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Spencer RN, Hecher K, Norman G, Marsal K, Deprest J, Flake A, Figueras F, Lees C, Thornton S, Beach K, Powell M, Crispi F, Diemert A, Marlow N, Peebles DM, Westgren M, Gardiner H, Gratacos E, Brodszki J, Batista A, Turier H, Patel M, Power B, Power J, Yaz G, David AL. Development of standard definitions and grading for Maternal and Fetal Adverse Event Terminology. Prenat Diagn 2021; 42:15-26. [PMID: 34550624 DOI: 10.1002/pd.6047] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 09/06/2021] [Accepted: 09/11/2021] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Adverse event (AE) monitoring is central to assessing therapeutic safety. The lack of a comprehensive framework to define and grade maternal and fetal AEs in pregnancy trials severely limits understanding risks in pregnant women. We created AE terminology to improve safety monitoring for developing pregnancy drugs, devices and interventions. METHOD Existing severity grading for pregnant AEs and definitions/indicators of 'severe' and 'life-threatening' conditions relevant to maternal and fetal clinical trials were identified through a literature search. An international multidisciplinary group identified and filled gaps in definitions and severity grading using Medical Dictionary for Regulatory Activities (MedDRA) terms and severity grading criteria based on Common Terminology Criteria for Adverse Event (CTCAE) generic structure. The draft criteria underwent two rounds of a modified Delphi process with international fetal therapy, obstetric, neonatal, industry experts, patients and patient representatives. RESULTS Fetal AEs were defined as being diagnosable in utero with potential to harm the fetus, and were integrated into MedDRA. AE severity was graded independently for the pregnant woman and her fetus. Maternal (n = 12) and fetal (n = 19) AE definitions and severity grading criteria were developed and ratified by consensus. CONCLUSIONS This Maternal and Fetal AE Terminology version 1.0 allows systematic consistent AE assessment in pregnancy trials to improve safety.
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Affiliation(s)
- Rebecca N Spencer
- School of Medicine, University of Leeds, Leeds, UK.,Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
| | - Kurt Hecher
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gill Norman
- Division of Nursing, Midwifery & Social Work, Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, Manchester, UK.,Antenatal Results and Choices Charity, UK
| | | | - Jan Deprest
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK.,Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Alan Flake
- Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Francesc Figueras
- Institut D'Investigacions Biomèdiques August Pi ì Sunyer, Barcelona, Spain.,BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Ciínic and Hospital Sant Joan de Deu), University of Barcelona, Spain
| | - Christoph Lees
- Queen Charlottes and Chelsea Hospital, Imperial College London, London, UK
| | | | - Kathleen Beach
- Global Health Unit, GlaxoSmithKline, Research Triangle Park, North Carolina, USA
| | - Marcy Powell
- Safety and Medical Governance, GlaxoSmithKline, Research Triangle Park, North Carolina, USA
| | - Fatima Crispi
- Institut D'Investigacions Biomèdiques August Pi ì Sunyer, Barcelona, Spain.,BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Ciínic and Hospital Sant Joan de Deu), University of Barcelona, Spain
| | - Anke Diemert
- Clinic for Obstetrics and Prenatal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Neil Marlow
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
| | - Donald M Peebles
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK.,NIHR UCLH Biomedical Research Centre, London, UK
| | | | - Helena Gardiner
- The Fetal Center, UTHealth McGovern Medical School, Houston, Texas, USA
| | - Eduard Gratacos
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Ciínic and Hospital Sant Joan de Deu), University of Barcelona, Spain.,Center for Biomedical Research on rare Diseases (CIBERER), Institut D'Investigacions Biomèdiques August Pi ì Sunyer, Universitat de Barcelona, Barcelona, Spain
| | | | - Albert Batista
- Institut D'Investigacions Biomèdiques August Pi ì Sunyer, Barcelona, Spain
| | | | - Mehali Patel
- Bliss Charity, London, UK.,Sands Charity, London, UK
| | - Beverley Power
- CDH UK: The Congenital Diaphragmatic Hernia Support Charity, King's Lynn, UK
| | - James Power
- CDH UK: The Congenital Diaphragmatic Hernia Support Charity, King's Lynn, UK
| | - Gillian Yaz
- SHINE: Spina bifida, Hydrocephalus, Information, Networking, Equality Charity, Peterborough, UK
| | - Anna L David
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK.,NIHR UCLH Biomedical Research Centre, London, UK
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