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Drugs During Pregnancy 1st edition

Drugs During Pregnancy 1st edition

Since the middle of the 1960s, author have been working on problems associated with maternal drug use and the risk for the pregnancy and the offspring. During this time, the methodology has developed and today various strategies are used to study these complex problems. There is a very large literature in the field which is sometimes difficult to evaluate. The practical question, raised by the patient or her doctor, is if the use of a drug during pregnancy increases the risk for a negative outcome of the pregnancy and especially the risk of a congenital malformation. Drugs During Pregnancy 1st edition  gives the answer for all query .

This question is often difficult to answer both for the patient and for her doctor, partly due to the complexity of the problem and therefore the possibility to draw wrong conclusions from published studies. This Drugs During Pregnancy 1st edition  tries to summarize my experiences and my views on these problems. It may be of some use notably for researchers who intend to enter the field.

In the text, a number of examples are given taken from the literature or based on unpublished analyses made during the more than 50 years author have been working for the National Board of Health and Welfare in Stockholm. A limited number of references are given in each chapter. They are obviously subjectively selected from the vast literature present.

Drugs During Pregnancy 1st edition
Drugs During Pregnancy 1st edition

Drugs During Pregnancy 1st edition pdf content

 

1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

2 The “Alert Clinician” . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

2.1 Thalidomide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
2.2 Anticonvulsants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
2.3 Warfarin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
2.4 Drugs for Thyrotoxicosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
2.5 Retinoids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
2.6 Mycophenolate Mofetil . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

3 Animal Experiments and Adverse Drug Reaction Reports . . . . . . . . . . 9

3.1 Animal Experiments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
3.2 Adverse Drug Reaction Reports . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

4 Some Epidemiological Principles. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

4.1 Population Studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
4.2 Case-Control Studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
4.3 Cohort Studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
4.4 Comparison Between Case-Control and Cohort Studies . . . . . . . . . . . 21
4.5 Nested Case-Control Studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
4.6 The Sibling Approach . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

5 Pregnancy Outcomes with the Exception of Congenital
Malformations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
5.1 Maternal Pregnancy Complications . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
5.1.1 Preeclampsia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
5.1.2 Placenta Previa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
5.1.3 Placenta Abruption . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
5.1.4 Other Pregnancy Complications . . . . . . . . . . . . . . . . . . . . . . . . 27

6 Congenital Malformations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37

6.1 Definition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
6.2 Major and Minor Malformations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
6.3 Single and Multiple Malformations . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
6.4 Causes of Congenital Malformations . . . . . . . . . . . . . . . . . . . . . . . . . . 40
6.4.1 Genetics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
6.4.2 Chromosome Anomalies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
6.4.3 External Factors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
6.5 Sources of Information on Malformations . . . . . . . . . . . . . . . . . . . . . . 42
6.6 Prenatal Diagnosis and Induced Abortion . . . . . . . . . . . . . . . . . . . . . . 43
6.7 Grouping of Congenital Malformations . . . . . . . . . . . . . . . . . . . . . . . . 44
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46

7 Identification of Maternal Use of Drugs . . . . . . . . . . . . . . . . . . . . . . . . . 47
7.1 Questionnaires or Interviews in a Case-Control Setting . . . . . . . . . . . 47
7.2 Prospective Randomized Studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
7.3 Teratology Information Services (TIS) . . . . . . . . . . . . . . . . . . . . . . . . 48
7.4 Prospective Studies of Pregnant Populations . . . . . . . . . . . . . . . . . . . . 49
7.5 Pregnancy Registers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50
7.6 The Swedish Medical Birth Register . . . . . . . . . . . . . . . . . . . . . . . . . . 51
7.7 Prescription Registers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52
7.8 The Effect of Errors in Drug Exposure Ascertainment . . . . . . . . . . . . 53
7.9 Information on Dosage of Drugs Used . . . . . . . . . . . . . . . . . . . . . . . . 54
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55

8 The Problem of Confounding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57

8.1 Mediating Factors Should Not Be Adjusted for . . . . . . . . . . . . . . . . . . 57
8.2 Some Common and Sometimes Important Confounders . . . . . . . . . . . 58
8.2.1 Year of Birth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58
8.2.2 Maternal Age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
8.2.3 Parity and Gravidity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
8.2.4 Smoking . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
8.2.5 Use of Alcohol . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
8.2.6 Overweight and Obesity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
8.2.7 Subfertility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63

 

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