Development, University of Manchester, United Kingdom (M.D., L.R.); St Mary's Hospital, Central Manchester University Hospitals NHS Trust, Manchester Academic Health Science Centre, United Kingdom (M.D., L.R.)
| | - Toshihiko Hirano
- From the Translational Obstetrics Group, Department of Obstetrics and Gynaecology, Mercy Hospital for Women, University of Melbourne, Heidelberg, Victoria, Australia (K.O., S.T., S.B., N.B., F.B., R.H., L.T., K.P., T.K.-L., N.J.H.); Department of Clinical Pharmacology, Tokyo University of Pharmacy and Life Sciences, Hachioji, Japan (K.O., T.H.); Research Institute for Microbial Diseases, Osaka University, Japan (M.M., M.I.); School of Biosciences, University of Melbourne, Parkville, Victoria, Australia (S.N.S., L.P.); Maternal and Fetal Health Research Centre, Institute of Human Development, University of Manchester, United Kingdom (M.D., L.R.); St Mary's Hospital, Central Manchester University Hospitals NHS Trust, Manchester Academic Health Science Centre, United Kingdom (M.D., L.R.)
| | - Masahito Ikawa
- From the Translational Obstetrics Group, Department of Obstetrics and Gynaecology, Mercy Hospital for Women, University of Melbourne, Heidelberg, Victoria, Australia (K.O., S.T., S.B., N.B., F.B., R.H., L.T., K.P., T.K.-L., N.J.H.); Department of Clinical Pharmacology, Tokyo University of Pharmacy and Life Sciences, Hachioji, Japan (K.O., T.H.); Research Institute for Microbial Diseases, Osaka University, Japan (M.M., M.I.); School of Biosciences, University of Melbourne, Parkville, Victoria, Australia (S.N.S., L.P.); Maternal and Fetal Health Research Centre, Institute of Human Development, University of Manchester, United Kingdom (M.D., L.R.); St Mary's Hospital, Central Manchester University Hospitals NHS Trust, Manchester Academic Health Science Centre, United Kingdom (M.D., L.R.)
| | - Tu'uhevaha Kaitu'u-Lino
- From the Translational Obstetrics Group, Department of Obstetrics and Gynaecology, Mercy Hospital for Women, University of Melbourne, Heidelberg, Victoria, Australia (K.O., S.T., S.B., N.B., F.B., R.H., L.T., K.P., T.K.-L., N.J.H.); Department of Clinical Pharmacology, Tokyo University of Pharmacy and Life Sciences, Hachioji, Japan (K.O., T.H.); Research Institute for Microbial Diseases, Osaka University, Japan (M.M., M.I.); School of Biosciences, University of Melbourne, Parkville, Victoria, Australia (S.N.S., L.P.); Maternal and Fetal Health Research Centre, Institute of Human Development, University of Manchester, United Kingdom (M.D., L.R.); St Mary's Hospital, Central Manchester University Hospitals NHS Trust, Manchester Academic Health Science Centre, United Kingdom (M.D., L.R.)
| | - Natalie J Hannan
- From the Translational Obstetrics Group, Department of Obstetrics and Gynaecology, Mercy Hospital for Women, University of Melbourne, Heidelberg, Victoria, Australia (K.O., S.T., S.B., N.B., F.B., R.H., L.T., K.P., T.K.-L., N.J.H.); Department of Clinical Pharmacology, Tokyo University of Pharmacy and Life Sciences, Hachioji, Japan (K.O., T.H.); Research Institute for Microbial Diseases, Osaka University, Japan (M.M., M.I.); School of Biosciences, University of Melbourne, Parkville, Victoria, Australia (S.N.S., L.P.); Maternal and Fetal Health Research Centre, Institute of Human Development, University of Manchester, United Kingdom (M.D., L.R.); St Mary's Hospital, Central Manchester University Hospitals NHS Trust, Manchester Academic Health Science Centre, United Kingdom (M.D., L.R.)
| |
Collapse
|
45
|
Campbell K, Rowe H, Azzam H, Lane CA. Prise en charge des nausées et vomissements de la grossesse. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2016; 38:1138-1149. [DOI: 10.1016/j.jogc.2016.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
46
|
Huerta-Iga F, Bielsa-Fernández MV, Remes-Troche JM, Valdovinos-Díaz MA, Tamayo-de la Cuesta JL. Diagnosis and treatment of gastroesophageal reflux disease: recommendations of the Asociación Mexicana de Gastroenterología. REVISTA DE GASTROENTEROLOGIA DE MEXICO 2016; 81:208-222. [PMID: 27595382 DOI: 10.1016/j.rgmx.2016.04.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Revised: 04/20/2016] [Accepted: 04/22/2016] [Indexed: 12/12/2022]
Abstract
Emerging concepts in the pathophysiology of gastroesophageal reflux disease (GERD) and the constant technologic advances in the diagnosis and treatment of this clinical condition make it necessary to frequently review and update the clinical guidelines, recommendations, and official statements from the leading academic groups worldwide. The Asociación Mexicana de Gastroenterología (AMG), aware of this responsibility, brought together national experts in this field to analyze the most recent scientific evidence and formulate a series of practical recommendations to guide and facilitate the diagnostic process and efficacious treatment of these patients. The document includes algorithms, figures, and tables for convenient consultation, along with opinions on GERD management in sensitive populations, such as pregnant women and older adults.
Collapse
Affiliation(s)
- F Huerta-Iga
- Hospital Ángeles Torreón, Torreón, Coahuila, México.
| | - M V Bielsa-Fernández
- Servicio de Gastroenterología, Universidad Autónoma de Guadalajara, Guadalajara, Jalisco, México
| | | | - M A Valdovinos-Díaz
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
| | | |
Collapse
|
47
|
Diagnosis and treatment of gastroesophageal reflux disease: recommendations of the Asociación Mexicana de Gastroenterología. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO (ENGLISH EDITION) 2016. [DOI: 10.1016/j.rgmxen.2016.09.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
|
48
|
Abstract
There are currently limited data on the management of eosinophilic esophagitis (EoE) during pregnancy. At our center, however, we have followed several pregnant women with EoE and others have asked pertinent questions in pre-pregnancy counseling. The relatively young age of patients with EoE implies that many practitioners will also encounter patients with these questions. In this review, we use four cases to prompt a discussion about concerns focused on the safety of steroids and diet therapy during pregnancy and breast-feeding, potential nutritional risks with dietary elimination, how to optimize therapy, and whether endoscopic evaluation for monitoring of disease activity is safe during pregnancy and breast-feeding. An additional concern is whether the disease could progress during pregnancy and breast-feeding if no therapies are used. Although there are no studies specifically examining pregnant EoE patients, we have reviewed the literature relevant to this population as informed by the treatment of inflammatory bowel disease patients during pregnancy, where these issues have been studied in more depth. Providers who care for EoE patients who could become pregnant should familiarize themselves with these issues.
Collapse
|
49
|
Panchaud A, Di Paolo ER, Koutsokera A, Winterfeld U, Weisskopf E, Baud D, Sauty A, Csajka C. Safety of Drugs during Pregnancy and Breastfeeding in Cystic Fibrosis Patients. Respiration 2016; 91:333-48. [PMID: 26942733 DOI: 10.1159/000444088] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 01/13/2016] [Indexed: 11/19/2022] Open
Abstract
Health management of cystic fibrosis (CF) patients should be maximized during pregnancy and breastfeeding because of its significant impact on the maternal and newborn outcomes. Thus, numerous drugs will have to be continued during pregnancy and lactation. Most of the drugs representing CF treatment lines cross the placenta or are excreted into human milk. Research addressing the risks and benefits of drugs used in CF patients during pregnancy and lactation is often incomplete or challenged by limited methodology, which often leads to conflicting or inconclusive results. Yet, potential treatment benefits for CF pregnant patients most often outbalance potential risks for the unborn child.
Collapse
Affiliation(s)
- Alice Panchaud
- School of Pharmaceutical Sciences, University of Geneva and University of Lausanne, Geneva, Switzerland
| | | | | | | | | | | | | | | |
Collapse
|
50
|
Cea Soriano L, Hernández-Díaz S, Johansson S, Nagy P, García-Rodríguez LA. Exposure to acid-suppressing drugs during pregnancy and the risk of asthma in childhood: an observational cohort study. Aliment Pharmacol Ther 2016; 43:427-37. [PMID: 26612701 DOI: 10.1111/apt.13486] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 09/21/2015] [Accepted: 11/04/2015] [Indexed: 12/23/2022]
Abstract
BACKGROUND Some research has suggested a potential link between prenatal exposure to proton pump inhibitors (PPIs) or H2 -receptor antagonists (H2 RAs) and the development of childhood asthma. AIM To quantify the relative risk of asthma in children who experienced pre-natal exposure to PPIs and/or H2 RAs, adjusting for potential confounders. METHODS In this observational cohort study (NCT01787435), women aged 18-45 years with completed pregnancies between January 1996 and December 2010 were identified from The Health Improvement Network in the United Kingdom, and were linked to infants. Hazard ratios (HRs) were estimated using Cox proportional hazard models. RESULTS Our analysis identified 2371 prenatally exposed and 7745 unexposed infants. The incidence of asthma (per 1000 person-years) was 19.52 in the unexposed cohort, 23.88 in the PPI cohort and 32.16 in the H2 RA cohort. After adjusting for maternal healthcare utilisation during the year before pregnancy, the HR for asthma in infants whose mothers received prescriptions at any time during pregnancy was 1.12 (95% confidence interval: 0.88-1.44) for PPIs and 1.43 (1.20-1.70) for H2 RAs, when compared with unexposed infants. With further adjustment for maternal comorbidities and other medications, the HR for asthma was 1.03 (0.76-1.40) for PPIs and 1.32 (1.05-1.64) for H2 RAs. CONCLUSIONS Our analysis showed no association between prenatal exposure to PPIs and asthma in childhood after adjusting for confounders. The association found for H2 RAs may be explained largely by underlying environmental or genetic factors, as suggested by reductions in hazard ratio estimates following adjustment for maternal comorbidities.
Collapse
Affiliation(s)
- L Cea Soriano
- Centro Español de Investigación Farmacoepidemiológica (CEIFE), Madrid, Spain
| | - S Hernández-Díaz
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - S Johansson
- AstraZeneca Gothenburg, Global Medicines Development, Mölndal, Sweden
| | - P Nagy
- AstraZeneca Gothenburg, Global Medicines Development, Mölndal, Sweden
| | | |
Collapse
|