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.