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Zou W, Xie S, Liang C, Xie D, Fang J, Ouyang B, Sun L, Wang H. Medication use during pregnancy and birth defects in Hunan province, China, during 2016-2019: A cross-sectional study. Medicine (Baltimore) 2022; 101:e30907. [PMID: 36221426 PMCID: PMC9542665 DOI: 10.1097/md.0000000000030907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Safety of drug use during pregnancy attracts attentions from clinicians, pregnant woman, and even the total society. However, the studies about medication use during pregnancy and the followed birth defects (BDs) are rare in Chinese. To study condition about medication use during pregnancy and the followed BDs in Hunan province of China, here a cross-sectional study was carried out. All women using medication during pregnancy and delivering fetuses with BDs in Hunan province, China, during 2016 to 2019 were employed in this study. The descriptive analysis was carried out with Excel 2010, and the data analyses were performed by using Chi-Squared test in SPSS 16.0. After filtering, a total of 752 cases were included. In these fetuses, the males are more than females (P < .05). The severe BDs, leading to death or uncorrectable lifelong deformity, were observed for 346 times, and the other (minor) BDs were observed for 593 times. The most used drugs, categorized into pregnancy C, D, or X degrees by food and drug administration (FDA) or pharmaceutical manufacturers, mainly included anti-hyperthyroidism drugs, anti-epilepsy drugs, preventing miscarriage drugs, etc. This population-based data highlight the potential high risks for BDs from the aspect of drug use during pregnancy in Hunan province of China, and drugs with more safety, less kinds, and lower doses should be the better choice for pregnant women.
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Affiliation(s)
- Wei Zou
- NHC Key Laboratory of Birth Defects Research, Prevention and Treatment, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, PR China
- *Correspondence: Hua Wang, Hunan Provincial Maternal and Child Health Care Hospital, 53 Xiangchun Road, Changsha, Hunan 410008, PR China (e-mail: )
| | - Shuting Xie
- NHC Key Laboratory of Birth Defects Research, Prevention and Treatment, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, PR China
| | - Changbiao Liang
- NHC Key Laboratory of Birth Defects Research, Prevention and Treatment, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, PR China
| | - Donghua Xie
- NHC Key Laboratory of Birth Defects Research, Prevention and Treatment, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, PR China
| | - Junqun Fang
- NHC Key Laboratory of Birth Defects Research, Prevention and Treatment, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, PR China
| | - Bo Ouyang
- NHC Key Laboratory of Birth Defects Research, Prevention and Treatment, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, PR China
| | - Li Sun
- NHC Key Laboratory of Birth Defects Research, Prevention and Treatment, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, PR China
| | - Hua Wang
- NHC Key Laboratory of Birth Defects Research, Prevention and Treatment, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, PR China
- *Correspondence: Hua Wang, Hunan Provincial Maternal and Child Health Care Hospital, 53 Xiangchun Road, Changsha, Hunan 410008, PR China (e-mail: )
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Blotière PO, Damase-Michel C, Weill A, Maura G. Dispensing of Potentially Harmful Prescription Drugs in 1.8 Million Pregnant Women in France: A Nationwide Study Based on Two Risk Classification Systems. Drug Saf 2021; 44:1323-1339. [PMID: 34613596 PMCID: PMC8626395 DOI: 10.1007/s40264-021-01117-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2021] [Indexed: 12/01/2022]
Abstract
Introduction Nationwide prevalence of potentially harmful drug prescribing during pregnancy is unknown in France, and several risk classification systems (RCS) exist to guide prescribers. Objective The aim of this study was to estimate the nationwide prevalence of potentially harmful drug prescribing during pregnancy in France and to describe maternal characteristics associated with this prescription. Methods This drug utilisation study, conducted on the French health databases (67 million beneficiaries), included all pregnancies beginning in 2016–2017, regardless of pregnancy outcome. Potentially harmful drug prescribing was defined as at least one reimbursement during pregnancy of Swedish RCS category D drugs, Australian RCS category D/X drugs, or contraindicated drugs in France for drugs not listed in these two RCSs. Maternal characteristics associated with potentially harmful drug prescribing were described using a univariate logistic regression analysis. Results Among the 1,844,447 pregnant women identified, the prevalence of potentially harmful drug prescribing was higher according to the Australian RCS (3.9%) than according to the Swedish RCS (2.2%), with good agreement between the two RCSs (Kappa = 0.81 [0.74–0.87]). This prevalence increased to 9.2% and 6.9%, respectively, when considering contraindications in France. Prescribing of teratogenic drugs, including retinoids and valproate, was highest during the first trimester, whereas prescribing of foetotoxic drugs decreased after the first trimester but remained high for nonsteroidal anti-inflammatory drugs (N = 10,021). In women with no chronic diseases, polymedication (five or more drugs) was the strongest maternal characteristic associated with potentially harmful drug prescribing in both RCSs. Conclusions Potentially harmful drug prescribing during pregnancy is not uncommon in France. This study supports the comparative analysis of RCS to assess potentially harmful drug prescribing in claims databases. Supplementary Information The online version contains supplementary material available at 10.1007/s40264-021-01117-4.
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Affiliation(s)
- Pierre-Olivier Blotière
- French National Health Insurance (Caisse Nationale de l'Assurance Maladie/Cnam), 50 avenue du Pr. André Lemierre, 75 986, Paris Cedex 20, France.
| | - Christine Damase-Michel
- Pharmacologie Médicale, Faculté de Médecine, Université de Toulouse UPS, Inserm CERPOP, CHU, Toulouse, France
| | - Alain Weill
- French National Health Insurance (Caisse Nationale de l'Assurance Maladie/Cnam), 50 avenue du Pr. André Lemierre, 75 986, Paris Cedex 20, France
| | - Géric Maura
- French National Health Insurance (Caisse Nationale de l'Assurance Maladie/Cnam), 50 avenue du Pr. André Lemierre, 75 986, Paris Cedex 20, France
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Vélez-Jiménez MK, Chiquete-Anaya E, Orta DSJ, Villarreal-Careaga J, Amaya-Sánchez LE, Collado-Ortiz MÁ, Diaz-García ML, Gudiño-Castelazo M, Hernández-Aguilar J, Juárez-Jiménez H, León-Jiménez C, Loy-Gerala MDC, Marfil-Rivera A, Antonio Martínez-Gurrola M, Martínez-Mayorga AP, Munive-Báez L, Nuñez-Orozo L, Ojeda-Chavarría MH, Partida-Medina LR, Pérez-García JC, Quiñones-Aguilar S, Reyes-Álvarez MT, Rivera-Nava SC, Torres-Oliva B, Vargas-García RD, Vargas-Méndez R, Vega-Boada F, Vega-Gaxiola SB, Villegas-Peña H, Rodriguez-Leyva I. Comprehensive management of adults with chronic migraine: Clinical practice guidelines in Mexico. CEPHALALGIA REPORTS 2021. [DOI: 10.1177/25158163211033969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction: Migraine is a polygenic multifactorial disorder with a neuronal initiation of a cascade of neurochemical processes leading to incapacitating headaches. Headaches are generally unilateral, throbbing, 4–72 h in duration, and associated with nausea, vomiting, photophobia, and sonophobia. Chronic migraine (CM) is the presence of a headache at least 15 days per month for ≥3 months and has a high global impact on health and economy, and therapeutic guidelines are lacking. Methods: Using the Grading of Recommendations, Assessment, Development, and Evaluations system, we conducted a search in MEDLINE and Cochrane to investigate the current evidence and generate recommendations of clinical practice on the identification of risk factors and treatment of CM in adults. Results: We recommend avoiding overmedication of non-steroidal anti-inflammatory drugs (NSAIDs); ergotamine; caffeine; opioids; barbiturates; and initiating individualized prophylactic treatment with topiramate eptinezumab, galcanezumab, erenumab, fremanezumab, or botulinum toxin. We highlight the necessity of managing comorbidities initially. In the acute management, we recommend NSAIDs, triptans, lasmiditan, and gepants alone or with metoclopramide if nausea or vomiting. Non-pharmacological measures include neurostimulation. Conclusions: We have identified the risk factors and treatments available for the management of CM based on a grading system, which facilitates selection for individualized management.
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Affiliation(s)
| | - Erwin Chiquete-Anaya
- Department of Neurology and Psychiatry, National Institute of Medical Science and Nutrition “Salvador Zubirán”, Mexico City, México
| | - Daniel San Juan Orta
- Department of Clinical Research of the National Institute of Neurology and Neurosurgery “Dr. Manuel Velazco Suárez”, Mexico City, Mexico
| | | | - Luis Enrique Amaya-Sánchez
- Department of Neurology, Hospital de Especialidades del Centro Médico Nacional SXXI Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Miguel Ángel Collado-Ortiz
- Staff physician of the hospital and the Neurological Center ABC (The American British Cowdray Hospital IAP, Mexico City, Mexico
| | | | | | - Juan Hernández-Aguilar
- Department of Neurology, Hospital Infantil de México. Federico Gómez, Mexico City, Mexico
| | | | - Carolina León-Jiménez
- Department of Neurology, ISSSTE Regional Hospital, “Dr. Valentin Gomez Farías”, Zapopan, Jalisco, Mexico
| | | | - Alejandro Marfil-Rivera
- Headache and Chronic Pain Clinic, Neurology Service, Hospital Univrsitario Autónoma de Nuevo Leon, Mexico City, Mexico
| | | | - Adriana Patricia Martínez-Mayorga
- Department of Neurology, Central Hospital “Dr. Ignacio Morones Prieto”, Faculty of Medicine, Universidad Autónoma de San Luis Potosi, SLP, Mexico City, Mexico
| | | | - Lilia Nuñez-Orozo
- Department of Neurology, National Medical Center 20 de Noviembre, ISSSTE, Mexico City, Mexico
| | | | - Luis Roberto Partida-Medina
- Department of Neurology, Hospital de Especialidades, Centro Medico Nacional de Occidente, IMSS, Guadalajara, Jalisco, Mexico
| | | | | | | | | | | | | | | | - Felipe Vega-Boada
- Department of Neurology and Psychiatry, National Institute of Medical Science and Nutrition “Salvador Zubirán”, Mexico City, México
| | | | - Hilda Villegas-Peña
- Department of Pediatric Neurology, Clínica de Guadalajara, Guadalajara, Jalisco, Mexico
| | - Ildefonso Rodriguez-Leyva
- Department of Neurology, Central Hospital “Dr. Ignacio Morones Prieto”, Faculty of Medicine, Universidad Autónoma de San Luis Potosi, SLP, Mexico City, Mexico
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Alema NM, Semagn G, Melesse S, Araya EM, Gebremedhin H, Demsie DG, Asgedom SW, Weldekidan E. Patterns and determinants of prescribed drug use among pregnant women in Adigrat general hospital, northern Ethiopia: a cross-sectional study. BMC Pregnancy Childbirth 2020; 20:624. [PMID: 33059613 PMCID: PMC7558672 DOI: 10.1186/s12884-020-03327-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 10/09/2020] [Indexed: 11/18/2022] Open
Abstract
Background A vigilant prescription of drugs during pregnancy can potentially safeguard the growing fetus from the deleterious effect of the drug while attempting to manage the mother’s health problems. There is a paucity of information about the drug utilization pattern in the area of investigation. Hence, this study was implemented to investigate the pattern of drug utilization and its associated factors among pregnant women in Adigrat general hospital, Northern Ethiopia. Methods An institution-based cross-sectional study was conducted among randomly selected 314 pregnant women who attended obstetrics-gynecology and antenatal care units of the hospital. Relevant data were retrieved from the pregnant women’s medical records and registration logbook. The drugs prescribed were categorized based on the United States Food and Drug Administration (US-FDA) fetal harm classification system. Data analysis was done using SPSS version 20 statistical software. Multivariate logistic regression was employed to analyze the association of the explanatory variables with the medication use, and p < 0.05 was declared statistically significant. Results The overall prescribed drug use in this study was found to be 87.7%. A considerable percentage of the study participants (41.4%) were prescribed with supplemental drugs (iron folate being the most prescribed drug) followed by antibiotics (23.4%) and analgesics (9.2%). According to the US-FDA drug’s risk classification, 42.5, 37, 13, and 7% of the drugs prescribed were from categories A, B, C, and D or X respectively. Prescribed drug use was more likely among pregnant women who completed primary [AOR = 5.34, 95% CI (1.53–18.6)] and secondary education [AOR = 4.1, 95% CI (1.16–14)], who had a history of chronic illness [AOR = 7.9, 95% CI (3.14–19.94)] and among multigravida women [AOR = 2.9, 95% CI (1.57 5.45)]. Conclusions The finding of this study revealed that a substantial proportion of pregnant women received drugs with potential harm to the mother and fetus. Reasonably, notifying health practitioners to rely on up-to-date treatment guidelines strictly is highly demanded. Moreover, counseling and educating pregnant women on the safe and appropriate use of medications during pregnancy are crucial to mitigate the burden that the mother and the growing fetus could face.
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Affiliation(s)
- Niguse Meles Alema
- Department of Pharmacy, College of Medicine and Health Sciences, Adigrat University, P.O.Box: 50, Adigrat, Ethiopia.
| | - Getachew Semagn
- Department of Pharmacy, College of Medicine and Health Sciences, Adigrat University, P.O.Box: 50, Adigrat, Ethiopia
| | - Shetey Melesse
- Department of Pharmacy, College of Medicine and Health Sciences, Adigrat University, P.O.Box: 50, Adigrat, Ethiopia
| | - Ephrem Mebrahtu Araya
- Department of Pharmacy, College of Medicine and Health Sciences, Adigrat University, P.O.Box: 50, Adigrat, Ethiopia
| | - Hagazi Gebremedhin
- Department of Pharmacy, College of Medicine and Health Sciences, Adigrat University, P.O.Box: 50, Adigrat, Ethiopia
| | - Desalegn Getnet Demsie
- Department of Pharmacy, College of Medicine and Health Sciences, Adigrat University, P.O.Box: 50, Adigrat, Ethiopia
| | - Solomon Weldegebreal Asgedom
- Department of Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Etasy Weldekidan
- Department of Pharmacy, College of Medicine and Health Sciences, Adigrat University, P.O.Box: 50, Adigrat, Ethiopia
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Parikh SK, Delbono MV, Silberstein SD. Managing migraine in pregnancy and breastfeeding. PROGRESS IN BRAIN RESEARCH 2020; 255:275-309. [PMID: 33008509 DOI: 10.1016/bs.pbr.2020.07.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 04/16/2020] [Accepted: 05/01/2020] [Indexed: 02/08/2023]
Abstract
The disproportionate prevalence of migraine among women in their reproductive years underscores the clinical significance of migraine during pregnancy. This paper discusses how migraine evolves during pregnancy, secondary headache disorders presenting in pregnancy and puerperium, and acute and preventive options for migraine management during pregnancy and lactation. Migraine is influenced by rising estrogen levels during pregnancy and their sharp decline in puerperium. Migraine, and migraine aura, can present for the first time during pregnancy and puerperium. There is also a higher risk for the development of preeclampsia and cerebrovascular headache during these periods. New or refractory headache, hypertension, and abnormal neurological signs are important "red flags" to consider. This paper reviews the diagnostic utility of neuroimaging studies and the risks of each during pregnancy. Untreated migraine can itself lead to preterm delivery, preeclampsia, and low birth weight infants. Behavioral interventions and lifestyle modifications are the cornerstone for migraine treatment during pregnancy. In addition, one should consider the risks and efficacy of each treatment during pregnancy on an individual basis. The protective nature of breastfeeding for migraine is debated, but there is no evidence to suggest breastfeeding worsens migraine. Acute and preventive migraine treatment options are available for nursing mothers. Neuromodulation and neurostimulation devices are additional options for treatment during pregnancy and lactation, while the safety of using calcitonin gene-related peptide receptor antagonists during these times remains to be determined.
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Affiliation(s)
- Simy K Parikh
- Thomas Jefferson University, Philadelphia, PA, United States
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6
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van Tongeren JMZ, Harkes-Idzinga SF, van der Sijs H, Atiqi R, van den Bemt BJF, Draijer LW, Hiel D, Kerremans A, Kremers B, de Leeuw M, Olthoff MV, Pham TKL, Valentijn-Robertz R, Tsoi K, Wichers I, de Wit M, Borgsteede SD. The Development of Practice Recommendations for Drug-Disease Interactions by Literature Review and Expert Opinion. Front Pharmacol 2020; 11:707. [PMID: 32499701 PMCID: PMC7243438 DOI: 10.3389/fphar.2020.00707] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 04/29/2020] [Indexed: 12/12/2022] Open
Abstract
Background Drug-disease interactions negatively affect the benefit/risk ratio of drugs for specific populations. In these conditions drugs should be avoided, adjusted, or accompanied by extra monitoring. The motivation for many drug-disease interactions in the Summary of Product Characteristics (SmPC) is sometimes insufficiently supported by (accessible) evidence. As a consequence the translation of SmPC to clinical practice may lead to non-specific recommendations. For the translation of this information to the real world, it is necessary to evaluate the available knowledge about drug-disease interactions, and to formulate specific recommendations for prescribers and pharmacists. The aim of this paper is to describe a standardized method how to develop practice recommendations for drug-disease interactions by literature review and expert opinion. Methods The development of recommendations for drug-disease interactions will follow a six-step plan involving a multidisciplinary expert panel (1). The scope of the drug-disease interaction will be specified by defining the disease and by describing relevant effects of this drug-disease interaction. Drugs possibly involved in this drug-disease interaction are selected by checking the official product information, literature, and expert opinion (2). Evidence will be collected from the official product information, guidelines, handbooks, and primary literature (3). Study characteristics and outcomes will be evaluated and presented in standardized reports, including preliminary conclusions on the clinical relevance and practice recommendations (4). The multidisciplinary expert panel will discuss the reports and will either adopt or adjust the conclusions (5). Practice recommendations will be integrated in clinical decision support systems and published (6). The results of the evaluated drug-disease interactions will remain up-to-date by screening new risk information, periodic literature review, and (re)assessments initiated by health care providers. Actionable Recommendations The practice recommendations will result in advices for specific DDSI. The content and considerations of these DDSIs will be published and implemented in all Clinical Decision Support Systems in the Netherlands. Discussion The recommendations result in professional guidance in the context of individual patient care. The professional will be supported in the decision making in concerning pharmacotherapy for the treatment of a medical problem, and the clinical risks of the proposed medication in combination with specific diseases.
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Affiliation(s)
| | - S Froukje Harkes-Idzinga
- Medicines Information Centre, Royal Dutch Pharmacists Association (KNMP), The Hague, Netherlands
| | - Heleen van der Sijs
- Department of Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Roya Atiqi
- Department of Internal Medicine, University Medical Center Groningen, Groningen, Netherlands
| | - Bart J F van den Bemt
- Department of Pharmacy, Sint Maartenskliniek, Nijmegen, Netherlands.,Department of Pharmacy, Radboud University Medical Center, Nijmegen, Netherlands
| | | | - Deline Hiel
- Department of Hospital Pharmacy, Alrijne Zorggroep, Leiden, Netherlands
| | | | | | - Marc de Leeuw
- Medicines Information Centre, Royal Dutch Pharmacists Association (KNMP), The Hague, Netherlands
| | - Marleen V Olthoff
- Department of Clinical Decision Support, Health Base Foundation, Houten, Netherlands
| | - T Kim-Loan Pham
- Department of Clinical Decision Support, Health Base Foundation, Houten, Netherlands
| | | | - Kayan Tsoi
- Department of Clinical Decision Support, Health Base Foundation, Houten, Netherlands
| | - Iris Wichers
- Department of Guideline Development and Research, Dutch College of General Practitioners, Utrecht, Netherlands
| | - Maaike de Wit
- Medicines Information Centre, Royal Dutch Pharmacists Association (KNMP), The Hague, Netherlands
| | - Sander D Borgsteede
- Department of Clinical Decision Support, Health Base Foundation, Houten, Netherlands.,Department of Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, Netherlands
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Cendoya X, Quevedo C, Ipiñazar M, Planes FJ. Computational approach for collection and prediction of molecular initiating events in developmental toxicity. Reprod Toxicol 2020; 94:55-64. [PMID: 32344110 DOI: 10.1016/j.reprotox.2020.03.010] [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] [Received: 11/12/2019] [Revised: 03/04/2020] [Accepted: 03/20/2020] [Indexed: 02/06/2023]
Abstract
Developmental toxicity is defined as the occurrence of adverse effects on the developing organism as a result from exposure to a toxic agent. These alterations can have long-term acute effects. Current in vitro models present important limitations and the evaluation of toxicity is not entirely objective. In silico methods have also shown limited success, in part due to complex and varied mechanisms of action that mediate developmental toxicity, which are sometimes poorly understood. In this article, we compiled a dataset of compounds with developmental toxicity categories and annotated mechanisms of action for both toxic and non-toxic compounds (DVTOX). With it, we selected a panel of protein targets that might be part of putative Molecular Initiating Events (MIEs) of Adverse Outcome Pathways of developmental toxicity. The validity of this list of candidate MIEs was studied through the evaluation of new drug-target relationships that include such proteins, but were not part of the original database. Finally, an orthology analysis of this protein panel was conducted to select an appropriate animal model to assess developmental toxicity. We tested our approach using the zebrafish embryo toxicity test, finding positive results.
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Affiliation(s)
- Xabier Cendoya
- TECNUN, University of Navarra, San Sebastian, 20018, Spain
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8
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Donald S, Sharples K, Barson D, Horsburgh S, Parkin L. Prescription medicines with potential for foetal harm: dispensing before and during pregnancy in New Zealand, 2005–2015. Eur J Clin Pharmacol 2020; 76:887-896. [DOI: 10.1007/s00228-020-02868-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 03/26/2020] [Indexed: 01/19/2023]
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Abstract
Approximately 90% of pregnant women use medications while they are pregnant including both over-the-counter (OTC) and prescription medications. Some medications can pose a threat to the pregnant woman and fetus with 10% of all birth defects directly linked to medications taken during pregnancy. Many medications have documented safety for use during pregnancy, but research is limited due to ethical concerns of exposing the fetus to potential risks. Much of the information gleaned about safety in pregnancy is collected from registries, case studies and reports, animal studies, and outcomes management of pregnant women. Common OTC categories of readily accessible medications include antipyretics, analgesics, nonsteroidal anti-inflammatory drugs, nasal topicals, antihistamines, decongestants, expectorants, antacids, antidiarrheal, and topical dermatological medications. We review the safety categories for medications related to pregnancy and provide an overview of OTC medications a pregnant woman may consider for management of common conditions.
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10
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Zhang J, Ung COL, Guan X, Shi L. Safety of medication use during pregnancy in mainland China: based on a national health insurance database in 2015. BMC Pregnancy Childbirth 2019; 19:459. [PMID: 31795963 PMCID: PMC6892234 DOI: 10.1186/s12884-019-2622-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 11/22/2019] [Indexed: 12/15/2022] Open
Abstract
Background Medication safety during pregnancy has drawn global attention, little of which has been reported about the Chinese population. This study aims to describe patterns and risks of medication use among pregnant women in mainland China with reference to the U.S. Food and Drug Administration (FDA) pregnancy risk category. Methods Hospital diagnostic and drug dispensing information of a national representative sample of basic medical insurance (BMI) beneficiaries was obtained from the China Health Insurance Association (CHIRA) database in 2015. Prevalence of use and number of medicines involved in each risk category were calculated. Most commonly used medicines from each risk category were illustrated. Factors associated with the use of category D/X medicines were evaluated through multiple logistic regression. Results Out of 11,373 women who had singleton deliveries in 2015, there were 2896 women with records covering their entire pregnancies, 5377, and 7946 women with records through the 2nd, and the 3rd trimester, respectively. It was found that 11.1% pregnant women used at least one medication and a total of 321 medications had been used during pregnancy. Most pregnant women used medicines which were classified FDA category C (66.2%), followed by category B (57.8%), category A (16.8%), category X (7.5%) and category D (5.0%). The most commonly used medicines from category D and X were anxiolytics and hormonal preparations respectively. Women who were from mid-western area (p = 0.045) or used four or more medications (p < 0.001) were more likely to use category D/X medicines. Conclusions This study revealed that about one in ten pregnant women used at least one medication during pregnancy in China and a significant number of them used FDA Category D or X medicines. The usage patterns identified in the present study indicate that sub-optimal medicine use might exist warranting further evaluation and intervention in future studies. More efforts are needed to uncover the safety concerns about medication use during pregnancy and improve current information system for clinical practice.
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Affiliation(s)
- Jingyuan Zhang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Carolina Oi Lam Ung
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao, China
| | - Xiaodong Guan
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China. .,Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA. .,International Research Center for Medicinal Administration, Peking University, Beijing, China.
| | - Luwen Shi
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China. .,International Research Center for Medicinal Administration, Peking University, Beijing, China.
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11
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Black E, Khor KE, Kennedy D, Chutatape A, Sharma S, Vancaillie T, Demirkol A. Medication Use and Pain Management in Pregnancy: A Critical Review. Pain Pract 2019; 19:875-899. [PMID: 31242344 DOI: 10.1111/papr.12814] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 06/20/2019] [Accepted: 06/21/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Pain during pregnancy is common, and its management is complex. Certain analgesics may increase the risk for adverse fetal and pregnancy outcomes, while poorly managed pain can result in adverse maternal outcomes such as depression and hypertension. Guidelines to assist clinicians in assessing risks and benefits of exposure to analgesics for the mother and unborn infant are lacking, necessitating evidence-based recommendations for managing pain in pregnancy. METHODS A comprehensive literature search was conducted to assess pregnancy safety data for pharmacological and nonpharmacological pain management methods. Relevant clinical trials and observational studies were identified using multiple medical databases, and included studies were evaluated for quality and possible biases. RESULTS Paracetamol and nonsteroidal anti-inflammatory drugs (NSAIDs) are appropriate for mild to moderate pain, but NSAIDs should be avoided in the third trimester due to established risks. Short courses of weaker opioids are generally safe in pregnancy, although neonatal abstinence syndrome must be monitored following third trimester exposure. Limited safety data for pregabalin and gabapentin indicate that these are unlikely to be major teratogens, and tricyclic antidepressants and serotonin-norepinephrine reuptake inhibitors have limited but overall reassuring safety data. Many of the included studies were limited by methodological issues. CONCLUSIONS Findings from this review can guide clinicians in their decision to prescribe analgesics for pregnant women. Treatment should be tailored to the lowest therapeutic dose and shortest possible duration, and management should involve a discussion of risks and benefits and monitoring for response. Further research is required to better understand the safety profile of various analgesics in pregnancy.
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Affiliation(s)
- Eleanor Black
- Drug and Alcohol Services, South Eastern Sydney Local Health District, Sydney, NSW, Australia.,School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Kok Eng Khor
- Pain Management Centre, Prince of Wales Hospital, Randwick, NSW, Australia.,Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Debra Kennedy
- MotherSafe, The Royal Hospital for Women, Randwick, NSW, Australia.,School of Women's and Children's Health, University of New South Wales, Sydney, NSW, Australia
| | - Anuntapon Chutatape
- Department of Pain Medicine, Singapore General Hospital, Singapore, Singapore
| | - Swapnil Sharma
- Pain Management Centre, Prince of Wales Hospital, Randwick, NSW, Australia.,University of New South Wales, Sydney, NSW, Australia
| | - Thierry Vancaillie
- School of Women's and Children's Health, University of New South Wales, Sydney, NSW, Australia.,Women's Health and Research Institute of Australia, Sydney, NSW, Australia
| | - Apo Demirkol
- Drug and Alcohol Services, South Eastern Sydney Local Health District, Sydney, NSW, Australia.,School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia.,Pain Management Centre, Prince of Wales Hospital, Randwick, NSW, Australia
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12
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Abstract
PURPOSE OF REVIEW Migraine is a disabling and prevalent neurological disease, commonly affecting women during their reproductive years. It is crucial for providers to be able to adequately counsel women who are pregnant, planning pregnancy, or nursing, regarding preventive and abortive treatment options for episodic migraine. This review will discuss (1) the expected course of migraine during pregnancy and the post-partum period, (2) recommended preventive therapies for migraine during pregnancy and lactation, and (3) recommended abortive medications for migraine during pregnancy and lactation. RECENT FINDINGS Recent research has indicated safety for triptan use during pregnancy and ibuprofen use during the first trimester of pregnancy. Considerations for use of emerging migraine-preventive treatment, such as non-invasive neurostimulators, are discussed. For clinical decision-making and patient counseling, it is important to understand both the limitations in determining teratogenic effects in humans and the principles affecting medication transmission from mother to breast milk.
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13
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Schnitzer ME, Blais L. Methods for the assessment of selection bias in drug safety during pregnancy studies using electronic medical data. Pharmacol Res Perspect 2018; 6:e00426. [PMID: 30258633 PMCID: PMC6149369 DOI: 10.1002/prp2.426] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 07/23/2018] [Accepted: 07/25/2018] [Indexed: 11/26/2022] Open
Abstract
Electronic health data are routinely used for population drug studies. Due to the ethical dilemma in carrying out experimental drug studies on pregnant women, the effects of medication usage during pregnancy on fetal and maternal outcomes are largely evaluated using this data collection medium. One major limitation in this type of study is the delayed inclusion of pregnancies in the cohort. For example, in the province of Quebec, Canada, a major pregnancy cohort only captured pregnancies after 20 weeks gestation. The purpose of this study was to demonstrate three methods that can be used to assess the extent of selection bias due to the delayed inclusion of pregnancies. We use causal directed acyclic graphs to explain the source of this selection bias. In an example involving a cohort of pregnant asthmatic women reconstructed from the linkage of administrative health databases from the province of Quebec, we use numerical derivations, a simulation study and a sensitivity analysis to investigate the potential for bias and loss of power due to the delayed inclusion. We find that this selection bias can be partially mitigated by controlling for variables related to (spontaneous or therapeutic) abortion and the outcome of interest. The three proposed methods allow for the pre and post hoc ascertainment of the bias. While delayed pregnancy inclusion selection bias (which includes "live birth bias") can produce substantial bias in pregnancy drug studies, all three methods are effective at producing estimates of the size of the bias.
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Affiliation(s)
| | - Lucie Blais
- Faculté de pharmacieUniversité de MontréalMontrealCanada
- Hôpital du Sacré Cœur de MontréalCentre intégré universitaire de santé et de services sociaux du Nord‐de‐l’île‐de‐MontréalMontrealCanada
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14
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Megna M, Villani A, Balato N, Balato A. Letter to the editor submitted in response to “psoriasis in pregnancy: case series and literature review of data concerning exposure during pregnancy to ustekinumab”. J DERMATOL TREAT 2018; 30:309. [DOI: 10.1080/09546634.2018.1508818] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Matteo Megna
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Alessia Villani
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Nicola Balato
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Anna Balato
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
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15
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Noh Y, Yoon D, Song I, Jeong HE, Bae JH, Shin JY. Discrepancies in the Evidence and Recommendation Levels of Pregnancy Information in Prescription Drug Labeling in the United States, United Kingdom, Japan, and Korea. J Womens Health (Larchmt) 2018; 27:1086-1092. [DOI: 10.1089/jwh.2017.6792] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Yunha Noh
- Departments of Pharmacoepidemiology and Pharmacovigilance, School of Pharmacy, Sungkyunkwan University, Suwon, Korea
| | - Dongwon Yoon
- Departments of Pharmacoepidemiology and Pharmacovigilance, School of Pharmacy, Sungkyunkwan University, Suwon, Korea
| | - Inmyung Song
- Departments of Pharmacoepidemiology and Pharmacovigilance, School of Pharmacy, Sungkyunkwan University, Suwon, Korea
| | - Han Eol Jeong
- Departments of Pharmacoepidemiology and Pharmacovigilance, School of Pharmacy, Sungkyunkwan University, Suwon, Korea
| | - Ji Hwan Bae
- Departments of Pharmacoepidemiology and Pharmacovigilance, School of Pharmacy, Sungkyunkwan University, Suwon, Korea
| | - Ju-Young Shin
- Departments of Pharmacoepidemiology and Pharmacovigilance, School of Pharmacy, Sungkyunkwan University, Suwon, Korea
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16
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Galluzzo M, D'Adamio S, Bianchi L, Talamonti M. Psoriasis in pregnancy: case series and literature review of data concerning exposure during pregnancy to ustekinumab. J DERMATOL TREAT 2018; 30:40-44. [PMID: 29676599 DOI: 10.1080/09546634.2018.1468066] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Psoriasis tends to improve for approximately half of patients during pregnancy, but an equal number of patients report no change or worsening during this period, when lots of medications, like biologics, are not indicated. The aim of our study was to review data of patient that had been pregnant during ustekinumab treatment, analyzing data of our data set between September 2010 and February 2018. We found data of three patients that had been pregnant during ustekinumab treatment. All three patients successfully completed the pregnancy without complications. One of the three patients was pregnant even twice during treatment with ustekinumab, with also a successful birth of two perfectly healthy twins. Biologic agents approved for the treatment of moderate-to-severe psoriasis are currently classified as pregnancy category B, even if, particularly for ustekinumab, there are several case reports regarding exposure during pregnancy in humans related to a healthy pregnancy, both for women and children. Although further studies are required to find real indication of biological treatment in pregnant patients, according to our and to the reviewed experience, ustekinumab does not interfere with gestation.
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Affiliation(s)
- Marco Galluzzo
- a Division of Dermatology, Department of "Medicina dei Sistemi" , University of Rome "Tor Vergata" , Rome , Italy
| | - Simone D'Adamio
- a Division of Dermatology, Department of "Medicina dei Sistemi" , University of Rome "Tor Vergata" , Rome , Italy
| | - Luca Bianchi
- a Division of Dermatology, Department of "Medicina dei Sistemi" , University of Rome "Tor Vergata" , Rome , Italy
| | - Marina Talamonti
- a Division of Dermatology, Department of "Medicina dei Sistemi" , University of Rome "Tor Vergata" , Rome , Italy
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17
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van der Zande ISE, van der Graaf R, Oudijk MA, van Delden JJM. A qualitative study on acceptable levels of risk for pregnant women in clinical research. BMC Med Ethics 2017; 18:35. [PMID: 28506267 PMCID: PMC5432995 DOI: 10.1186/s12910-017-0194-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 04/27/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is ambiguity with regard to what counts as an acceptable level of risk in clinical research in pregnant women and there is no input from stakeholders relative to such research risks. The aim of our paper was to explore what stakeholders who are actively involved in the conduct of clinical research in pregnant women deem an acceptable level of risk for pregnant women in clinical research. Accordingly, we used the APOSTEL VI study, a low-risk obstetrical randomised controlled trial, as a case-study. METHODS We conducted a prospective qualitative study using 35 in-depth semi-structured interviews and one focus group. We interviewed healthcare professionals, Research Ethics Committee members (RECs) and regulators who are actively involved in the conduct of clinical research in pregnant women, in addition to pregnant women recruited for the APOSTEL VI case-study in the Netherlands. RESULTS Three themes characterise the way stakeholders view risks in clinical research in pregnant women in general. Additionally, one theme characterises the way healthcare professionals and pregnant women view risks with respect to the case-study specifically. First, ideas on what constitutes an acceptable level of risk in general ranged from a preference for zero risk for the foetus up to minimal risk. Second, the desirability of clinical research in pregnant women in general was questioned altogether. Third, stakeholders proposed to establish an upper limit of risk in potentially beneficial clinical research in pregnant women in order to protect the foetus and the pregnant woman from harm. Fourth and finally, the case-study illustrates that healthcare professionals' individual perception of risk may influence recruitment. CONCLUSIONS Healthcare professionals, RECs, regulators and pregnant women are all risk adverse in practice, possibly explaining the continuing underrepresentation of pregnant women in clinical research. Determining the acceptable levels of risk on a universal level alone is insufficient, because the individual perception of risk also influences behaviour towards pregnant women in clinical research. Therefore, bioethicists and researchers might be interested in changing the perception of risk, which could be achieved by education and awareness about the actual benefits and harms of inclusion and exclusion of pregnant women.
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Affiliation(s)
- Indira S. E. van der Zande
- Julius Center for Health Sciences and Primary Care, Department of Medical Humanities, University Medical Center Utrecht, Utrecht, P.O. box 85500, 3508 GA The Netherlands
| | - Rieke van der Graaf
- Julius Center for Health Sciences and Primary Care, Department of Medical Humanities, University Medical Center Utrecht, Utrecht, P.O. box 85500, 3508 GA The Netherlands
| | - Martijn A. Oudijk
- Academic Medical Center, Department of Obstetrics and Gynaecology, Amsterdam, The Netherlands
| | - Johannes J. M. van Delden
- Julius Center for Health Sciences and Primary Care, Department of Medical Humanities, University Medical Center Utrecht, Utrecht, P.O. box 85500, 3508 GA The Netherlands
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18
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Trønnes JN, Lupattelli A, Nordeng H. Safety profile of medication used during pregnancy: results of a multinational European study. Pharmacoepidemiol Drug Saf 2017; 26:802-811. [PMID: 28449197 PMCID: PMC5518438 DOI: 10.1002/pds.4213] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 02/17/2017] [Accepted: 03/21/2017] [Indexed: 11/06/2022]
Abstract
PURPOSE The present study describes the safety profile of medications used during pregnancy across European countries and examines maternal factors associated with the use of risky medications during pregnancy. METHODS This study is based on a multinational, web-based study conducted in 15 European countries from October 2011 to February 2012. Information about maternal demographics, illnesses, and medication use during pregnancy was collected via an electronic questionnaire. Pregnant women and new mothers with a child less than 1-year-old could participate. The Swedish, Australian, and U.S. risk classification systems were used to evaluate medication safety. Descriptive statistics and generalized estimating equation models were used. RESULTS A total of 587 medications were reported by the study sample (n = 6657). Sixty-nine percent of the women used medications classified as safe, 28% used medications classified as risky, and 3% used medications with no classification available. Both socio-demographic and medical factors were associated with the use of risky medications during pregnancy. Having a chronic disorder was the factor with the strongest association with the use of risky medications during pregnancy (adjusted odds ratio = 3.99, 95% confidence interval 3.54-4.49). CONCLUSIONS The majority of women used medications classified as safe to use during pregnancy. However, a considerable proportion of women still used medications classified as risky. Having a chronic disorder was an important driver for using risky medications. Such use may still be appropriate when considering the woman's underlying condition. Pre-pregnancy counselling is important to ensure safe medication use for both mother and child. © 2017 The Authors. Pharmacoepidemiology & Drug Safety Published by John Wiley & Sons Ltd.
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Affiliation(s)
- Johanne N Trønnes
- PharmacoEpidemiology and Drug Safety Research Group, School of Pharmacy, PharmaTox Strategic Initiative, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway
| | - Angela Lupattelli
- PharmacoEpidemiology and Drug Safety Research Group, School of Pharmacy, PharmaTox Strategic Initiative, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway
| | - Hedvig Nordeng
- PharmacoEpidemiology and Drug Safety Research Group, School of Pharmacy, PharmaTox Strategic Initiative, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway.,Department of Child Health, Norwegian Institute of Public Health, Oslo, Norway
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19
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Abrouk M, Beroukhim K, Nakamura M, Zhu TH, Farahnik B, Singh R, Lee K, Koo J, Bhutani T. Considerations on biologic agents in psoriasis with the new pregnancy lactation labeling rule. Int J Womens Dermatol 2017; 3:S67-S69. [PMID: 28492043 PMCID: PMC5419054 DOI: 10.1016/j.ijwd.2017.02.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 02/02/2016] [Accepted: 02/02/2016] [Indexed: 11/06/2022] Open
Affiliation(s)
- Michael Abrouk
- Irvine School of Medicine, University of California, Irvine, CA
| | - Keroush Beroukhim
- David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA
| | - Mio Nakamura
- Department of Dermatology, Psoriasis, and Skin Treatment Center, University of California, San Francisco, CA
| | - Tian Hao Zhu
- Keck School of Medicine, University of Southern California, Los Angeles, CA
| | | | - Rasnik Singh
- David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA
| | - Kristina Lee
- Department of Dermatology, Psoriasis, and Skin Treatment Center, University of California, San Francisco, CA
| | - John Koo
- Department of Dermatology, Psoriasis, and Skin Treatment Center, University of California, San Francisco, CA
| | - Tina Bhutani
- Department of Dermatology, Psoriasis, and Skin Treatment Center, University of California, San Francisco, CA
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20
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Esin OR, Esin RG, Khairullin IK. Headache in pregnancy. Zh Nevrol Psikhiatr Im S S Korsakova 2017. [DOI: 10.17116/jnevro201711721136-142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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21
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Weersink RA, Bouma M, Burger DM, Drenth JPH, Hunfeld NGM, Kranenborg M, Monster-Simons MH, van Putten SAW, Metselaar HJ, Taxis K, Borgsteede SD. Evaluating the safety and dosing of drugs in patients with liver cirrhosis by literature review and expert opinion. BMJ Open 2016; 6:e012991. [PMID: 27733414 PMCID: PMC5073492 DOI: 10.1136/bmjopen-2016-012991] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Liver cirrhosis can have a major impact on drug pharmacokinetics and pharmacodynamics. Patients with cirrhosis often suffer from potentially preventable adverse drug reactions. Guidelines on safe prescribing for these patients are lacking. The aim of this study is to develop a systematic method for evaluating the safety and optimal dosage of drugs in patients with liver cirrhosis. METHODS AND ANALYSIS For each drug, a six-step evaluation process will be followed. (1) Available evidence on the pharmacokinetics and safety of a drug in patients with liver cirrhosis will be collected from the Summary of Product Characteristics (SmPC) and a systematic literature review will be performed. (2) Data regarding two outcomes, namely pharmacokinetics and safety, will be extracted and presented in a standardised assessment report. (3) A safety classification and dosage suggestion will be proposed for each drug. (4) An expert panel will discuss the validity and clinical relevance of this suggested advice. (5) Advices will be implemented in all relevant Clinical Decision Support Systems in the Netherlands and published on a website for patients and healthcare professionals. (6) The continuity of the advices will be guaranteed by a yearly check of new literature and comments on the advices. This protocol will be applied in the evaluation of a selection of drugs: (A) drugs used to treat (complications of) liver cirrhosis, and (B) drugs frequently prescribed to the general population. ETHICS AND DISSEMINATION Since this study does not directly involve human participants, it does not require ethical clearance. Besides implementation on a website and in clinical decision support systems, we aim to publish the generated advices of one or two drug classes in a peer-reviewed journal and at conference meetings.
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Affiliation(s)
- Rianne A Weersink
- Health Base Foundation, Houten, The Netherlands Department of Pharmacy, Unit of Pharmacotherapy, -Epidemiology & -Economics, University of Groningen, Groningen, The Netherlands
| | - Margriet Bouma
- Department of Guideline Development, Dutch College of General Practice, Utrecht, The Netherlands
| | - David M Burger
- Department of Pharmacy, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Joost P H Drenth
- Department of Gastroenterology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Nicole G M Hunfeld
- Department of Pharmacy and Department of Intensive Care, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Minke Kranenborg
- Centre for Information on Medicines, Royal Dutch Pharmacists Association (KNMP), The Hague, The Netherlands
| | | | | | - Herold J Metselaar
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Katja Taxis
- Department of Pharmacy, Unit of Pharmacotherapy, -Epidemiology & -Economics, University of Groningen, Groningen, The Netherlands
| | - Sander D Borgsteede
- Health Base Foundation, Houten, The Netherlands SIR Institute for Pharmacy Practice and Policy, Leiden, The Netherlands
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22
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Sanaati F, Mohammad-Alizadeh Charandabi S, Farrokh Eslamlo H, Mirghafourvand M, Alizadeh Sharajabad F. The effect of lifestyle-based education to women and their husbands on the anxiety and depression during pregnancy: a randomized controlled trial. J Matern Fetal Neonatal Med 2016; 30:870-876. [DOI: 10.1080/14767058.2016.1190821] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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23
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24
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Abrouk M, Beroukhim K, Nakamura M, Zhu TH, Farahnik B, Singh R, Brodsky M, Lee K, Koo J, Bhutani T. Considerations on biologic agents in psoriasis with the new pregnancy lactation labeling rule. Int J Womens Dermatol 2016; 2:62-64. [PMID: 28492009 PMCID: PMC5412117 DOI: 10.1016/j.ijwd.2016.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 02/02/2016] [Accepted: 02/02/2016] [Indexed: 11/05/2022] Open
Affiliation(s)
- Michael Abrouk
- Irvine School of Medicine, University of California, Irvine, CA
| | - Kourosh Beroukhim
- David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA
| | - Mio Nakamura
- Department of Dermatology, Psoriasis, and Skin Treatment Center, University of California, San Francisco, CA
| | - Tian Hao Zhu
- Keck School of Medicine, University of Southern California, Los Angeles, CA
| | | | - Rasnik Singh
- David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA
| | - Merrick Brodsky
- Irvine School of Medicine, University of California, Irvine, CA
| | - Kristina Lee
- Department of Dermatology, Psoriasis, and Skin Treatment Center, University of California, San Francisco, CA
| | - John Koo
- Department of Dermatology, Psoriasis, and Skin Treatment Center, University of California, San Francisco, CA
| | - Tina Bhutani
- Department of Dermatology, Psoriasis, and Skin Treatment Center, University of California, San Francisco, CA
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25
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Blattner CM, Danesh M, Safaee M, Murase JE. Understanding the new FDA pregnancy and lactation labeling rules. Int J Womens Dermatol 2016; 2:5-7. [PMID: 28491993 PMCID: PMC5412100 DOI: 10.1016/j.ijwd.2015.12.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Revised: 12/21/2015] [Accepted: 12/21/2015] [Indexed: 11/17/2022] Open
Affiliation(s)
| | - Melissa Danesh
- Department of Dermatology, University of California, San Francisco, CA, USA
| | - Maryam Safaee
- Department of Dermatology, University of Utah, Salt Lake City, UT, USA
| | - Jenny E Murase
- Department of Dermatology, University of California, San Francisco, CA, USA
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26
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Danesh MJ, Murase JE. The new US Food and Drug Administration pregnancy and lactation labeling rules: Their impact on clinical practice. J Am Acad Dermatol 2015; 73:310-1. [DOI: 10.1016/j.jaad.2015.04.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2015] [Revised: 04/15/2015] [Accepted: 04/16/2015] [Indexed: 10/23/2022]
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27
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Dillon P, O'Brien KK, McDonnell R, Donnelly-Swift E, Galvin R, Roche A, Cronin K, Walsh DR, Schelten R, Smith S, Fahey T. Prevalence of prescribing in pregnancy using the Irish primary care research network: a pilot study. BMC Pregnancy Childbirth 2015; 15:67. [PMID: 25884886 PMCID: PMC4389301 DOI: 10.1186/s12884-015-0489-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 02/24/2015] [Indexed: 11/10/2022] Open
Abstract
Background To establish the prevalence and patterns of prescribing to pregnant women in an Irish primary care setting. Methods We reviewed electronic healthcare records routinely collected in primary care, of pregnant women attending nine Dublin-based General Practices affiliated to the Irish Primary Care Research Network (IPCRN) for antenatal care between January 2007 and October 2013 (n = 2,361 pregnancies). Results Excluding folic acid, 46.8% (n = 1,104) of pregnant women were prescribed at least one medication. Amoxicillin (11.1%, n = 263) and co-amoxiclav (8.0%, n = 190) were the most commonly prescribed medication followed by topical clotrimazole (4.9%, n = 117), salbutamol inhalers (4.1%, n = 96) and paracetamol (4.0%, n = 95). General Medical Services (GMS) patients were more likely to receive a prescription than private patients (OR 2.81; 95%CI (2.28, 3.47)). We applied the US FDA pregnancy-risk categories as a proxy measure of prescribing appropriateness, with FDA Category D and X medications considered inappropriate. FDA Category D drugs were prescribed in 5.9% (n = 140) of pregnancies. FDA Category X drugs were prescribed in 4.9% (n = 116) of pregnancies but after exclusion of oral contraceptives, progestogens, infertility treatments Category X medications were prescribed in 0.6% (n = 13) of pregnancies. After the initial antenatal consultation the prescribing prevalence of FDA Category D medications reduced to 4.7% (n = 110) and Category X to 3.1% (n = 72). Conclusions The overall prevalence of prescribing to pregnant women in our cohort is low compared to studies internationally, however similar levels of prescribing for FDA Category D and X were found. Following the initial antenatal consultation levels of prescribing of the FDA Category D and X medications reduced, however there is potential to further reduce their use in early pregnancy. The IPCRN database has provided valuable information on the current practice of antenatal prescribing within this pilot group of practices however it is limited by the absence of morbidity and pregnancy outcome data.
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Affiliation(s)
- Paul Dillon
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin, 2, Ireland.
| | - Kirsty K O'Brien
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin, 2, Ireland.
| | - Ronan McDonnell
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin, 2, Ireland.
| | - Erica Donnelly-Swift
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin, 2, Ireland.
| | - Rose Galvin
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin, 2, Ireland.
| | - Adam Roche
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin, 2, Ireland.
| | - Kate Cronin
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin, 2, Ireland.
| | - David R Walsh
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin, 2, Ireland.
| | - Rowan Schelten
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin, 2, Ireland.
| | - Susan Smith
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin, 2, Ireland.
| | - Tom Fahey
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin, 2, Ireland.
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28
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Arguello B, Salgado TM, Fernandez-Llimos F. Assessing the information in the Summaries of Product Characteristics for the use of medicines in pregnancy and lactation. Br J Clin Pharmacol 2015; 79:537-44. [PMID: 25224071 PMCID: PMC4345964 DOI: 10.1111/bcp.12515] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 09/10/2014] [Indexed: 01/16/2023] Open
Abstract
AIMS To assess the completeness and applicability of information for the use of medicines in pregnancy and lactation contained in European Summaries of Product Characteristics (SmPCs). METHODS SmPCs available on the EMA website in April 2011 were retrieved, and information on the use of medicines during pregnancy and lactation was analyzed. A form was designed to extract information regarding drug concentrations crossing the placenta, excretion of the drug in milk, the existence of pre-clinical and clinical studies and clinical experience describing the use of the medicine in pregnancy and lactation, medicine effects on human fertility, medicines use in women of child-bearing potential and specific recommendations for use during pregnancy and breastfeeding. SmPCs were classified as containing 'conclusive' or 'ambiguous' information depending on whether (or not) they provided clear instructions regarding medicine use in pregnancy and lactation. RESULTS Of the 534 SmPCs, 89.3% did not mention whether the drug crossed the placenta, 67.6% indicated that there was no clinical experience during pregnancy and in 61.4% it was unknown whether the medicine was excreted in human milk. Recommendations for medicine use during pregnancy and breastfeeding were ambiguous in 57.0% and 16.5% of the SmPCs, respectively, and medicine use was restricted in over 90% SmPCs for both pregnancy and breastfeeding, despite no information supporting these restrictions being reported. The time elapsed since a SmPCs first approval was not associated with an increase in information quality. CONCLUSIONS Important information deficits on the use of medicines during pregnancy and breastfeeding were found in European SmPCs.
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Affiliation(s)
- Blanca Arguello
- Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, University of LisbonLisbon, Portugal
| | - Teresa M Salgado
- Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, University of LisbonLisbon, Portugal
| | - Fernando Fernandez-Llimos
- Research Institute for Medicines (iMed.ULisboa), Department of Social Pharmacy, Faculty of Pharmacy, University of LisbonLisbon, Portugal
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Ekusheva EV, Damulin IV. [Current approaches to treatment of migraine during pregnancy]. Zh Nevrol Psikhiatr Im S S Korsakova 2015; 115:124-132. [PMID: 27030834 DOI: 10.17116/jnevro2015115111124-132] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Migraine is one of the most common complaints in the majority of pregnant women. Migraine without aura is the most frequent cause of headache. Improvement of this disease is reported in 50-80% of patient. However, about one third of pregnant women have severe prolonged attacks with marked concomitant symptoms and maladaptation that necessarily need treatment. Authors consider the issues of differential diagnosis and principles of management of these patients.
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Affiliation(s)
- E V Ekusheva
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - I V Damulin
- Sechenov First Moscow State Medical University, Moscow, Russia
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Zomerdijk IM, Ruiter R, Houweling LMA, Herings RMC, Straus SMJM, Stricker BH. Dispensing of potentially teratogenic drugs before conception and during pregnancy: a population-based study. BJOG 2014; 122:1119-29. [DOI: 10.1111/1471-0528.13128] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2014] [Indexed: 12/16/2022]
Affiliation(s)
- IM Zomerdijk
- Department of Medical Informatics; Erasmus Medical Centre; Rotterdam the Netherlands
- Department of Epidemiology; Erasmus Medical Centre; Rotterdam the Netherlands
- Dutch Medicines Evaluation Board; Utrecht the Netherlands
| | - R Ruiter
- Department of Epidemiology; Erasmus Medical Centre; Rotterdam the Netherlands
| | - LMA Houweling
- PHARMO Institute for Drug Outcomes Research; Utrecht the Netherlands
| | - RMC Herings
- PHARMO Institute for Drug Outcomes Research; Utrecht the Netherlands
| | - SMJM Straus
- Department of Medical Informatics; Erasmus Medical Centre; Rotterdam the Netherlands
| | - BH Stricker
- Department of Epidemiology; Erasmus Medical Centre; Rotterdam the Netherlands
- Drug Safety Unit; Inspectorate of Health Care; The Hague the Netherlands
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Safety of dermatologic medications in pregnancy and lactation. J Am Acad Dermatol 2014; 70:401.e1-14; quiz 415. [DOI: 10.1016/j.jaad.2013.09.010] [Citation(s) in RCA: 129] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Revised: 08/29/2013] [Accepted: 09/04/2013] [Indexed: 12/12/2022]
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Abstract
Acne vulgaris is a common condition in adolescence and also for many women of childbearing age. The management of acne in pregnancy is complicated by the lack of clinical studies and pharmacokinetic data in this patient population and safety concerns regarding retinoid use in pregnancy. Of primary concern to both patients and clinicians is the safety profile of medications used during pregnancy. This review seeks to clarify what management options are available to treat acne during pregnancy and what data are available to guide decision making. Topical treatments are considered the safest option during pregnancy. They have the best safety profile and minimize the levels of systemic absorption, and therefore the least risk of fetal exposure. If these are applied properly with a strong emphasis on adherence, excellent results can be achieved.
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Millsop JW, Heller MM, Murase JE. Safety classification systems used in dermatological medication risk counseling of pregnant and lactating patients: a case for an evidence-based approach. Dermatol Ther 2013; 26:347-53. [DOI: 10.1111/dth.12015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | - Misha M. Heller
- Department of Dermatology; University of California; Davis; Sacramento
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Weng SS, Chen YH, Lin CC, Keller JJ, Wang IT, Lin HC. Physician characteristics and prescription drug use during pregnancy: a population-based study. Ann Epidemiol 2013; 23:54-9. [DOI: 10.1016/j.annepidem.2012.11.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Revised: 10/11/2012] [Accepted: 11/16/2012] [Indexed: 11/25/2022]
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Kersting A. [Peripartum depression and grief after pregnancy loss: special problem areas in obstetrics]. DER NERVENARZT 2012; 83:1434-41. [PMID: 23104603 DOI: 10.1007/s00115-012-3663-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
There is evidence that postpartum depression increases the risk of premature birth and developmental disabilities of the child. Risk factors include a history of depression, prenatal anxiety, lack of social support, intimate partner violence, low socioeconomic status and lack of a relationship. For women in high risk groups antenatal interventions could reveal positive effects to prevent postpartum depression. In the peripartum period routine screening is recommended to detect women at risk of developing depression. Furthermore, prenatal losses during pregnancy, specifically occurring during the first weeks of pregnancy may result in complicated grief disorders. Only very few controlled and randomized intervention studies for the treatment after prenatal loss have been conducted; however, aimed at specific high-risk groups these bereavement interventions demonstrated a high treatment efficacy.
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Affiliation(s)
- A Kersting
- Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Semmelweisstr. 10, 04103 Leipzig, Deutschland.
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Drugs and Birth Defects: a knowledge database providing risk assessments based on national health registers. Eur J Clin Pharmacol 2012; 69:889-99. [PMID: 23011015 DOI: 10.1007/s00228-012-1399-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2012] [Accepted: 07/30/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE To present concept, methods and use of a knowledge database providing assessments of potential fetal risks for all drugs on the Swedish market. METHODS Assessments of fetal risks are made primarily by analyzing prospective epidemiological data from the Swedish Medical Birth Register on drug intake in relation to birth outcome. This is complemented by evaluation of the scientific literature. Following standardized working procedures, a statement is compiled for each substance, which is also classified into one of three categories depending on the estimated risk level. The final documents include drug product names on the market, via linkage to a medicinal products register. The information is free and published on the website www.janusinfo.se . It can also be used as an integrated part of electronic health records. RESULTS The database covers assessments of fetal risks for close to 1,250 medicinal drug substances on the Swedish market. Each year, 96,000 searches are made, which might be compared to the around 100,000 children born in Sweden yearly. Apart from the Swedish Physicians' Desk Reference (Fass), the database is the most commonly used resource among specialists within gynaecology and perinatal medicine for information on drugs during pregnancy. CONCLUSIONS A non-commercial knowledge base with assessments of fetal risk of different drugs is valued by health care professionals and is used extensively in Sweden. Based on analyses of national health registers, the database provides unique information on teratogenic drug risks.
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Bae YSC, Van Voorhees AS, Hsu S, Korman NJ, Lebwohl MG, Young M, Bebo B, Kimball AB. Review of treatment options for psoriasis in pregnant or lactating women: From the Medical Board of the National Psoriasis Foundation. J Am Acad Dermatol 2012; 67:459-77. [DOI: 10.1016/j.jaad.2011.07.039] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2010] [Revised: 07/27/2011] [Accepted: 07/29/2011] [Indexed: 02/08/2023]
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Hancock-Howard RL, Ungar WJ, Marshall D, Einarson A, Koren G. Public preferences for counseling regarding antidepressant use during pregnancy: A discrete choice experiment. ACTA ACUST UNITED AC 2012; 94:532-9. [DOI: 10.1002/bdra.23042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2012] [Revised: 05/07/2012] [Accepted: 05/10/2012] [Indexed: 11/11/2022]
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Long AJ, Chang P. The effect of using the health smart card vs. CPOE reminder system on the prescribing practices of non-obstetric physicians during outpatient visits for pregnant women in Taiwan. Int J Med Inform 2012; 81:605-11. [PMID: 22705085 DOI: 10.1016/j.ijmedinf.2012.04.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2009] [Revised: 04/18/2012] [Accepted: 04/18/2012] [Indexed: 11/16/2022]
Abstract
INTRODUCTION There is an evidence that pregnant women have been prescribed a significant number of improper medications that could lead to potential damage for a developing fetus due to discontinuity of care. The safety of pregnant women raises public concern and there is a need to identify ways to prevent potential adverse events to the pregnant woman. This study used a health smart card with a clinical reminder system to keep continuous records of general outpatient visits of pregnant women to protect them from potential adverse events caused by improper prescription. METHOD The health smart card, issued to all 23 million citizens in Taiwan, was used to work with a Computerized Physician Order Entry (CPOE) implemented at a 700-bed teaching medical center in Taipei to provide the outpatient information of pregnant women. FDA pregnancy risk classification was used to categorize the risk of pregnant women. The log file, combined with the physicians' and patients' profiles, were statistically examined using the Mantel-Haenszel technique to evaluate the impact of system in changing physician's prescription behavior. RESULTS A total of 441 patients ranged in age from 15 to 50 years with 1114 prescriptions involved in FDA pregnancy risk classification C, D, and X during the study period. 144 reminders (13.1%) were accepted by physicians for further assessment and 100 (69.4%) of them were modified. Non-obstetric physicians in non-emergency setting were more intended to accept reminders (27.8%, 4.9 folds than obstetricians). Reminders triggered on patients in second trimester (15.5%) were accepted by all physicians more than third trimester (OR 1.52, p<0.05). CONCLUSION A health smart card armed with CPOE reminder system and well-defined criteria had the potential to decrease harmful medication prescribed to pregnant patients. The results show better conformance for non-obstetric physicians (26%) and when physicians accepted the alerts they are more likely to went back and review their orders (69%). In sum, reminder criteria of FDA pregnancy risk classification C for obstetricians and reminder based on different trimesters is suggested to be refined to improve system acceptability and to decrease improper prescription.
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Affiliation(s)
- An-Jim Long
- Division of Isotope Application, Institute of Nuclear Energy Research, Taiwan, ROC.
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40
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Ruiter R, Teichert M, Straus SMJM, Stricker BHC, Visser LE. Concomitant use of contraceptives and potentially teratogenic medicinal products--results from a study using pharmacy dispensing data in the Netherlands. Reprod Sci 2012; 19:987-94. [PMID: 22527986 DOI: 10.1177/1933719112440050] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The objective of this study was to analyze to what extent potentially teratogenic medicinal products are dispensed concomitantly with contraceptives. Data on dispensed medicinal products in this population-based study were obtained from the Dutch Foundation for Pharmaceutical Statistics. For over 178 potentially teratogenic medicinal products, concomitant use of contraceptives was assessed. The proportion of potentially teratogenic medicinal products dispensed concomitantly with a contraceptive varied significantly from 40.9% (95% CI 40.7-41.2) in 2005 to 43.4% in 2009 (95% CI 44.2-43.7). Significant differences existed as well between age categories with the lowest proportions of concomitant use of contraceptives for any potentially teratogenic drug in women aged 36 through 45 years (35.0%, 95% CI 34.9-35.1) in comparison to those aged 26 through 35 years (47.1%, 95% CI 46.9-47.3) and 15 through 25 years (53.6%, 95% CI 53.4-53.8). Although our data retrieval did not cover the use of nonpharmacological forms of contraception such as condoms and sterilization and as situations may occur during which the use of drugs with (low) teratogenic potential is a balanced decision, our results raise doubts about the safe use of medicinal products with teratogenic potential.
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Affiliation(s)
- Rikje Ruiter
- Department of Epidemiology, Erasmus MC, Rotterdam, the Netherlands
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Daw JR, Mintzes B, Law MR, Hanley GE, Morgan SG. Prescription drug use in pregnancy: a retrospective, population-based study in British Columbia, Canada (2001-2006). Clin Ther 2011; 34:239-249.e2. [PMID: 22169049 DOI: 10.1016/j.clinthera.2011.11.025] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2011] [Indexed: 11/25/2022]
Abstract
BACKGROUND Owing to the paucity of evidence available on the risks and benefits of drug use in pregnancy, the use of prescription medicines is a concern for both pregnant women and their health care providers. OBJECTIVE The aim of this study was to measure the frequency, timing, and type of medicines used before, during, and after pregnancy in a Canadian population. METHODS This retrospective cohort analysis used population-based health care data from all pregnancies ending in live births in hospitals in British Columbia from April 2001 to June 2006 (n = 163,082). Data from hospital records were linked to those in outpatient prescription-drug claims. Data from prescriptions filled from 6 months before pregnancy to 6 months postpartum were analyzed. Drugs were classified by therapeutic category and US Food and Drug Administration (FDA) pregnancy risk categories. RESULTS Prescriptions were filled in 63.5% of pregnancies. Evidence on safety is limited for many of the medicines most frequently filled in pregnancy, including codeine, salbutamol, and betamethasone. At least 1 prescription for a category D or X medicine was filled in 7.8% of pregnancies (5.5% category D; 2.5% category X). The most frequently filled prescriptions for category D drugs were benzodiazepines and antidepressants. The most frequently filled prescriptions for category X drugs were oral contraceptives and ovulation stimulants filled in the first trimester. CONCLUSIONS The majority of pregnant women in British Columbia filled at least 1 prescription, and ~1 in 13 filled a prescription for a drug categorized as D or X by the FDA. The prevalence of maternal prescription drug use emphasizes the need for postmarketing evaluation of the risk-benefit profiles of pharmaceuticals in pregnancy. Future research on prenatal drug use based on administrative databases should examine maternal treatment adherence and the determinants of maternal drug use, considering maternal health status, sociodemographics, and the characteristics and providers of prenatal care.
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Affiliation(s)
- Jamie R Daw
- Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
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Daw JR, Hanley GE, Greyson DL, Morgan SG. Prescription drug use during pregnancy in developed countries: a systematic review. Pharmacoepidemiol Drug Saf 2011; 20:895-902. [PMID: 21774029 DOI: 10.1002/pds.2184] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2011] [Revised: 04/26/2011] [Accepted: 05/08/2011] [Indexed: 12/20/2022]
Abstract
PURPOSE To review the literature describing patterns of outpatient prescription drug use during pregnancy by therapeutic category, potential for fetal harm, and overall. METHODS We conducted a systematic review of peer-reviewed literature published from 1989 to 2010. We included studies evaluating individual-level exposures to prescription medicines during pregnancy. We selected only studies conducted in developed (Organization of Economic Co-operation and Development) countries and published in English. RESULTS Published drug utilization studies reveal wide variation in estimates of overall prescription drug use in pregnancy (27-93% of pregnant women filling at least one prescription excluding vitamins and minerals). Among studies of similar design, estimates were lowest in Northern European countries (44-47%) and highest in France (93%) and Germany (85%). Measured rates of use of contraindicated medicines in pregnancy ranged from 0.9% (Denmark, 1991-1996) to 4.6% (USA, 1996-2000). The use of medicines with positive evidence of risk ranged from 2.0% (Italy, 2004) to 59.3% (France, 1996). CONCLUSION Avoidable inconsistencies in study design and reporting attenuate conclusions that can be drawn from the literature on antenatal drug utilization. Nevertheless, the body of published research shows that antenatal prescription drug use is common, with many studies finding that a majority of women use one or more prescription medicine during pregnancy. Similarly, studies consistently report the use of drugs recognized as having potential risks in pregnancy. Given this widespread use, it is particularly important to develop standards for calculating and reporting antenatal exposures to improve the value of future research in this area.
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Affiliation(s)
- Jamie R Daw
- Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.
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Adherence to oral contraception in women on Category X medications. Am J Med 2010; 123:929-934.e1. [PMID: 20920695 DOI: 10.1016/j.amjmed.2010.05.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2010] [Revised: 05/13/2010] [Accepted: 05/15/2010] [Indexed: 11/23/2022]
Abstract
BACKGROUND Over 6% of women become pregnant when taking teratogenic medications, and contraceptive counseling appears to occur at suboptimal rates. Adherence to contraception is an important component in preventing unwanted pregnancy and has not been evaluated in this population. We undertook a pharmacy claims-based analysis to evaluate the degree to which women of childbearing age who receive Category X medications adhere to their oral contraception. METHODS We evaluated the prescription medication claims for over 6 million women, age 18-44 years, with prescription benefits administered by a pharmacy benefits manager. Women with 2 or more claims for a Category X medication and 2 or more claims for oral contraception were evaluated in further detail. Adherence to oral contraception was measured by analyzing pharmacy claims. Multivariable logistic regression was performed to identify factors associated with adherence. RESULTS There were 146,758 women of childbearing age who received Category X medications, of which 26,136 also took oral contraceptive medication. Women who received Category X medications were prescribed oral contraception (18%) at rates similar to others of childbearing age (17%). Women prescribed both Category X and oral contraception demonstrated adherence similar to the overall population. Age, class of Category X medication, number of medications, prescriber's specialty, and ethnicity correlated with lower adherence rates. CONCLUSIONS Despite added risk associated with unintended pregnancy, many women who receive Category X medications have refill patterns suggesting nonadherence to oral contraception. Compared with all women age 18-44 years, women receiving teratogenic medications do not have better adherence to oral contraception.
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Erdeljić V, Francetić I, Makar-Aušperger K, Likić R, Radačić-Aumiler M. Clinical pharmacology consultation: a better answer to safety issues of drug therapy during pregnancy? Eur J Clin Pharmacol 2010; 66:1037-46. [DOI: 10.1007/s00228-010-0867-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2010] [Accepted: 07/06/2010] [Indexed: 11/25/2022]
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Contag SA, Mertz HL, Bushnell CD. Migraine during pregnancy: is it more than a headache? Nat Rev Neurol 2009; 5:449-56. [DOI: 10.1038/nrneurol.2009.100] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Frost Widnes SK, Schjøtt J. Advice on drug safety in pregnancy: are there differences between commonly used sources of information? Drug Saf 2009; 31:799-806. [PMID: 18707194 DOI: 10.2165/00002018-200831090-00008] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND OBJECTIVE Safety regarding use in pregnancy is not established for many drugs. Inconsistencies between sources providing drug information can give rise to confusion with possible therapeutic consequences. Therefore, it is important to measure clinically important differences between drug information sources. The objective of this study was to compare two easily accessible Norwegian sources providing advice on drug safety in pregnancy - the product monographs in the Felleskatalog (FK), published by the pharmaceutical companies, and the five regional Drug Information Centres (DICs) in Norway - in addition to assessing the frequency of questions regarding drug safety in pregnancy made to the DICs according to the Anatomical Therapeutic Chemical (ATC) classification system. METHODS Advice on drug use in pregnancy provided by the DICs in 2003 and 2005 were compared with advice in the product monographs for the respective drugs in the FK. Comparison of advice was based on categorization to one of four categories: can be used, benefit-risk assessment, should not be used, or no available information. RESULTS A total of 443 drug advice were categorized. Seven out of ten of drugs frequently enquired about, according to the ATC system, were drugs acting on the nervous system (group N). For 208 (47%) of the drugs, advice differed between the DICs and FK. Advice from the FK was significantly (p < 0.01) more restrictive than advice from the DICs. There were no differences in the level of consistency of advice between drugs that were newly introduced and those that had been on the market for a longer time, advice regarding use of drugs in the first trimester and advice regarding use of drugs in the second or third trimester, or between advice provided during 2003 and during 2005. CONCLUSIONS The results of this study show considerable differences between two Norwegian sources providing advice on the use of drugs in pregnancy. Based on the knowledge that healthcare providers choose sources of information in a random manner, our results may be of clinical importance. We believe that the problem with heterogeneous drug information on this subject is not confined to Norway and that our results should be of international interest.
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Affiliation(s)
- Sofia K Frost Widnes
- Regional Drug Information Centre (RELIS Vest), Haukeland University Hospital, Bergen, Norway
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Tuccori M, Testi A, Antonioli L, Fornai M, Montagnani S, Ghisu N, Colucci R, Corona T, Blandizzi C, Tacca MD. Safety concerns associated with the use of serotonin reuptake inhibitors and other serotonergic/noradrenergic antidepressants during pregnancy: A review. Clin Ther 2009; 31 Pt 1:1426-53. [DOI: 10.1016/j.clinthera.2009.07.009] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2009] [Indexed: 11/27/2022]
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Rohra DK, Das N, Azam SI, Solangi NA, Memon Z, Shaikh AM, Khan NH. Drug-prescribing patterns during pregnancy in the tertiary care hospitals of Pakistan: a cross sectional study. BMC Pregnancy Childbirth 2008; 8:24. [PMID: 18627607 PMCID: PMC2491594 DOI: 10.1186/1471-2393-8-24] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2007] [Accepted: 07/15/2008] [Indexed: 11/17/2022] Open
Abstract
Background The rationale for use of drugs during pregnancy requires a careful assessment as in addition to the mother, the health and life of her unborn child is also at stake. Information on the use of drugs during pregnancy is not available in Pakistan. The aim of this study was to evaluate the patterns of drug prescriptions to pregnant women in tertiary care hospitals of Pakistan. Methods This was a cross-sectional study conducted at five tertiary care hospitals of Pakistan. Copies of outpatient medicinal prescriptions given to pregnant patients attending the antenatal clinics were collected. The drugs were classified according to the pharmacological class and their teratogenic potential. Results All the pregnant women attending the antenatal clinics received a prescription containing at least one drug. A total of 3769 distinct prescriptions given to different women were collected. Majority of the women who received the prescriptions belonged to third trimester (55.4%) followed by second (33.6%) and first trimester (11.0%). On an average, each prescription contained 1.66 ± 0.14 drugs. The obstetricians at Civil Hospital, Karachi and Chandka Medical College Hospital, Larkana showed a tendency of prescribing lesser number of drugs compared to those in other hospitals. Anti-anemic drugs including iron preparations and vitamin and mineral supplements (79.4%) were the most frequently prescribed drugs followed by analgesics (6.2%) and anti-bacterials (2.2%). 739 women (19.6%) received prescriptions containing drugs other than vitamin or mineral supplements. Only 1275 (21.6%) of all the prescribed drugs (n = 6100) were outside this vitamin/mineral supplement class. Out of these 1275 drugs, 29 (2.3%) drugs were prescribed which are considered to be teratogenic. Misoprostol was the most frequently prescribed (n = 6) among the teratogenic drugs followed by carbimazole (n = 5) and methotrexate (n = 5). Twenty nine pregnant women (0.8% of all the women studied) were prescribed these teratogenic drugs. Conclusion Less than one percent of the pregnant women attending tertiary care hospitals in Pakistan are prescribed teratogenic drugs. The prescribing practices of Pakistani physicians are similar to those in western countries.
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Affiliation(s)
- Dileep K Rohra
- Department of Biological & Biomedical Sciences, Aga Khan University, Stadium Road, Karachi, Pakistan.
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