Medications in the first trimester of pregnancy: most common exposures and critical gaps in understanding fetal risk

Thorpe, Phoebe; Gilboa, Suzanne M.; Hernández–Dı́az, Sonia; Lind, Jennifer N.; Cragan, Janet D.; Briggs, Gerald G.; Kweder, Sandra L.; Friedman, Jan M.; Mitchell, Allen A.; Honein, Margaret A.

doi:10.1002/pds.3495

Cited by 151 publications

(167 citation statements)

References 11 publications

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“…Similarly, Thorpe et al (2013) found in a case control study that analgesics are largely consumed by pregnant women and acetaminophen was the most used. The use of this medicine during pregnancy is not associated with increased risk of abortion, stillbirth, low weight birth or increased prevalence of congenital anomalies Rebordosa et al, 2009).…”

Section: Discussionmentioning

confidence: 99%

Prevalence of medication use among low risk pregnant women: A drug utilization study

Fontoura¹,

Ayres²,

Martins-Nagai³

et al. 2014

Afr. J. Pharm. Pharmacol.

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This study aimed to characterize the profile of medication consumption by low risk pregnant women and to correlate it with sociodemographic characteristics of this population. A cross-sectional descriptive study was conducted in the Reference Center of Women's Health in the Brazilian municipality of Ribeirão Preto. This study included women which were at least in the 32nd week of the gestation period. Data related to sociodemographic characteristics of the pregnant women and to their pregnancy and medication consumption were collected from June, 2008 to November, 2008. A total of 699 pregnant women were included. About 20% of the pregnant women began prenatal care in the 12th week of gestation and 75.3% had at least six antenatal visits. The use of at least one drug during pregnancy was reported by 98% of the participants. The mean number of medications used was 4.35. According to the Food and Drug Administration (FDA) risk classification, 14.07% of the medication belonged to C category, 1.85% to D and 0.03% to X, and 38.30% were not identified or not classified by the FDA. When correlating the number of prenatal visits with the amount of medication used, it was verified that pregnant women who underwent less than six visits during pregnancy used a higher number of medications. Pregnant women have been exposed to a variety of medications and there is a need to improve the quality of care in order to prevent potential risks to the fetus, especially in relation to the use of medications.

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Section: Discussionmentioning

confidence: 99%

Prevalence of medication use among low risk pregnant women: A drug utilization study

Fontoura¹,

Ayres²,

Martins-Nagai³

et al. 2014

Afr. J. Pharm. Pharmacol.

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“…This is especially true in the first 10-12 weeks of gestation [100,101]. Known teratological agents include, for instance, certain medications or drug of abuse taken by the pregnant woman, exposure to X-rays and elevated temperature, secondary to infectious diseases [102].…”

Section: Fetal Susceptibility To External Insultsmentioning

confidence: 99%

Ultrasound in the First Trimester and Earlier: How to Keep It Safe

Abramowicz

2016

First-Trimester Ultrasound

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1"Ultrasound is safe. Ultrasound is not X-rays. Our machines are FDA-approved." These are the statements most commonly made when initiating a conversation on safety of ultrasound. This is one of the reasons cited for its becoming an essential tool in medicine (together with its relatively low cost and immediate results availability). Diagnostic ultrasound (DUS) has been in use for over half a century in obstetrics and gynecology [1] and the benefits of this technology are multiple [2]. Most pregnant women have 2-3 ultrasound examinations (and many more in certain countries) during their pregnancies. In early pregnancy and before (i.e., in Artificial Reproductive Technologies [(ART]), these include serial scans of the developing follicles during ovulation induction [3] and in the earliest stages of gestation [4], first-trimester ultrasound for viability and/or aneuploidy screening (nuchal translucency, NT) and, more and more, early anatomy survey [5]. Such is the widespread enthusiasm and the generally accepted notion of safety that its use has spilled into the commercial world with mall stores offering non-medical ultrasound or "souvenir" scans. The record of safety of DUS is excellent: there are no epidemiological studies demonstrating harmful effects in human fetuses [6]. Most human epidemiological studies, however, published so far are based on information obtained with pre-1991/1992 machines. Around that time, the US Federal Drug Administration (FDA) allowed the acoustic output of ultrasound machines for fetal use to be increased from 94 to 720 mW/cm 2 , a factor of almost 8 [7,8]. Is there enough evidence to validate the use of ultrasound imaging in general and Doppler in particular in the first trimester [9] and could ultrasound have detrimental effects on the fetus in the first trimester, a time of maximal susceptibility to external factors? If there are clinical indications to perform these scans (and if there were none, there would be no raison-d'être for this book) safety must be guaranteed by educating the end-users on ways to limit the possible hazards of exposure of the follicles/ova and the fetus at early stages of gestation [2].

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“…They must decide what to eat, what to drink, what test they will undergo and nearly every pregnant woman faces a decision about whether or not to take a medication during pregnancy, ranging from over-the-counter (OTC) antacids for gastroesophageal reflux to prescription medications for life-threatening chronic conditions (2,3). In the last three decades the use of medications during pregnancy has increased and it is now common during pregnancy (3,4). Estimates of the usage prevalence of at least one prescription medication during pregnancy range from less than 30 % to over 90 % of women (3).…”

Section: Introductionmentioning

confidence: 99%

“…The safety of medication use during pregnancy is frequently unclear because, for the majority of medications, there is a lack of sufficient data available to fully characterise the foetal risk. Thus, it is difficult to make informed clinical decisions about the best management of acute and chronic disorders during pregnancy (3,4). Since 1979, health care providers used a standard five-letter nomenclature published by the Food and Drug Administration (FDA) to assign a pregnancy risk category to medications (6).…”

Section: Introductionmentioning

confidence: 99%

Characteristics of health behaviours and health status indicators among pregnant women in Slovenia

et al. 2017

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Navade, povezane z zdravjem in socialno demografske značilnosti nosečnic v Sloveniji tina kek,1 nataša karas kuželički,2 Irena Mlinarič raščan,2 ksenija Geršak 1,3 IzvlečekIzhodišča: Nosečnost je obdobje, ko ženske za zdravje bodočega otroka kritično presojajo in ocenjujejo svoje zdravje ter z zdravjem povezane navade. Skupaj z zdravstvenimi delavci se srečujejo s šte-vilnimi tveganji in odločitvami, ki postanejo veliko kompleksnejše, saj je v igri vpliv na dva organizma. Namen članka je pregled ter iskanje morebitnih povezav med zdravjem, z zdravjem povezanimi navadami ter socialno demografskimi dejavniki v nosečnosti, ki so jih poročale sodelujoče ženske.Metode: Podatke študije smo pridobili v okviru raziskovalnega projekta Analiza bioloških označe-valcev presnove folatov pri ugotavljanju tveganja za nastanek napak nevralne cevi, orofacialnih shiz ter prirojenih srčnih napak, ki je potekal od maja 2013 do septembra 2015. Vprašalnik o maternalnem zdravju, z zdravjem povezanih navadah ter socialno demografskih karakteristikah je izpolnilo 450 sodelujočih žensk. Podatki zajemajo nosečnosti, ki datirajo od osemdesetih let prejšnjega stoletja pa do leta 2015.Rezultati: Mlajše in manj izobražene ženske so pogosteje poročale o kajenju med nosečnostjo, medtem ko so starejše, bolj izobražene ter nulipare ženske v višjem odstotku jemale folatne/multivitaminske dodatke. Opazili smo U-obliko porazdelitve uporabe zdravil (brez recepta in na recept) glede na stopnjo izobrazbe. Najvišji odstotek uporabe so imele ženske z najvišjo stopnjo izobrazbe (magisterij/doktorat) in ženske z doseženo najnižjo stopnjo izobrazbe (osnovna šola). Večjo uporabo zdravil med nosečnostjo so poročale tudi starejše ženske. Opazili smo trend višanja uporabe zdravil in folatnih/multivitaminskih pripravkov kot tudi incidence nosečniške sladkorne bolezni preko preiskovanega obdobja, z najvišjo incidenco v zadnjih desetletjih. Višjo pojavnost kroničnih bolezni smo opazili v skupini multiparih žensk.Zaključki: V navadah povezanih z zdravjem nosečnic obstajajo precejšnje socialno demografske razlike. Za izboljšanje zdravja so potrebni izboljšani javno zdravstveni ukrepi in individualno svetovanje, da lahko ustrezno naslovimo specifične potrebe socialno demografskih skupin z višjim tveganjem za neželene izide nosečnosti. AbstractBackground: Pregnancy is a period when women reconsider their own health and health related behaviour for the sake of their future child. Along with their health providers, they are faced with a number of risk assessments and decisions, which become far more complex as their effect on two organisms rather than one is at play. This paper provides an overview of possible associations between self-reported health status, health behaviours and socio-demographics during pregnancy. 296zdrav vestn | julij -avgust 2017 | letnik 86 reProdukCIja človeka Methods: Study data were obtained from the case-control research project "Analysis of folate metabolism biomarkers in the risk assessment for neural tube defects, orofacial clefts and cong...

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Medications in the first trimester of pregnancy: most common exposures and critical gaps in understanding fetal risk

Cited by 151 publications

References 11 publications

Prevalence of medication use among low risk pregnant women: A drug utilization study

Prevalence of medication use among low risk pregnant women: A drug utilization study

Ultrasound in the First Trimester and Earlier: How to Keep It Safe

Characteristics of health behaviours and health status indicators among pregnant women in Slovenia

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