Guide for Drug Selection During Pregnancy and Lactation: What Pharmacists Need to Know for Current Practice

Establishment of a measurement system to evaluate breast milk transfer of biological agents using dry filter paper: A multi-institutional study

AIMS

Information on breastfeeding and safety of biologics in infants is lacking due to difficulties in case collection. We evaluated methods for determining the concentration of biologics in breast milk using a dry filter method that can simplify the collection, storage and transport of breast milk.

METHODS

To generate dried filter paper (DFP) samples, approximately 30 μL of breast milk was placed onto a Whatman 903 card and punched out. After extraction, the supernatant was measured using an enzyme-linked immunosorbent assay. Three concentrations of each drug were prepared in liquid breast milk (LBM) and DFP samples to determine their stability up to 28 days after storage at 2-8°C or -20°C for LBM and 25 ± 5°C for DFP. LBM and DFP samples were also provided by nursing mothers using biologics during lactation, and drug concentrations in both samples were compared. The agreement between the two measurement methods was confirmed by Bland-Altman analysis.

RESULTS

Breast milk was provided by 12 mothers who used biologics (tocilizumab, abatacept, etanercept, golimumab, sarilumab and belimumab). The coefficients of variation for within-run and between-run precision for the six drugs were within 15% for both LBM and DFP, and accuracy was within 90%-110% of the quality controls. After 28 days, concentrations remained at more than 90%. The difference between the values obtained by each method was within the acceptable range of error (-12.1 to +16.6 ng/mL).

CONCLUSIONS

A method for determining the concentration of biologics using DFP is expected to help improve pharmacotherapy for lactating women.

Considerations for Treating Nonobstetric Diseases in Pregnant Patients in the Emergency Department Setting

OBJECTIVE

To provide nonobstetric practitioners with an overview of key concepts for the pregnant patient and review treatment of 3 common acute nonobstetric diseases encountered in the emergency department setting.

DATA SOURCES

A literature search of PubMed was performed (1997-February 2023) using key search terms related to pregnancy, pain, urinary tract infection (UTI), venous thromboembolism (VTE), and anticoagulants.

STUDY SELECTION AND DATA EXTRACTION

Relevant articles in English and humans were considered.

DATA SYNTHESIS

When caring for a pregnant patient, it is important to utilize appropriate assessments, understand terms used in this population, and recognize how the physiological and pharmacokinetic changes that occur in pregnancy can influence medication use. Pain, UTIs, and VTE are common in this population. Acetaminophen is the most widely used medication for the management of pain during pregnancy and the drug of choice for mild pain in pregnancy not responsive to nonpharmacologic treatment. Pyelonephritis is the most common nonobstetric cause of hospitalization for pregnant patients. Antimicrobial treatment should consider maternal-fetal safety and local resistance patterns. Pregnant and postpartum patients have a 4- to 5-fold increased risk of developing a VTE compared with nonpregnant patients. Low-molecular-weight heparin is the preferred treatment.

RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE

Pregnant patients often seek acute care in the emergency department setting for nonobstetric needs. Pharmacists in this setting should understand appropriate assessment questions and terms used within this population, the basics of physiological and pharmacokinetic changes in pregnancy that can impact treatment, and which resources are best to utilize for drug information of the pregnant patient.

CONCLUSION

Practitioners in the acute care setting commonly encounter pregnant patients seeking care for nonobstetric concerns. This article covers key pregnancy-related information for the nonobstetric practitioner and focuses on the management of acute pain, UTI, and VTE during pregnancy.

Social Determinants of Health in People Living with Psychiatric Disorders: The Role of Pharmacists

Introduction

Social determinants of health (SDOH) affect outcomes of people living with psychiatric disorders, including substance use disorders. As experts in medication optimization, pharmacists play a vital role in identifying and addressing medication-related problems associated with SDOH. However, there is a paucity of literature on how pharmacists can be part of the solution.

Objective

The purpose of this article is to provide a narrative review and commentary on the intersection between SDOH, medication-related outcomes in people living with psychiatric disorders, and the role of pharmacists in addressing them.

Method

The American Association of Psychiatric Pharmacists appointed an expert panel to research the issue, identify barriers, and develop a framework for including pharmacists in addressing medication therapy problems associated with SDOH in people with psychiatric disorders. The panel used Healthy People 2030 as the framework and sought input from public health officials to propose solutions for their commentary.

Results

We identified potential connections between SDOH and their impact on medication use in people with psychiatric disorders. We provide examples of how comprehensive medication management can afford opportunities for pharmacists to mitigate medication-related problems associated with SDOH.

Conclusion

Public health officials should be aware of the vital role that pharmacists play in addressing medication therapy problems associated with SDOH to improve health outcomes and to incorporate them in health promotion programs.

Drivers of Research Outcomes in Developing Countries: The Case of Lebanon

This paper uses a unique dataset from Lebanon, a developing country with unstable political conditions, to explore the drivers of research outcomes. We use the Negative Binomial model to empirically examine the determinants of the total number of publications and single and co-authored articles. The results indicate that males are more likely to publish co-authored papers than females. Moreover, our findings show a quadratic relationship between age and the number of published papers with a peak at the age of 40. After this turning point, the publication rate starts to decrease at an increasing rate. When we run the model by gender, we find that females in large departments tend to publish more co-authored papers. We also find that full professors tend to publish more papers in Q1 and Q2 journals, while associate professors have more papers in Q2 and Q3 journals.

Community pharmacist counseling in early pregnancy-Results from the SafeStart feasibility study

Background

Community pharmacists are available to counsel women in early pregnancy, but no studies have assessed the feasibility of such a service.

Objective

To test the feasibility of a pharmacist consultation in early pregnancy and to inform the design of a definitive trial.

Setting

Six community pharmacies in Norway from Oct. to Dec. 2017.

Method

We evaluated recruitment approaches and an automatic data preprocessing system (ADPS) to enroll, assign participants, and distribute questionnaires. Women (≥18 years) in early pregnancy were eligible for inclusion. Participants were assigned to a pharmacist consultation (intervention group) or standard care (control group). The intervention aimed to address each woman’s concerns and needs regarding medications and ailments in pregnancy, and was documented on a standard form. The women’s acceptability of the intervention was measured by a questionnaire.

Main outcome measures

Appropriate recruitment approaches, workflow of the ADPS, and women’s acceptability of the intervention.

Results

Of the 35 participants recruited, 19 were recruited through Facebook. The ADPS worked well. Treatment of nausea and vomiting (NVP) (10/11) and general information about medications (8/11) were frequently discussed during the consultations (n = 11). The women reported high satisfaction with the consultation. Having the option of telephone and follow-up consultations was important to the women.

Conclusion

It is feasible to provide community pharmacist consultations in early pregnancy. In a definitive study, the consultations should focus on NVP and general medication use and further explore social media as a recruiting tool. Both in-pharmacy and telephone consultations should be offered to deliver the intervention.