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Ayele AA, Islam MS, Cosh S, East L. Community pharmacy professionals' practice in responding to minor symptoms experienced by pregnant women in Ethiopia: results from sequential mixed methods. J Pharm Policy Pract 2022; 15:29. [PMID: 35387691 PMCID: PMC8988357 DOI: 10.1186/s40545-022-00427-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 03/29/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND In countries with limited access to healthcare services, community pharmacists' management of minor symptoms experienced by pregnant women could be beneficial in terms of alleviating the burden of other health professionals and cost of services. However, evidence is limited regarding the practice of community pharmacy professionals in responding to minor pregnancy-related symptoms more generally, particularly in Ethiopia. OBJECTIVE The aim of this study was to evaluate actual and self-reported practice of community pharmacists in the management of minor symptoms during pregnancy in Ethiopia. METHODS A sequential mixed method study using self-reported survey from 238 community pharmacists followed by 66 simulated client visits was conducted from March to July 2020 in six towns of the Amhara regional state in Ethiopia. Independent samples t-test and one-way Analysis of Variance was used to test the mean difference of practice score among subgroups of study participants. RESULTS The self-reported survey showed that most community pharmacist would 'always' gather most symptom-related information particularly about 'duration of symptoms,' 'frequency of symptoms,' and 'gestational age' and provide medication-related information on 'how to use the medication' and 'duration of use.' The highest mean practice scores were observed in relation to information gathering about 'gestational age' and information provision on 'how to use the medication.' In contrast, the lowest mean practice scores were observed in relation to information gathering about 'weight of the woman' and information provision on 'dosage form.' However, the actual practice, as revealed by the simulated client visits, demonstrated that most community pharmacists would rarely gather symptom-related information nor provide medication-related information. In addition, dispensing of non-prescribed medications to pregnant women was also common. The extent of self-reported practice differed among subgroups of study participants. CONCLUSIONS This study highlights extent of practice of community pharmacy professionals during the management of minor symptoms in pregnancy in Ethiopia. Discrepancies of results between self-reported and actual practices of community pharmacy professionals were observed. The inadequate actual practice of symptom-related information gathering and medication-related information provisions needs considerations of implementing interventions to minimize potential harms.
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Affiliation(s)
- Asnakew Achaw Ayele
- School of Health, Faculty of Medicine and Health, University of New England, Armidale, 2351, Australia.
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia.
| | - Md Shahidul Islam
- School of Health, Faculty of Medicine and Health, University of New England, Armidale, 2351, Australia
| | - Suzanne Cosh
- School of Psychology, Faculty of Medicine and Health, University of New England, Armidale, 2351, Australia
| | - Leah East
- School of Health, Faculty of Medicine and Health, University of New England, Armidale, 2351, Australia
- Hunter New England Health, Armidale, 2350, Australia
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Kamath P, Kamath A, Ullal SD. Liver injury associated with drug intake during pregnancy. World J Hepatol 2021; 13:747-762. [PMID: 34367496 PMCID: PMC8326163 DOI: 10.4254/wjh.v13.i7.747] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 04/14/2021] [Accepted: 05/25/2021] [Indexed: 02/06/2023] Open
Abstract
Drug use during pregnancy is not common. Drug-induced liver injury (DILI) is a potential complication that is rare but can adversely affect both the mother and the fetus. Although many drugs can directly cause hepatotoxicity, idiosyncratic liver injury is common in pregnancy. Underreporting of adverse drug reactions, lack of adequate literature regarding drug safety in pregnancy, and the inherent difficulty in diagnosing DILI during pregnancy make the management of this condition challenging. This review attempts to describe the existing literature regarding DILI in pregnancy, which is mainly in the form of case reports; several studies have looked at the safety of antithyroid drugs, antiretroviral drugs, and paracetamol, which have an indication for use in pregnancy; the relevant data from these studies with regard to DILI has been presented. In addition, the review describes the diagnosis of DILI, grading the disease severity, assessment of causality linking the drug to the adverse event, regulatory guidelines for evaluating the potential of drugs to cause liver injury, efforts to ensure better participation of women in clinical trials and studies in pregnant women population in particular, and the challenges involved in generating adequate research evidence. The establishment of DILI registries in various countries is an encouraging development; however, there is a need for promoting active, spontaneous reporting of adverse events during pregnancy to ensure rapid generation of evidence regarding the safety of a drug in pregnant women.
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Affiliation(s)
- Priyanka Kamath
- Department of Pharmacology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India - 575001
| | - Ashwin Kamath
- Department of Pharmacology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India - 575001
| | - Sheetal D Ullal
- Department of Pharmacology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India - 575001
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Mastroianni AC, Franceschini R, Wicks SL, Henry LM. The Pathway Forward: Insights on Factors that Facilitate Research with Pregnant Women. Ethics Hum Res 2021; 42:2-16. [PMID: 32672419 DOI: 10.1002/eahr.500058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The near-routine exclusion of pregnant women from clinical research has resulted in evidence gaps that endanger the health of pregnant women and their future offspring. Although existing literature documents numerous obstacles along the clinical trial pathway that can stymie research involving pregnant women, there is little guidance on how to facilitate such research. This qualitative study aims to fill that void by examining the experiences of individuals involved in conducting, approving, or overseeing research involving pregnant women at one academic institution. The study identifies factors throughout the clinical pathway-from protocol development, to IRB review, and ultimately trial execution-that likely contribute to the successful conduct of research with pregnant women. Attention to those factors, coupled with agreement among stakeholders that research with pregnant women should and can be done ethically and legally, is critical to shifting the narrative from "why we cannot" do such research to "how we can."
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Affiliation(s)
- Anna C Mastroianni
- Professor at the School of Law at the University of Washington and an associate director at the Institute for Public Health Genetics at the University of Washington
| | | | | | - Leslie Meltzer Henry
- Professor of law at the University of Maryland Carey School of Law and a member of the core faculty at the Johns Hopkins Berman Institute of Bioethics
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Koehn LM, Huang Y, Habgood MD, Kysenius K, Crouch PJ, Dziegielewska KM, Saunders NR. Effects of paracetamol (acetaminophen) on gene expression and permeability properties of the rat placenta and fetal brain. F1000Res 2020; 9:573. [PMID: 32934805 PMCID: PMC7477648 DOI: 10.12688/f1000research.24119.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/27/2020] [Indexed: 03/30/2024] Open
Abstract
Background: Paracetamol (acetaminophen) is widely used in pregnancy and generally regarded as "safe" by regulatory authorities. Methods: Clinically relevant doses of paracetamol were administered intraperitoneally to pregnant rats twice daily from embryonic day E15 to 19 (chronic) or as a single dose at E19 (acute). Control samples were from un-treated age-matched animals. At E19, rats were anaesthetised, administered a final paracetamol dose, uteruses were opened and fetuses exposed for sample collection. For RNA sequencing, placentas and fetal brains were removed and flash frozen. Fetal and maternal plasma and cerebrospinal fluid were assayed for ⍺-fetoprotein and interleukin 1β (IL1β). Brains were fixed and examined (immunohistochemistry) for plasma protein distribution. Placental permeability to a small molecule ( 14C-sucrose) was tested by injection into either mother or individual fetuses; fetal and maternal blood was sampled at regular intervals to 90 minutes. Results: RNA sequencing revealed a large number of genes up- or down-regulated in placentas from acutely or chronically treated animals compared to controls. Most notable was down-regulation of three acute phase plasma proteins (⍺-fetoprotein, transferrin, transthyretin) in acute and especially chronic experiments and marked up-regulation of immune-related genes, particularly cytokines, again especially in chronically treated dams. IL1β increased in plasma of most fetuses from treated dams but to variable levels and no IL1β was detectable in plasma of control fetuses or any of the dams. Increased placental permeability appeared to be only from fetus to mother for both 14C-sucrose and ⍺-fetoprotein, but not in the reverse direction. In the fetal brain, gene regulatory changes were less prominent than in the placenta of treated fetuses and did not involve inflammatory-related genes; there was no evidence of increased blood-brain barrier permeability. Conclusion: Results suggest that paracetamol may induce an immune-inflammatory-like response in placenta and more caution should be exercised in use of paracetamol in pregnancy.
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Affiliation(s)
- Liam M. Koehn
- Pharmacology & Therapeutics, University of Melbourne, Parkville, Victoria, 3010, Australia
| | - Yifan Huang
- Pharmacology & Therapeutics, University of Melbourne, Parkville, Victoria, 3010, Australia
| | - Mark D Habgood
- Pharmacology & Therapeutics, University of Melbourne, Parkville, Victoria, 3010, Australia
| | - Kai Kysenius
- Pharmacology & Therapeutics, University of Melbourne, Parkville, Victoria, 3010, Australia
| | - Peter J. Crouch
- Pharmacology & Therapeutics, University of Melbourne, Parkville, Victoria, 3010, Australia
| | | | - Norman R Saunders
- Pharmacology & Therapeutics, University of Melbourne, Parkville, Victoria, 3010, Australia
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5
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Koehn LM, Huang Y, Habgood MD, Kysenius K, Crouch PJ, Dziegielewska KM, Saunders NR. Effects of paracetamol (acetaminophen) on gene expression and permeability properties of the rat placenta and fetal brain. F1000Res 2020; 9:573. [PMID: 32934805 PMCID: PMC7477648 DOI: 10.12688/f1000research.24119.2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/12/2020] [Indexed: 01/10/2023] Open
Abstract
Background: Paracetamol (acetaminophen) is widely used in pregnancy and generally regarded as "safe" by regulatory authorities. Methods: Clinically relevant doses of paracetamol were administered intraperitoneally to pregnant rats twice daily from embryonic day E15 to 19 (chronic) or as a single dose at E19 (acute). Control samples were from un-treated age-matched animals. At E19, rats were anaesthetised, administered a final paracetamol dose, uteruses were opened and fetuses exposed for sample collection. For RNA sequencing, placentas and fetal brains were removed and flash frozen. Fetal and maternal plasma and cerebrospinal fluid were assayed for α-fetoprotein and interleukin 1β (IL1β). Brains were fixed and examined (immunohistochemistry) for plasma protein distribution. Placental permeability to a small molecule ( 14C-sucrose) was tested by injection into either mother or individual fetuses; fetal and maternal blood was sampled at regular intervals to 90 minutes. Results: RNA sequencing revealed a large number of genes up- or down-regulated in placentas from acutely or chronically treated animals compared to controls. Most notable was down-regulation of three acute phase plasma proteins (α-fetoprotein, transferrin, transthyretin) in acute and especially chronic experiments and marked up-regulation of immune-related genes, particularly cytokines, again especially in chronically treated dams. IL1β increased in plasma of most fetuses from treated dams but to variable levels and no IL1β was detectable in plasma of control fetuses or any of the dams. Increased placental permeability appeared to be only from fetus to mother for both 14C-sucrose and α-fetoprotein, but not in the reverse direction. In the fetal brain, gene regulatory changes were less prominent than in the placenta of treated fetuses and did not involve inflammatory-related genes; there was no evidence of increased blood-brain barrier permeability. Conclusion: Results suggest that paracetamol may induce an immune-inflammatory-like response in placenta and more caution should be exercised in use of paracetamol in pregnancy.
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Affiliation(s)
- Liam M. Koehn
- Pharmacology & Therapeutics, University of Melbourne, Parkville, Victoria, 3010, Australia
| | - Yifan Huang
- Pharmacology & Therapeutics, University of Melbourne, Parkville, Victoria, 3010, Australia
| | - Mark D Habgood
- Pharmacology & Therapeutics, University of Melbourne, Parkville, Victoria, 3010, Australia
| | - Kai Kysenius
- Pharmacology & Therapeutics, University of Melbourne, Parkville, Victoria, 3010, Australia
| | - Peter J. Crouch
- Pharmacology & Therapeutics, University of Melbourne, Parkville, Victoria, 3010, Australia
| | | | - Norman R Saunders
- Pharmacology & Therapeutics, University of Melbourne, Parkville, Victoria, 3010, Australia
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Lao TT. Drug-induced liver injury in pregnancy. Best Pract Res Clin Obstet Gynaecol 2020; 68:32-43. [PMID: 32312690 DOI: 10.1016/j.bpobgyn.2020.03.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 02/28/2020] [Accepted: 03/05/2020] [Indexed: 12/14/2022]
Abstract
Drug intake in pregnant women is common, including prescribed and over-the-counter medications, and herbal medicine and supplements. Drug-induced liver injury (DILI) has become the leading cause of acute liver failure in Western countries, and pregnancy is thought to be a risk factor, but only few anecdotal reports concerning pregnant women are found. These involved antihypertensive, antithyroid, antiretroviral, and antituberculosis medications, and antibiotics. Presentation was usually in the first 20 weeks of gestation following a latency of several weeks, because these drugs were usually prescribed before or in early pregnancy due to their fetal safety. The hepatotoxicity is usually of the idiosyncratic form, and most would resolve spontaneously although occasional liver transplantation and maternal death were reported. The scanty reports could have been related to under-reporting and missed diagnosis due to spontaneous resolution in most cases. DILI should remain one of the differential diagnoses in pregnant women with hepatitis.
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Affiliation(s)
- Terence T Lao
- Department of Obstetrics & Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong.
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7
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Abstract
Background: A major concern for clinicians in prescribing medications to pregnant women and neonates is the possibility that drugs might have damaging effects, particularly on long-term brain development. Current understanding of drug permeability at placental and blood-brain barriers during development is poor. In adults, ABC transporters limit many drugs from entering the brain; however, little is known about their function during development. Methods: The transfer of clinically relevant doses of paracetamol (acetaminophen), digoxin and cimetidine into the brain and cerebrospinal fluid (CSF) was estimated using radiolabelled drugs in Sprague Dawley rats at three developmental stages: E19, P4 and adult. Drugs were applied intraperitoneally either acutely or following chronic exposure (for five days). Entry into brain, CSF and transfer across the placenta was measured and compared to three markers (L-glucose, sucrose, glycerol) that cross barriers by "passive diffusion". The expression of ABC transporters in the brain, choroid plexus and placenta was estimated using RT-qPCR. Results: All three drugs entered the developing brain and CSF in higher amounts than the adult brain and CSF. Comparisons with "passive" permeability markers suggested that this might be due to age-related differences in the functional capacity of ABC-efflux mechanisms. In adult animals, chronic treatment reduced digoxin (12% to 5%, p<0.01) and paracetamol (30% to 21%, p<0.05) entry compared to acute treatment, with the decrease in digoxin entry correlating with up-regulation of efflux transporter abcb1a (PGP). In fetal and newborn animals, no gene up-regulation or transfer decreases were observed. Instead, chronic paracetamol treatment resulted in increased transfer into the fetal brain (66% to 104%, p<0.001). Conclusions: These results suggest that the developing brain may be more at risk from acute drug exposure than the adult brain due to reduced efflux capacity and at greater risk from chronic treatment due to a lack of efflux mechanism regulatory capacity.
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Affiliation(s)
- Liam Koehn
- Department of Pharmacology & Therapeutics, University of Melbourne, Parkville, Victoria, 3010, Australia
| | - Mark Habgood
- Department of Pharmacology & Therapeutics, University of Melbourne, Parkville, Victoria, 3010, Australia
| | - Yifan Huang
- Department of Pharmacology & Therapeutics, University of Melbourne, Parkville, Victoria, 3010, Australia
| | - Katarzyna Dziegielewska
- Department of Pharmacology & Therapeutics, University of Melbourne, Parkville, Victoria, 3010, Australia
| | - Norman Saunders
- Department of Pharmacology & Therapeutics, University of Melbourne, Parkville, Victoria, 3010, Australia
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Saunders NR, Dziegielewska KM, Møllgård K, Habgood MD. Recent Developments in Understanding Barrier Mechanisms in the Developing Brain: Drugs and Drug Transporters in Pregnancy, Susceptibility or Protection in the Fetal Brain? Annu Rev Pharmacol Toxicol 2018; 59:487-505. [PMID: 30183506 DOI: 10.1146/annurev-pharmtox-010818-021430] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Efflux mechanisms situated in various brain barrier interfaces control drug entry into the adult brain; this review considers the effectiveness of these protective mechanisms in the embryo, fetus, and newborn brain. The longstanding belief that the blood-brain barrier is absent or immature in the fetus and newborn has led to many misleading statements with potential clinical implications. The immature brain is undoubtedly more vulnerable to damage by drugs and toxins; as is reviewed here, some developmentally regulated normal brain barrier mechanisms probably contribute to this vulnerability. We propose that the functional status of brain barrier efflux mechanisms should be investigated at different stages of brain development to provide a rational basis for the use of drugs in pregnancy and in newborns, especially in those prematurely born, where protection usually provided by the placenta is no longer present.
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Affiliation(s)
- Norman R Saunders
- Department of Pharmacology and Therapeutics, University of Melbourne, Parkville, Victoria 3010, Australia;
| | - Katarzyna M Dziegielewska
- Department of Pharmacology and Therapeutics, University of Melbourne, Parkville, Victoria 3010, Australia;
| | - Kjeld Møllgård
- Department of Cellular and Molecular Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, DK-2200 Copenhagen, Denmark
| | - Mark D Habgood
- Department of Pharmacology and Therapeutics, University of Melbourne, Parkville, Victoria 3010, Australia;
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Li HY, Zhou YC, Zhou XD, Zheng LW. [Pharmacokinetics and drug safety of oral infectious disease during pregnancy]. HUA XI KOU QIANG YI XUE ZA ZHI = HUAXI KOUQIANG YIXUE ZAZHI = WEST CHINA JOURNAL OF STOMATOLOGY 2018; 36:319-324. [PMID: 29984936 PMCID: PMC7030287 DOI: 10.7518/hxkq.2018.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Revised: 12/29/2017] [Indexed: 02/05/2023]
Abstract
Pregnancy is a time of particular vulnerability in terms of physiologic changes resulting in higher risk of oral infectious diseases. There is emerging evidence showing that irrational dental treatment and drug therapy are associated with adverse pregnancy outcomes, including infant malformation or spontaneous abortion. This article reviews the pharmacokinetics of medications in pregnant women and the fetus and introduces a guideline for drug therapy and common dental drugs used during pregnancy.
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Affiliation(s)
- Hong-Yu Li
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Pediatric Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Ya-Chuan Zhou
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Pediatric Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Xue-Dong Zhou
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Pediatric Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Li-Wei Zheng
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Pediatric Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
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Leung HY, Saini B, Ritchie HE. Medications and pregnancy: The role of community pharmacists - A descriptive study. PLoS One 2018; 13:e0195101. [PMID: 29742159 PMCID: PMC5942805 DOI: 10.1371/journal.pone.0195101] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 03/18/2018] [Indexed: 12/31/2022] Open
Abstract
Background Safe use of medications during pregnancy requires a comprehensive understanding of risk-benefit profiles for individual treatments. Pharmacists are supported in this aspect by clinical information agencies (e.g. MotherSafe, a telephone-based teratogen information service) and reference texts. To what extent and for what reasons Australian pharmacists utilise these services/resources are yet unknown. Further, debate on replacement of conventionally defined medication safety in pregnancy categories (A, B1-3, C, D, X) by narratively stated safety evidence may affect pharmacists’ routine practice. This study aimed to gauge pharmacists’ experiences and resource needs in undertaking support roles regarding gestational drug use. Methods Semi-structured interviews (audio-recorded or documented using field notes) were performed with community pharmacists in Australia and transcribed verbatim. Inductive thematic analysis was conducted using the NVivo software (Version 11, QSR International). Results Data saturation was achieved with 24 interviews. Qualitative data yielded 5 emergent themes: barriers to effective counselling, patient trust, risk perception, role definition and practice support needs. Overall, participants relied on pregnancy categories, were risk averse and cautious in offering advice. Currently available data for unclassified and category B therapeutic agents (limited human data) were deemed inadequate. Reluctance to use the proposed narrative system was also expressed. Discussion This study highlights key barriers in the provision of maternal care by pharmacists and the potential tension present if the existing category system is replaced by a narrative one. These need to be addressed through training and development of practice support resources to enhance pharmacists’ skills in evidence-based risk estimation and communication.
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Affiliation(s)
- Hoi Ying Leung
- Faculty of Pharmacy, University of Sydney, Sydney, New South Wales, Australia
| | - Bandana Saini
- Faculty of Pharmacy, University of Sydney, Sydney, New South Wales, Australia
- Woolcock Institute of Medical Research, Sydney, New South Wales, Australia
| | - Helen E. Ritchie
- Discipline of Biomedical Science, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
- * E-mail:
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Golembesky A, Cooney M, Boev R, Schlit AF, Bentz JWG. Safety of cetirizine in pregnancy. J OBSTET GYNAECOL 2018; 38:940-945. [DOI: 10.1080/01443615.2018.1441271] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Ke AB, Greupink R, Abduljalil K. Drug Dosing in Pregnant Women: Challenges and Opportunities in Using Physiologically Based Pharmacokinetic Modeling and Simulations. CPT-PHARMACOMETRICS & SYSTEMS PHARMACOLOGY 2018; 7:103-110. [PMID: 29349870 PMCID: PMC5824116 DOI: 10.1002/psp4.12274] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 12/22/2017] [Accepted: 12/28/2017] [Indexed: 01/04/2023]
Abstract
The unmet medical need of providing evidence‐based pharmacotherapy for pregnant women is recognized by the regulatory bodies. Physiologically based pharmacokinetic (PBPK) modeling offers an attractive platform to quantify anticipated changes in the pharmacokinetics (PKs) of drugs during pregnancy. Recent publications applying a pregnancy PBPK module to the prediction of maternal and fetal exposure of drugs are summarized. Future opportunities to use PBPK models to predict breast milk exposure and assess human fetotoxicity risks are presented.
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Affiliation(s)
- Alice Ban Ke
- Simcyp Limited (a Certara company), Sheffield, UK
| | - Rick Greupink
- Department of Pharmacology and Toxicology, Radboud University Medical Centre, Radboud Institute for Molecular Life Sciences, Nijmegen, The Netherlands
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Saenz C, Cheah PY, van der Graaf R, Henry LM, Mastroianni AC. Ethics, regulation, and beyond: the landscape of research with pregnant women. Reprod Health 2017; 14:173. [PMID: 29297343 PMCID: PMC5751636 DOI: 10.1186/s12978-017-0421-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Scarce research with pregnant women has led to a dearth of evidence to guide medical decisions about safe and effective treatment and preventive interventions for pregnant women and their potential offspring. In this paper, we highlight three aspects of the landscape in which pregnant women are included or, more frequently, excluded from research: international ethics guidance, regional and national regulatory frameworks, and prevailing practices. Our paper suggests that, in some cases, regulatory frameworks can be more restrictive than international ethics guidance, and that even when regulations permit research with pregnant women, practical challenges-as well as the prevailing practices of stakeholders, such as ethics review committees and investigators-may lead to the generalized exclusion of pregnant women from research.
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Affiliation(s)
- Carla Saenz
- Knowledge Management, Bioethics and Research, Pan American Health Organization, Washington, D.C, USA
| | - Phaik Yeong Cheah
- Mahidol Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | | | - Leslie Meltzer Henry
- University of Maryland Carey School of Law, Baltimore, MD USA
- Johns Hopkins Berman Institute of Bioethics, Baltimore, MD USA
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