Prescribing In Pregnancy Research Articles

Antiepileptic Drugs during Pregnancy in Primary Care: A UK Population Based Study

ObjectiveAntiepileptic drugs (AEDs) are commonly prescribed for epilepsy and bipolar disorder but little is known about their use in pregnancy. We examined secular trends in AED prescribing in pregnancy and pregnancy as a determinant for stopping AED prescribing.MethodsWe identified 174,055 pregnancies from The Health Improvement Network UK primary care database. Secular trends in AED prescribing during pregnancy were examined between 1994 and 2009. We used Cox's regression analyses to compare time to discontinuation of AED prescriptions between pregnant and non-pregnant women and to identify predictors of discontinuation of AEDs in pregnancy.ResultsPrescribing of carbamazepine and sodium valproate have declined since 1994 despite being the most commonly prescribed AEDs in pregnancy up to 2004. Prescribing of lamotrigine in pregnancy has steadily increased and has been the most popular AED prescribed in pregnancy since 2004. Pregnant women with epilepsy were twice as likely to stop receiving AEDs (Hazard Ratio (HR) 2.00, 95% Confidence Interval (CI) 1.62–2.47) when compared to non-pregnant women and for women with bipolar disorder this was even higher (HR 3.07, 95% CI 2.04–4.62). For pregnant women with epilepsy, those receiving AEDs less regularly before pregnancy were more likely to stop receiving AEDs in pregnancy.ConclusionsLamotrigine has been increasingly prescribed in pregnancy over older AEDs namely carbamazepine and sodium valproate. Pregnancy is a strong determinant for the discontinuation of AED prescribing particularly for women with bipolar disorder.

PS25 Discontinuation of Antiepileptic Drugs in Pregnancy: A UK Population Based Study in the Health Improvement Network (THIN)

BackgroundSince the thalidomide tragedy in the 1960s, many women are concerned with the use of drugs in pregnancy. Antiepileptic drugs (AEDs) are commonly used to treat epilepsy and bipolar disorders...

Pregnancy, breast-feeding and drugs used in dentistry

Despite advances in the study of birth defects related to drug exposures during pregnancy, medication use during pregnancy still causes anxiety and misunderstanding among both members of the public and health care professionals. This may result in a woman's unknowingly taking a medication that may harm the fetus or cause a birth defect or discontinuing medications necessary for treating chronic conditions. Using medications while breast-feeding also represents a challenge for patients and prescribers. Many mothers are told they must stop breast-feeding or "pump and discard" their breast milk if they are taking certain medications; however, in many cases, this advice-based on what may be limited education on the part of the health care provider about breast-feeding and medication use-may be incorrect. The authors review the current evidence regarding drugs that may be safe for pregnant or breast-feeding patients and medications that such patients should avoid. When considering prescribing in pregnancy, the dentist must weigh the risk to the fetus versus the benefit to the mother, and the appropriate conclusion should reflect current evidence. In some cases medication dosing should be avoided or altered; however, there are times when it is unnecessary to stop the use of medications. Breast-feeding also represents a clinical challenge, the risks and benefits of which need to be understood by both the patient and practitioner before any medication is administered. Dentists should be familiar with the risks and benefits for pregnant or breast-feeding patients posed by five types of medications: analgesics and anti-inflammatories, antibiotics, local anesthetics, sedatives and emergency medications.

Prescribing medications for heart disease in pregnancy

AbstractOur series Prescribing in pregnancy provides guidance on what information to offer pregnant women about the risks and benefits of drug treatment. Here the authors outline the management of heart disease in pregnancy. Copyright © 2011 Wiley Interface Ltd

Substitute methadone prescribing in pregnancy is associated with impaired fetal head growth

BackgroundExposure to illicit drugs in utero is associated with restricted fetal growth. The magnitude of this effect is not clear as data are commonly confounded by cigarette smoking and social...

Managing viral infections in pregnancy and the puerperium

AbstractOur series Prescribing in pregnancy provides guidance on what information to offer pregnant women about the risks and benefits of drug treatment. Here the author outlines the management of common viral infections in pregnancy. Copyright © 2011 Wiley Interface Ltd

Pregnancy as a Major Determinant for Discontinuation of Antidepressants

Potential adverse effects of antidepressants during pregnancy have caused concern about their use. There are, however, very limited detailed data on patterns of antidepressant prescribing in pregnancy. To examine secular trends in prescribing during pregnancy, to assess whether pregnancy is a major determinant for stopping antidepressants, and to identify characteristics of those who stopped antidepressants during pregnancy. In this cohort study, we obtained data on 114,999 pregnant women (median age at delivery, 30.5 years [interquartile range, 26-34 years]) who had a live birth between 1992 and 2006 and 22,677 nonpregnant women from The Health Improvement Network primary care database, one of the largest sources of continuous anonymized primary care data in the United Kingdom and broadly representative of UK general practice. This database includes information on age, sex, medical diagnosis and symptoms, health promotion activities, referrals to secondary care, and prescriptions for each registered individual. The database also holds information about social deprivation as measured using quintiles of the Townsend score. We used Cox regression analysis to compare time to last prescription in pregnant versus nonpregnant women and to identify characteristics of those women who stopped antidepressants during pregnancy. Antidepressant prescribing in pregnancy increased nearly 4-fold from 1992 to 2006 (relative risk = 3.87; 95% CI, 1.73-8.66; P < .001). Since 2001, approximately 3% of the cohort received antidepressants at some stage during pregnancy. Selective serotonin reuptake inhibitors accounted for approximately 80% of the prescribed antidepressants. Antidepressants were more likely to be stopped in pregnant than in nonpregnant women, in particular during the first 6 weeks of pregnancy (hazard ratio = 5.19; 95% CI, 4.85-5.56; P < .001). Only 10% of women treated before pregnancy still received antidepressants at the start of the third trimester. In contrast, 35% of nonpregnant women were still treated after a similar time period. Although antidepressant prescribing in pregnancy increased nearly 4-fold from 1992 to 2006, pregnancy was a major determinant of cessation of antidepressant medication, and most women did not receive further antidepressant prescriptions beyond 6 weeks of gestation. This finding may be explained by concerns about potential adverse effects of the medications, even though these concerns need to be balanced against the potential harm of inadequate treatment of depression during pregnancy.

Managing bacterial infections in pregnancy and the puerperium

AbstractOur series Prescribing in pregnancy provides guidance on what information to offer pregnant women about the risks and benefits of drug treatment. Here the author outlines the management of common bacterial infections in pregnancy.

Safe use of medications in breastfeeding mothers

AbstractOur series Prescribing in pregnancy provides guidance on what information to offer pregnant women about the risk and benefits of drug treatment. Here the authors discuss drug safety for breastfeeding mothers.

Identifying and prioritising epilepsy treatment uncertainties

ObjectiveTo identify and prioritise uncertainties regarding epilepsy treatment from people with epilepsy, their carers and epilepsy clinicians.BackgroundFailure to acknowledge and address genuine treatment uncertainties has caused unnecessary iatrogenic harm. The...

Recommended micronutrient supplementation in pregnancy

AbstractOur series Prescribing in pregnancy provides a guide for GPs on what information to offer pregnant women about the risks and benefits of drug treatment. Here, the authors discuss the evidence and guidelines for prescribing dietary supplements during pregnancy. Copyright © 2010 Wiley Interface Ltd

Asthma treatment in pregnancy

AbstractOur series Prescribing in pregnancy provides guidance on what information to offer pregnant women about the risks and benefits of drug treatment. Here the authors discuss the course of asthma during pregnancy and the use and safety of asthma medications. Copyright © 2010 Wiley Interface Ltd

Prescribing in pregnant women: guide to general principles

AbstractOur series Prescribing in pregnancy provides a guide for GPs on what information to offer pregnant women about the risks and benefits of drug treatment. Here, the authors describe the general principles that should be observed when prescribing in pregnant women. Copyright © 2009 Wiley Interface Ltd

Pulmonary Problems in Pregnancy

The challenge of managing pulmonary problems in pregnancy is one that demands not only a thorough understanding of the normal physiological changes that arise but also a detailed knowledge of pulmonary issues that arise during pregnancy either as part of chronic respiratory disease or as a consequence of the pregnant state. This book is a welcome publication in this area that is relevant to trainees and consultants in the field of obstetrics, paediatrics, respiratory medicine, anaesthetics and critical care. It would serve as a useful reference text and as a revision text for postgraduate examinations. There is no doubt that the authors had a difficult task because of a paucity of evidence in many of the areas covered. Despite the lack of available data, this is a comprehensive and well-referenced book. In areas of limited evidence, the narrative is supplemented by the expert opinion. The book chapters are grouped into three parts: Part 1 provides a description of normal physiology; Part 2 reports on key management areas and Part 3 focuses on specific conditions. The physiology section includes the transition from fetal to neonatal life and the effects of high altitude on maternal and fetal physiology, a topic that is both fascinating and relevant to the effects on maternal hypoxia in pregnancy. The difficulty in deciding when a pregnant woman's breathlessness is pathological rather than physiological is covered in the maternal respiratory section. The second section covers key areas in management: imaging, prescribing, fetal monitoring and anaesthetics. The diagnostic imaging section is both informative and reassuring, with tables on relative radiation exposure that would be particularly useful when advising women and their families about the relative risks of undergoing imaging. The chapter on prescribing in pregnancy provides comprehensive reference tables on the safety of drugs commonly required in the treatment of respiratory disorders.

Prescribing in pregnancy and lactation: factors to consider

Prescribing in pregnancy and lactation is not as seamless as prescribing in other groups. There are limited data in the use of newer drugs and most drugs are not licensed in this category. However, this predicament can be overcome by researching in-house and wider studies from previous practice. This article explores, in a simple manner, factors to consider both in pregnancy and lactation.

Prescription drugs and pregnancy

Prescribing drugs in pregnancy is an unusual risk-benefit situation. Drugs that may be of benefit or even life-saving to the mother can deform or kill the fetus. However, the risk to the fetus should not be exaggerated. There are only ~ 20 drugs or groups of drugs which are known to cause birth defects in humans. For one of these drugs to cause birth defects, a number of criteria must be fulfilled. The drug exposure must take place at a critical stage of pregnancy and the dose must be high enough to cause a threshold of exposure for an appropriate duration of time. For most of the known human teratogens, > 90% of pregnancies exposed during the first trimester result in normal offspring. Although only a few drugs are known to cause birth defects in humans, uncertainty about the safety of the majority may lead to underprescribing for pregnant women and women of childbearing age. Epidemiological studies of pregnancy outcome after specific drug exposures are often superficially reassuring, but most are severely limited in their power to detect adverse outcomes. Safety in animal studies may also be reassuring but species differences demand caution in this interpretation. Concerns about prescription drugs in the first trimester, when they can cause birth defects, are mostly quite different to concerns about use in the second and third trimesters. As the fetal organ systems mature, the fetus can be affected by the pharmacological activity of the drug in the same way as the mother. Many drugs have pharmacological effects on the fetus in the second and third trimesters but in most cases, they are well recognised and can be managed or avoided. The material presented in this paper is mostly concerned with the ‘risks’ associated with drugs in pregnancy. No attempt has been made to quantitate the possible benefits to the mother or fetus. Communicating the risk-benefit situation to the patient is always a challenge for physicians with limited time and sometimes limited knowledge. Fear of litigation is an unfortunate and an unwanted parameter in the assessment. Better knowledge of the parameters that determine teratogenicity may allow physicians to feel more confident in assessing the risks and benefits associated with prescribing in pregnancy.

Drugs in pregnancy

Every drug has the potential to affect the fetus but few are definitely teratogenic. The prescription or inadvertent use of drugs in pregnancy often causes considerable anxiety in parents because of their concerns about fetal harm. Accurate information and appropriate counselling are required to avoid unnecessary terminations and improve patient compliance with essential treatment. This article outlines the principles of teratogenicity and gives practical advice regarding prescribing in pregnancy. The importance of pre-pregnancy counselling and stabilizing medical disorders in pregnancy is emphasized. Changes in maternal physiology that can affect pharmacokinetics and factors influencing transplacental passage of drugs are also addressed.

Good and bad drug prescription in pregnancy

The use of drugs during pregnancy has been of concern since the teratogenicity of thalidomide became known. The practical implications may, however, not always be fully understood or applied in current practice, and not all prescribers or women have the same degree of concern or understanding about drug use during pregnancy. Prescription of drugs during pregnancy in FranceA survey of the records of the French Health Insurance Service of drug prescriptions during pregnancy in 1000 women living in Haute-Garonne, southwest France, showed that 99% of the women received a prescription for at least one drug during pregnancy with a mean of 13·6 medications per woman. 1·6% of women received one or more prescriptions of drugs from the US Food and Drug Administration X category (fetal risk outweighs benefits). 59% of women had a prescription of drugs from the D category (fetal risk but benefits may be acceptable) and 79% of women were exposed to drugs for which information about safety in pregnancy was not available from animal or human studies. Full-Text PDF

Exercise prescription in pregnancy: Weight-bearing versus non-weight-bearing exercise

International Journal of Gynecology & ObstetricsVolume 32, Issue 4 p. 396-396 Citations from the literatue pregnancy, delivery Exercise prescription in pregnancy: Weight-bearing versus non-weight-bearing exercise R Artal, R ArtalSearch for more papers by this authorDI Masaki, DI MasakiSearch for more papers by this authorN Khodiguian, N KhodiguianSearch for more papers by this authorY Romem, Y RomemSearch for more papers by this author Rutherford, RutherfordSearch for more papers by this author R Artal, R ArtalSearch for more papers by this authorDI Masaki, DI MasakiSearch for more papers by this authorN Khodiguian, N KhodiguianSearch for more papers by this authorY Romem, Y RomemSearch for more papers by this author Rutherford, RutherfordSearch for more papers by this author First published: August 1990 https://doi.org/10.1016/0020-7292(90)90146-CAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume32, Issue4August 1990Pages 396-396 RelatedInformation

Exercise prescription in pregnancy: Weight-bearing versus non-weight-bearing exercise

Bicycle ergometry (non-weight-bearing exercise) and treadmill (weight-bearing exercise) were compared to assess physiologic responses to similar work loads. A total of 22 subjects at 29.3 +/- 1.6 (+/- SEM) weeks' gestation who performed non-weight-bearing exercise were compared with 15 similarly fit subjects at 26.1 +/- 2.3 weeks' gestation who performed weight-bearing exercise at three submaximal levels. Measurements by indirect calorimetry indicate preferential carbohydrate use during non-weight-bearing exercise at submaximal levels.