The safety of proton pump inhibitors in pregnancy: a multicentre prospective controlled study.

BACKGROUND: Proton pump inhibitors are used to treat gastro-oesophageal reflux and peptic ulcers. Gastro-oesophageal reflux is a common condition in pregnancy. Human pregnancy experience with lansoprazole or pantoprazole is very limited. More data exist on the safety of omeprazole in pregnancy. AIM: To assess the safety of proton pump inhibitors in pregnancy. METHODS: The rate of major anomalies was compared between pregnant women exposed to omeprazole, lanzoprazole, or pantoprazole and a control group counselled for non-teratogens. The study design is a multicentre (n = 8), prospective, controlled study of the European Network of Teratology Information Services. RESULTS: We followed up 295 pregnancies exposed to omeprazole [233 in the first trimester (T1)], 62 to lansoprazole (55 in T1) and 53 to pantoprazole (47 in T1), and compared pregnancy outcome to that of 868 European Network of Teratology Information Services controls. The rate of major congenital anomalies did not differ between the exposed and control groups [omeprazole nine of 249 (3.6%), lansoprazole two of 51 (3.9%) and pantoprazole one of 48 (2.1%) vs. controls 30 of 792 = 3.8%]. No differences were found when exposure was limited to the first trimester after exclusion of genetic, cytogenetic or infectious anomalies. CONCLUSIONS: This study suggests that proton pump inhibitors do not represent a major teratogenic risk in humans.

Synergistic cytotoxicity between pentachlorophenol and copper in a bacterial model.

Both pentachlorophenol (PCP) and copper compounds have been widely used as wood preservatives, and are commonly found not only in the area near wood-preserving facilities, but also in body fluids and tissues of people who are not occupationally exposed to them. In this study, we found that exposing bacteria to a combination of PCP and copper at non- or sub-toxic concentrations resulted in enhanced cytotoxic effect in a synergistic mode as indicated by both the inhibition of growth and the lowering of the colony-forming ability. The toxicity of the combination PCP/Cu(II) was relieved by hydrophilic chelating agents, thiol compounds and adventitious proteins, but was markedly potentiated by low levels of the lipophilic metal chelating agents.

Is carbamazepine teratogenic? A prospective controlled study of 210 pregnancies.

The Israeli Teratogen Information Service prospectively followed up 210 pregnancies with first trimester carbamazepine exposure. Pregnancy outcome was compared with that of two overlapping controls, matched and general (n = 629), exposed to nonteratogenic agents. Our study suggests a twofold increase in the rate of major congenital anomalies (12/160 [carbamazepine] versus 18/560 [general control]; relative risk 2.24; 95% CI 1.1-4.56) and a birth weight reduction of approximately 250 g after in utero exposure to carbamazepine.

Pregnancy outcome after gestational exposure to metronidazole: a prospective controlled cohort study.

BACKGROUND: Metronidazole is an important antibacterial agent commonly used in women of reproductive age. Its use in pregnancy is a reason for concern for women and their health care providers. The objective was to examine the fetal safety of metronidazole. METHODS: The Israeli Teratogen Information Service prospectively collected and followed up 228 women exposed to metronidazole in pregnancy, 86.2% of whom with first-trimester exposure. Pregnancy outcome was compared with that of a control group, who were counseled during the same period for nonteratogenic exposure. RESULTS: There was no difference in the rate of major malformations between the groups (3/190; 1.6% [metronidazole] vs. 8/575; 1.4% [control], P = 0.739). The rate of major malformations did not differ between the groups even after including elective terminations of pregnancy due to prenatally diagnosed malformations (5/192; 2.6% [metronidazole] vs. 12/579; 2.1% [control], P = 0.777). A reduced neonatal birth weight was found in the metronidazole group compared with controls without significant differences in the rate of prematurity or in gestational age at delivery. The mean birth weight was lower in the metronidazole group when comparing the subgroup of term infants. CONCLUSIONS: This study confirms that metronidazole does not represent a major teratogenic risk in humans when used in the recommended doses.

The use of psychiatric drugs in pregnancy and lactation.

To help determine which drugs can be used with relative safety during pregnancy, we reviewed the literature on the possible teratogenic, perinatal, behavioral or developmental effects of the various groups of commonly used psychiatric drugs, and their effects on lactation. Tricyclic antidepressants, fluoxetine, phenothiazines, and most benzodiazepines are not considered to be teratogenic and may be used during pregnancy. All anti-epileptic drugs seem to have an embryotoxic and teratogenic potential and we recommend, if possible, avoiding these drugs. Lithium administration during the first trimester of pregnancy increases the risk of cardiac malformations, but the risk is not as high as originally reported. Therefore lithium may be continued whenever it seems to be the "drug of choice" if fetal echocardiography and ultrasonography are performed. There is a lack of information on the teratogenic effect of the newer drugs, and in spite of the fact that similar "older" drugs do not seem to adversely affect the fetus, they should be used with care. Although the data on the development of children following in-utero exposure to psychiatric drugs is limited, there seems to be no evidence of any long-term adverse effects on the development of children exposed to most psychotropic medications. However, children exposed in utero to anti-epileptic drugs may exhibit long-term developmental problems. Most of the drugs are detected in breast milk only at low concentrations. In nursing women taking these drugs, breastfeeding is possible. The infant should be carefully monitored for any clinical side effects and whenever observed, nursing should be discontinued. In light of our knowledge today, there seems to be only rarely an indication for pregnancy interruption following maternal exposure to psychiatric drugs during pregnancy.

[The Israel Teratogen Information Service: a report of the last ten years with 20,613 calls].

The Israel Teratogen Information Service (TIS) was established 10 years ago with the help of the Ministry of Health and the Hebrew University-Hadassah Medical School. During these 10 years we have had 20,631 calls. We describe the results of our experience in counseling. There was a gradual increase in the number of calls, which in 1997 reached 4,447. Most calls (84.5%) were during pregnancy, while 12% were prior to pregnancy. In 75.7% the calls were due to drug exposure during pregnancy; 10.9% were due to exposure to X-rays; there was maternal infection in 6.6% and in 5% immunization during pregnancy. The callers were: physicians in 46.6%, nurses 18.9%, pregnant women 39.5%, and 4.8% others. In 76.6% there was no additional risk to the embryo or fetus and in 17.4% there was a small additional risk of less than 1%; a significant additional risk to the fetus was expected in only 6%. In 3625 pregnant women with known outcome there were 8.9% spontaneous and 9.2% induced abortions. Of the 2968 live-born children, 2.3% were malformed, a rate similar to that among controls. The information provided by the TIS alleviated the fears most pregnant women have, and reduced unnecessary terminations of pregnancy planned because of unjustified fear of the teratogenic effects of agents to which women were exposed. It reduced the number of children born with congenital anomalies, since pregnancies were interrupted whenever there was a high risk for congenital anomalies.

Is benzodiazepine use during pregnancy really teratogenic?

Benzodiazepines (BDs) have a widespread use among people suffering from anxiety. These drugs easily cross the placenta and may affect the developing embryo and fetus. The literature is divided as to whether BD may cause an increase in spontaneous abortions or congenital anomalies. From the years 1988 to 1996, 756 women called the Israeli TIS concerning exposures to BD prior to or during pregnancy. Of 599 women who called us during pregnancy, we have follow-up information on 460 pregnancies (76.6%). The incidence of congenital anomalies (3.1%) was not different from that found in 424 control pregnancies (2.6%). There was a significantly higher incidence of induced abortions (14.1% vs. 4.7%, P = 0.00) and of spontaneous abortions (8.7% vs. 5.2%, P = 0.01). From an examination of our results, it does not appear that BD during pregnancy caused an increase in the incidence of birth defects. There was no specific defect in the offspring. The increase in the rate of induced abortions is probably related to the counseling of the callers, and the increase in spontaneous abortions seems to be a result of the lower gestational age at the time of counseling in the women exposed to BD. It is unknown whether BD could be responsible for developmental or behavioral problems, which are observed only at a later stage.