The pregnant women as a drug orphan: a global survey of registered clinical trials of pharmacological interventions in pregnancy

OBJECTIVE

To undertake a survey of the world's clinical trial registries to provide current data on the number, nature, funding source and geographical distribution of pregnancy drug trials (PDT).

DESIGN AND SETTING

Comprehensive analysis of WHO-certified clinical trial registries.

METHODS

Sixteen registries containing 301 538 trials (168 826 active in 2013-2014) were analysed to identify the numbers, location, funding sources, and areas of interest/development of PDTs.

RESULTS

The percentage of PDTs varied from 0 to 7.4% across registries. Overall, just 0.32% (534) of all active registered studies were PDTs. The US registry (Clinicaltrials.gov) was the largest database, but contributed just 14% of all active PDTs. The majority of PDTs focused on anaesthesia/analgesia, preterm birth/tocolysis, labour induction, endocrine and hypertensive disorders. Less than 6% of active PDTs focused on maternal or fetal health as a specific primary outcome, and only 4.4% included a preplanned pharmacokinetic analysis of the trial medications. A third of all active PDTs involved repurposing of existing medicines for applications in pregnancy, whereas only three new investigational drugs had been developed for a pregnancy indication. Seven percent of all active PDTs identified were pharmaceutical industry-funded. Inter-disease comparisons identified a ~50-fold disparity in trial activity between pregnancy and other comparable areas.

CONCLUSIONS

This study demonstrates unequivocally the marked under-representation of medication development, evaluation and safety trials in pregnancy. The likelihood that the current pharmaceutical landscape in pregnancy will improve in the foreseeable future is slim. Advocacy and increased awareness of the issue is necessary to achieve positive change.

TWEETABLE ABSTRACT

Pregnant women are significantly under-represented in global clinical drug trials.

Observations in collinear femtosecond-nanosecond dual-pulse laser-induced breakdown spectroscopy

In the work reported herein, we have combined a short-lived femtosecond laser-induced plasma (LIP) and a longer-lived nanosecond LIP in a collinear pulse configuration to examine the source(s) of atomic emission and signal-to-noise enhancement in dual-pulse laser-induced breakdown spectroscopy (LIBS). Initial studies indicate that the primary source of dual-pulse LIBS enhancement in the collinear configuration may in large part be a matter of pulse focus; focusing on the sample surface, for example, yields atomic emission enhancements whose lifetime correlates reasonably well with the femtosecond LIP emissive lifetime, suggesting that plasma-plasma coupling may play an important role at that pulse focus. At a second "optimal" focal position above the sample surface, alternatively, atomic emission and signal-to-noise enhancements correlate quite well with the nitrogen and oxygen atomic emission reductions previously seen following use of a femtosecond air spark and a nanosecond ablative pulse in the orthogonal dual-pulse configuration, suggesting that pressure or number density reductions due to femtosecond LIP formation in air may be significant at that pulse focus.