Too often when it comes to medical care or inclusion in clinical research, pregnant women are treated differently and in effect penalized for being pregnant. Long ago, as a medical student, I learned that an absolute indication for cholecystectomy was gallstone pancreatitis. Yet, over the years (and recently), I have cared for pregnant patients with gallstone pancreatitis, some of them quite ill and some with recurrent disease, whom consulting surgeons declined to operate on specifically because of their pregnancy. Diagnostic imaging is sometimes foregone or modified unnecessarily because of pregnancy, and optimal medical therapies for various disorders, for example, autoimmune diseases, are not used out of theoretical concerns for fetal harm. The coronavirus disease 2019 (COVID-19) vaccine trials are but the most recent examples of why it is almost always a bad idea to make pregnancy an exclusion criterion in clinical trials of relevance to pregnant women. The upshot of that exclusion is that pregnant women who elect to receive COVID-19 vaccines do so without the knowledge they deserve to make an informed decision. In perhaps another example of pregnancy penalizing, in this month's issue of the journal (see page 855), Forbes et al 1 raise the possibility that, at least in the emergency department, pregnant women (and to a much smaller degree, nonpregnant, reproductive aged women) may be less likely to receive naloxone than reproductive-aged men when it is indicated for opioid-related overdose. Though multiple factors other than pregnancy might account for this differential treatment, their study makes one wonder whether opioid overdose therapy is another medical realm where the insidious problem of inappropriate pregnancy-modified care is operative.
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