drugs in pregnancy

Antiobiotics in Pregnant Women Lead to Allergies/ Asthma in Children

A study of British children suggests that women who have an infection or take antibiotics during pregnancy are more likely to have a child with an allergy-related condition such as asthma, hay fever or eczema. Researchers at the University of Nottingham evaluated the medical records of nearly 25,000 British children and their mothers. The study found that children exposed to antibiotics in the womb had a higher risk of developing asthma, hay fever and eczema than did children whose mothers did not take the medication during pregnancy. Because a person's immune system develops while he or she is still in the womb, some experts speculate that factors that modify microbial exposure at this time may have a long-term effect on the risk of developing allergic disease.

The importance of prenatal exposures on the development of allergic disease: a birth cohort study using the West Midlands General Practice Database   Am J Respir Crit Care Med 2002 (Sep 15);   166 (6):   827-832

Antidepressent Causes Infant Complications

Expectant mothers who take the antidepressants late in pregnancy may increase their baby's risk of complications.

Perinatal outcome following third trimester exposure to paroxetine   Arch Pediatr Adolesc Med 2002 (Nov);   156 (11):   1129-1132

Reported adverse drug events in infants and children under 2 years of age.

Adverse reactions to drug therapy are a significant cause of death and injury in infants and children under 2 years of age. Drugs administered to the mother in the perinatal period constituted a major route of exposure to adverse drug advents. These results underscore the need for additional drug testing in the youngest pediatric patients and for carefully weighing the risks versus benefits of medication.

Reported adverse drug events in infants and children under 2 years of age   Pediatrics 2002 (Nov);   110 (5):   e53

Birth Defect Risk Unknown for Most New Drugs

NEW YORK (Reuters Health) -   A recent study in OB/Gyn shows: more than nine-tenths of drugs approved since 1980 have not been properly tested to ensure they do not cause birth defects if taken by pregnant women.

According to researchers based at the University of British Columbia in Vancouver, Canada, new drugs must be tested to determine if they cause birth defects in pregnant animals before they are approved by the US Food and Drug Administration ...

However, as W.Y. Lo and Dr. J.M. Friedman show, these follow-up studies have not been performed for the vast majority of new drugs. As such, more than 90% of new drugs are still considered to have an "undetermined" risk of producing birth defects, according to the report in the September issue of the journal Obstetrics & Gynecology.

Many women need to take drugs for a variety of reasons during pregnancy, and not knowing the risks of these drugs can be frustrating, Friedman told Reuters Health.

"My experience is that many members of the general public, both pregnant women and their partners, are surprised and frustrated about how little we really know about the safety of medications in pregnancy," Friedman said. ...

Lo and Friedman base their findings on a review of information on birth defect risk of 468 drugs approved between 1980 and 2000. They found that 91% of these new drugs were designated as carrying an "undetermined" risk of birth defects if taken by pregnant women.

In an interview, Friedman said that the companies that manufacture the drugs often have no financial incentive to conduct further studies on birth defects once the drug is FDA-approved. Proper studies cost money, the researcher noted, and there is usually no regulatory requirement that the companies perform these tests.

Teratogenicity of recently introduced medications in human pregnancy   Obstet Gynecol 2002 (Sep);   100 (3):   465-473

Antibiotics Up the Risk of Preterm Dilevery

Many health-care providers routinely screen pregnant woman for trichomoniasis, because the infection has been linked with preterm delivery. However, a new study in the New England Journal of Medicine reveals that the treatment for trichomoniasis -not the condition itself - may be to blame for the heightened risk of preterm delivery.

The study looked at 617 pregnant women with asymptomatic trichomoniasis. Of this group, 320 were treated with the antibiotic metronidazole and 297 were given placebo. Trichomoniasis resolved in 93.6% of women who were treated with metronidazole, compared with 35.4% of those given placebo. In total, 19.0% of the metronidazole group delivered before 37 weeks of gestation, compared with 10.7% of controls. In other words, those taking the antibiotic were at almost double the risk of preterm delivery, compared with mothers who remained untreated.

Failure of metronidazole to prevent preterm delivery among pregnant women with asymptomatic Trichomonas vaginalis infection   N Engl J Med 2001 (Aug 16);   345 (7):   487-493

NSAID's Linked With Miscarriage

A report in the British Medical Journal reveals yet another danger of non-steroidal anti-inflammatory (NSAID) medication. It seems that pregnant women who take NSAIDs up their risk of miscarriage. The study enrolled 1,462 women in Denmark who had taken prescription NSAID medication during their pregnancies, or during the 30 days prior to conception. In addition, researchers investigated 4,268 women who had miscarriages and 29,750 women who had live births. NSAID use was significantly associated with an increased risk of miscarriage.

Risk of adverse birth outcome and miscarriage in pregnant users of non-steroidal anti-inflammatory drugs: population based observational study and case-control study   Brit Med J 2001 (Feb 3);   322 (7281):   266-270

Maternal Vaccination During Pregnancy

Pediatric News reports that an experimental vaccine is being tested in pregnant women to try to protect the developing fetus from group B streptococcus, which is said to cause sepsis and meningitis in newborns. The primary cause of this type of infection in newborns is amniocentesis, the premature rupture of membranes and the side-effects of epidurals, "Maternal vaccination is a two-for-one prevention strategy," said Dr. Baker, professor of microbiology and immunology at Boston University. The article says that in a preliminary study less than half of the women experienced mild to moderate side effects. They hope to have this licensed for use within 5 years.

NSAIDs Linked with Birth Defects

Along with exposure to cocaine, cigarette smoke and X-rays, exposure to over the counter (OTC) drugs such as aspirin, ibuprofen or decongestants during the first trimester of pregnancy appears to significantly increase the risk of gastroschisis in the developing baby.

A population-based study of gastroschisis: demographic, pregnancy, and lifestyle risk factors   Teratology 1994 (Jul);   50 (1):   44-53

Paxil in pregnancy linked to baby's complications

Using the antidepressant Paxil late in pregnancy seems to be associated with a higher rate of complications in the newborn 12 infants born to 55 women who took the drug late in pregnancy had complications that required prolonged hospitalization. Nine of the babies had respiratory distress, two had hypoglycemia (abnormally low blood sugar) and one had jaundice--a yellowing of the skin due to reduced liver function.

Paxil (paroxetine) is a newer type of antidepressant known as a selective serotonin-reuptake inhibitor (SSRI), and is known to cause a "discontinuation" syndrome in adults--a type of withdrawal--said Gideon Koren, lead study author. There had been case reports of a similar syndrome in infants born to mothers who have taken the drug during pregnancy, so Koren and colleagues at the Motherisk program at the Hospital for Sick Children in Toronto wanted to investigate.

Motherisk counsels physicians and women about the safety of medications during pregnancy, largely based on a huge database of its own safety studies. In this study, Koren, who is director of Motherisk, and colleagues compared outcomes for infants exposed to Paxil during the third trimester of pregnancy, to 27 babies exposed only during the first or second trimester, and to 27 infants whose mothers took other types of medication during pregnancy. Three babies of the women who used Paxil during the first or second trimester or who used other medications ended up having complications.

The higher rate of complications in infants exposed to Paxil late in gestation suggests they may have been experiencing discontinuation syndrome, Koren said.

He advised that physicians and women should discuss the risks and benefits of taking the drug later in pregnancy, and consider other options. Also, he said, for women who continue taking Paxil, their babies should be closely monitored.

"There should be higher awareness and a higher level of vigilance, and better follow-up," he said. "You can't just send them home after one or two days."

Steroids Can Be Dangerous

Researches from the University of Colorado and the Denver Medical Center have recently come to the conclusion that repeated administration of steroids to pregnant women who are at risk of premature birth does not appear to be beneficial. In fact their data revealed that it may actually be harmful to the fetus.

Previous research acknowledged that one dose of steroids given two to seven days prior to anticipated premature birth date cut the risk of lung problems and death in infants. The only problem is that if the child is not born within the anticipated time period, doctors often repeat the steroid shots weekly.

The researches concluded that this practice is dangerous and should be stopped after monitoring over 500 women at risk. According to a report published in JAMA, researches found that babies whose mothers had the weekly shots were more likely to develop bleeding in the brain.