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1.
S Afr Med J ; 109(6): 415-420, 2019 May 31.
Artigo em Inglês | MEDLINE | ID: mdl-31266560

RESUMO

BACKGROUND: Congenital abnormalities and pregnancy losses due to the teratogenic effects of warfarin are prevalent among the South African population. These are potentially preventable if the challenges and barriers faced by at-risk women are understood and addressed effectively. OBJECTIVES: To determine the practice, knowledge and attitudes regarding the teratogenic risks experienced by women administered warfarin. METHODS: A descriptive study was performed. Quantitative data were collected through a researcher-administered questionnaire. The target population comprised 101 women of reproductive age who received warfarin treatment and attended a single tertiary-level anticoagulation clinic. RESULTS: Patient-related challenges identified in this study are: language barriers, poor understanding of basic terminology and mathematics, poor contraceptive and family planning practices, lack of knowledge regarding the risks of warfarin in pregnancy and passive attitudes towards information attainment. CONCLUSIONS: Interventions are necessary to address the challenges in such settings. These include increased awareness of the teratogenic potential of specific chronic medications among healthcare providers, patients and the public. Standardised management protocols for women of reproductive age initiated on teratogenic medications should be implemented, including contraceptive and family planning discussions at follow-up visits. Improvement of the counselling skills of healthcare providers and the availability of translators or healthcare providers fluent in local languages could assist in risk reduction.


Assuntos
Anormalidades Induzidas por Medicamentos/prevenção & controle , Anticoagulantes/efeitos adversos , Conhecimentos, Atitudes e Prática em Saúde , Varfarina/efeitos adversos , Anormalidades Induzidas por Medicamentos/etiologia , Adolescente , Adulto , Atitude Frente a Saúde , Barreiras de Comunicação , Comportamento Contraceptivo , Embolia/prevenção & controle , Serviços de Planejamento Familiar , Feminino , Implante de Prótese de Valva Cardíaca , Humanos , Pessoa de Meia-Idade , Educação de Pacientes como Assunto , Gravidez , Trombose Venosa/tratamento farmacológico , Adulto Jovem
2.
Clin Perinatol ; 46(2): 203-213, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31010556

RESUMO

Many conditions that require frequent medication use are common during pregnancy. The purpose of this article is to list some of the most common of these disorders and to discuss the risk to the developing fetus of the medications used most frequently to treat them. Included are drugs used for the treatment of asthma, nausea and vomiting, hyperthyroidism, pain and fever, and depression during pregnancy.


Assuntos
Anormalidades Induzidas por Medicamentos/etiologia , Anormalidades Congênitas/epidemiologia , Complicações na Gravidez/tratamento farmacológico , Anormalidades Induzidas por Medicamentos/prevenção & controle , Acetaminofen/efeitos adversos , Acetaminofen/uso terapêutico , Corticosteroides/efeitos adversos , Corticosteroides/uso terapêutico , Agonistas Adrenérgicos beta/efeitos adversos , Agonistas Adrenérgicos beta/uso terapêutico , Analgésicos não Entorpecentes/efeitos adversos , Analgésicos não Entorpecentes/uso terapêutico , Antiasmáticos/efeitos adversos , Antiasmáticos/uso terapêutico , Antidepressivos/efeitos adversos , Antidepressivos/uso terapêutico , Antieméticos/efeitos adversos , Antieméticos/uso terapêutico , Antitireóideos/efeitos adversos , Antitireóideos/uso terapêutico , Asma/tratamento farmacológico , Transtorno Depressivo/tratamento farmacológico , Feminino , Humanos , Hipertireoidismo/tratamento farmacológico , Antagonistas de Leucotrienos/efeitos adversos , Antagonistas de Leucotrienos/uso terapêutico , Troca Materno-Fetal , Metimazol/uso terapêutico , Êmese Gravídica/tratamento farmacológico , Ondansetron/uso terapêutico , Gravidez , Propiltiouracila/uso terapêutico , Teratogênios
3.
Pediatrics ; 143(4)2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30837294

RESUMO

OBJECTIVES: Although teratogenic medications are commonly used to treat rheumatic disease, no standard model currently exists for educating adolescent patients about teratogenic risk or performing routine pregnancy screening. We performed a quality improvement project to increase education and pregnancy screening in girls and women of childbearing age prescribed teratogenic medications in our pediatric rheumatology clinic. METHODS: Eligible participants included female patients age 10 and older prescribed teratogenic medications in a single-center tertiary care pediatric rheumatology clinic. Seven plan-do-study-act cycles were completed to test the following interventions: visible project reminders, physician and nurse education, progress updates, previsit planning, and development of an electronic health record education template. Chart reviews were performed, and control charts were created for each aim to analyze improvement over time. RESULTS: At baseline, 57 of 231 (24.7%) clinic encounters of female patients age 10 years and older taking teratogenic medications had education documented within the last 12 months, and 47 of 231 (20.3%) had pregnancy screening performed at the visit. Implementation of our interventions resulted in improvement in documentation of annual teratogen education (904 of 1135; 79.6%) and routine pregnancy screening (940 of 1135; 82.8%), both of which were statistically significant (P < .0001). Control charts revealed special cause with sustained improvement over >1 year. CONCLUSIONS: The interventions made through this quality improvement project increased the frequency of both teratogen education and urine pregnancy screening in patients taking teratogenic medications. Development of a standardized education template in the electronic health record played a key role in sustaining these improvements over time.


Assuntos
Anormalidades Induzidas por Medicamentos/etiologia , Antirreumáticos/efeitos adversos , Monitorização Fisiológica/métodos , Educação de Pacientes como Assunto/métodos , Doenças Reumáticas/tratamento farmacológico , Teratogênios/análise , Anormalidades Induzidas por Medicamentos/prevenção & controle , Adolescente , Assistência Ambulatorial/métodos , Antirreumáticos/uso terapêutico , Criança , Estudos de Coortes , Prescrições de Medicamentos/estatística & dados numéricos , Registros Eletrônicos de Saúde , Feminino , Hospitais Pediátricos , Humanos , Seleção de Pacientes , Gravidez , Prognóstico , Doenças Reumáticas/diagnóstico , Medição de Risco , Centros de Atenção Terciária , Estados Unidos
7.
Expert Opin Drug Saf ; 17(12): 1171-1183, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30394114

RESUMO

Introduction: This review provides a guide for the rational use of prescription drugs in patients of reproductive age. Areas covered: A comprehensive retrieval of the labels of FDA-approved drugs was performed to identify drugs where the label recommends contraceptive use during and/or after treatment. The acquired data were analyzed and organized into a table. Contraception was recommended or mandated for 268 single-ingredient drugs. These could be divided into four main categories, with many having effects across several categories: 177 drugs required contraception because they were associated with pregnancy loss or stillbirth, 177 drugs were associated with teratogenesis, 136 were associated with non-teratogenic adverse peri- or postnatal effects on the fetus (e.g. low birth weight), and 44 were associated with decreased efficacy of contraception or a change in ovulatory cycle. We also discuss the period of time contraception is required, as well as the known or hypothesized reasons for the reproductive toxicity of these agents. Expert opinion: We have provided a comprehensive overview of the FDA-approved drugs where the warning labels currently stipulate that contraception should be used. Although other references are available for clinicians, this review provides a useful source of information regarding the single-ingredient prescription drugs that may affect the outcome of pregnancy. This information is particularly relevant for researchers, as it provides an overview of the different drugs with reproductive toxicity, and because it highlights the specific needs for future research. In particular, more work (especially epidemiological studies) is needed to clarify the clinical relevance of these findings, most of which were obtained through animal studies.


Assuntos
Anticoncepção/métodos , Rotulagem de Medicamentos/legislação & jurisprudência , Medicamentos sob Prescrição/efeitos adversos , Anormalidades Induzidas por Medicamentos/prevenção & controle , Aborto Espontâneo/induzido quimicamente , Aborto Espontâneo/prevenção & controle , Animais , Feminino , Humanos , Gravidez , Medicamentos sob Prescrição/administração & dosagem , Fatores de Tempo , Estados Unidos , United States Food and Drug Administration
8.
Rev. clín. med. fam ; 11(3): 144-153, oct. 2018. tab
Artigo em Espanhol | IBECS | ID: ibc-176092

RESUMO

El embarazo es un estado dinámico de cambios fisiológicos que afectan a la salud de la embarazada, a su percepción e interacción con el entorno. Una mujer embarazada necesita a lo largo de este tiempo supervisión médica, prevención y ayuda física y emocional. El cuidado dental de las embarazadas requiere una atención especial, retrasándose ciertos procedimientos terapéuticos, de modo que coincidan con los períodos del embarazo dedicados a la maduración y no a la organogénesis. La aplicación de la odontología preventiva irá enfocada al cuidado pre y postnatal. En este artículo repasamos algunos cambios fisiológicos y patologías orales que se asocian con el embarazo, y cómo estas alteraciones pueden afectar a la salud oral de la paciente


Pregnancy is a dynamic state of physiological changes that affect the patient's health, perceptions and interactions with the environment. A pregnant woman requires various forms of support throughout this time, such as medical monitoring or intervention, preventive care, and physical and emotional assistance. The dental care of pregnant patients requires special attention, delaying certain therapeutic procedures so that they coincide with the periods of pregnancy devoted to maturation versus organogenesis. Applying the basics of preventive dentistry at the primary level will broaden the scope of pre- and postnatal care. This article reviews some of the physiological changes and oral pathologies which are associated with pregnancy, and how these alterations can affect the oral health of the patient


Assuntos
Humanos , Feminino , Gravidez , Complicações na Gravidez/tratamento farmacológico , Anormalidades Induzidas por Medicamentos/prevenção & controle , Assistência Odontológica/normas , Prescrições de Medicamentos/normas , Teratogênios/análise , Doenças da Boca/tratamento farmacológico , Radiografia Dentária , Higiene Bucal/métodos
9.
Reprod Toxicol ; 80: 92-104, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29859881

RESUMO

We discuss the possibilities to prevent the post-exposure teratogenic effects of several teratogens: valproic acid (VPA), diabetes and alcohol. Co-administration of folic acid with VPA reduced the rate of Neural Tube Defects (NTD) and other anomalies in rodents, but apparently not in pregnant women. Antioxidants or the methyl donor S-adenosyl methionine prevented Autism Spectrum Disorder (ASD) like behavior in mice and rats. In vivo and in vitro studies demonstrated that antioxidants, arachidonic acid, myoinositol and nutritional agents may prevent diabetes-embryopathy. Prevention of alcohol-induced embryonic and fetal injuries and neurodevelopmental deficits was achieved by supplementation of zinc, choline, vasoactive intestinal proteins (VIP related peptides), antioxidants and folic acid. While the animal research described in this review is indicative of possible preventions of the different teratogenic effects, this is not yet the focus in human research. Future research should promote further knowledge where our current understanding is the vaguest, human prevention.


Assuntos
Anormalidades Induzidas por Medicamentos/prevenção & controle , Antioxidantes/administração & dosagem , Diabetes Gestacional , Ácido Fólico/administração & dosagem , Gravidez em Diabéticas , Efeitos Tardios da Exposição Pré-Natal/prevenção & controle , Teratogênios/toxicidade , Anormalidades Induzidas por Medicamentos/etiologia , Animais , Antioxidantes/uso terapêutico , Diabetes Gestacional/metabolismo , Etanol/toxicidade , Etil-Éteres , Feminino , Ácido Fólico/uso terapêutico , Antagonistas do Ácido Fólico/toxicidade , Humanos , Estresse Oxidativo , Gravidez , Gravidez em Diabéticas/metabolismo , Efeitos Tardios da Exposição Pré-Natal/induzido quimicamente , Compostos de Sulfidrila , Ácido Valproico/toxicidade
10.
Pharmacoepidemiol Drug Saf ; 27(9): 995-1004, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29920833

RESUMO

PURPOSE: To explore trends in use of maternal medication 3 months prior to, during and 3 months after pregnancy. METHODS: Data on births from the Medical Birth Registry of Norway were linked to the Norwegian Prescription Database, identifying women's use of medications around pregnancy. All women giving birth in Norway during 2005 to 2015 (638 532 singleton births to 414 567 women) were included. Proportions of pregnant women using different medications in association with pregnancy, and annual relative change in medication use during 2005 to 2015, were calculated. RESULTS: In Norway, 60% of pregnant women used prescription medications during pregnancy (2005-15), increasing from 57% in 2005 to 62% in 2015. The annual relative increase was 0.9% (95% CI: 0.8-1.0). In the first trimester, approximately 17% of the women used medications regarded as potentially teratogenic during 2005 to 2015, increasing from 15% to 19%. Overall, this proportion was higher in the first than in the second (8.9%) and third (8.0%) trimesters, and higher than in the 3 months after pregnancy (14%). The annual relative increase of medications regarded as potentially teratogenic in the first trimester was 2.5% (95% CI: 2.3-2.7). CONCLUSIONS: The proportion of women using potentially teratogenic medications in the first trimester of pregnancy have increased during the last decade. Clinicians need to be aware of the possibility of pregnancy when prescribing potentially teratogenic medication to women of fertile age and focus this in the consultations. The increasing trends call for the need of routine surveillance of adverse birth outcomes linked to medication use in pregnancy.


Assuntos
Anormalidades Induzidas por Medicamentos/prevenção & controle , Prescrições de Medicamentos/estatística & dados numéricos , Complicações na Gravidez/tratamento farmacológico , Medicamentos sob Prescrição/administração & dosagem , Teratogênios , Anormalidades Induzidas por Medicamentos/etiologia , Adulto , Bases de Dados Factuais , Feminino , Humanos , Exposição Materna/efeitos adversos , Exposição Materna/estatística & dados numéricos , Pessoa de Meia-Idade , Noruega , Período Pós-Parto , Gravidez , Primeiro Trimestre da Gravidez/efeitos dos fármacos , Medicamentos sob Prescrição/efeitos adversos , Sistema de Registros/estatística & dados numéricos , Adulto Jovem
12.
PLoS One ; 13(6): e0198618, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29920515

RESUMO

The study assessed knowledge, attitudes, and medication use of a random sample of pregnant women attending outpatient Gynecology and Obstetrics clinics at randomly selected public General and Teaching hospitals in Naples, Italy. A total of 503 women participated. Those more likely to know that a pregnant woman with chronic condition must discuss whether or not to take a medication with the physician were Italian, aged 31-40 years, employed, with no history of abortion, having had a medical problem within the previous year, with a better self-perceived health status, who knew how to use medications during pregnancy, and who needed information on medications. The knowledge of the potential risk of using non-prescribed medications during pregnancy was significantly higher in employed women, who received information from physicians, who knew how to use medications during pregnancy, and who knew the possible damages related to medications use. More than half had used at least one medication. Those aged 26-35 years, Italian, non-graduated, in the third trimester, having had a medical problem within the previous year, with a risky pregnancy, and with a knowledge that women with chronic condition must discuss whether or not to take a medication with the physician were more likely to use medication. Less than half had used medication without a physician's advice. Those who were more likely to self-medicate were older, Italian, multiparous, with no history of abortion, who knew that women with chronic condition must discuss whether or not to take a medication with the physician, who did not know the potential risk of using non-prescribed medication during pregnancy, who had used prescribed medication during pregnancy, and who needed information about medications. Educational programs for women about medication use are important to increase their knowledge of the potential risks to the pregnant women and the unborn child in order to reduce self-medication.


Assuntos
Tratamento Farmacológico/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Gravidez/psicologia , Anormalidades Induzidas por Medicamentos/prevenção & controle , Adolescente , Adulto , Estudos Transversais , Uso de Medicamentos/estatística & dados numéricos , Feminino , Comportamentos Relacionados com a Saúde , Necessidades e Demandas de Serviços de Saúde , Humanos , Itália , Paridade , Educação de Pacientes como Assunto , Relações Médico-Paciente , Risco , Automedicação/psicologia , Automedicação/estatística & dados numéricos , Inquéritos e Questionários , Adulto Jovem
13.
Pharmacoepidemiol Drug Saf ; 27(6): 668-673, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29726056

RESUMO

PURPOSE: To evaluate awareness of and compliance in Belgium by French-speaking health care professionals and patients with the isotretinoin safety recommendations regarding its teratogenic risk. METHOD: Survey using online questionnaires, delivered from December 2014 to March 2015 for patients, pharmacists, dermatologists, and GPs and delivered again from September 2015 to October 2015 for GPs. RESULTS: Questionnaires were completed by 24 dermatologists, 24 GPs, 58 pharmacists, and 33 female patients. The pregnancy prevention programme was poorly known by health care professionals (23.6%) and patients (15.2%). Health care professionals informed women of childbearing age in depth about the teratogenic risk (98.3% of pharmacists and 100.0% of GPs and dermatologists) and the importance of an effective contraceptive method (87.9% and 100.0%, respectively). Patients were less informed about the pregnancy test (25.9% and 14.6%) and the need to use a second contraceptive method (29.3% and 27.1%). The low compliance with the last 2 recommendations was due to a lack of adoption by health care professionals regarding the need for these recommendations if female patients have an effective contraceptive method and the pregnancy risk is discussed in detail with them. CONCLUSION: The effectiveness of the pregnancy prevention programme recommendations should be reconsidered by an expert committee. Justifications should be added to effective recommendations to increase their adoption by health care professionals and patients.


Assuntos
Anormalidades Induzidas por Medicamentos/prevenção & controle , Anticoncepção/estatística & dados numéricos , Fidelidade a Diretrizes/estatística & dados numéricos , Isotretinoína/efeitos adversos , Cooperação do Paciente/estatística & dados numéricos , Anormalidades Induzidas por Medicamentos/etiologia , Acne Vulgar/tratamento farmacológico , Adolescente , Adulto , Bélgica , Anticoncepção/normas , Fármacos Dermatológicos/efeitos adversos , Dermatologistas/estatística & dados numéricos , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Pessoa de Meia-Idade , Farmacêuticos/estatística & dados numéricos , Gravidez , Complicações na Gravidez/tratamento farmacológico , Inquéritos e Questionários/estatística & dados numéricos , Teratogênios/toxicidade , Adulto Jovem
14.
J Natl Compr Canc Netw ; 16(5S): 660-662, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29784750

RESUMO

Estimates suggest that nearly 30% of patients diagnosed with chronic myeloid leukemia (CML) are aged <49 years, with approximately half being women. For many of these women, childbearing concerns are a major factor as they initiate treatment with tyrosine kinase inhibitors, which are known to be teratogenic. During her presentation at the NCCN 23rd Annual Conference, Dr. Berman identified the challenges in helping women undergoing treatment for CML who want to have children, and emphasized the importance of an individualized and multidisciplinary approach to management. In addition, she encouraged NCCN to create a pregnancy registry of this patient population to enable clinicians to collect firm data to guide clinical decision-making.


Assuntos
Anormalidades Induzidas por Medicamentos/prevenção & controle , Fertilização In Vitro , Leucemia Mielogênica Crônica BCR-ABL Positiva/tratamento farmacológico , Complicações Neoplásicas na Gravidez/tratamento farmacológico , Inibidores de Proteínas Quinases/efeitos adversos , Anormalidades Induzidas por Medicamentos/etiologia , Feminino , Humanos , Masculino , Exposição Materna/efeitos adversos , Exposição Materna/prevenção & controle , Troca Materno-Fetal , Exposição Paterna/efeitos adversos , Gravidez , Primeiro Trimestre da Gravidez/efeitos dos fármacos , Segundo Trimestre da Gravidez/efeitos dos fármacos , Inibidores de Proteínas Quinases/administração & dosagem , Espermatozoides/efeitos dos fármacos , Fatores de Tempo
17.
Int J Dermatol ; 57(9): 1035-1046, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29508918

RESUMO

Isotretinoin has revolutionized the treatment of severe acne vulgaris, a condition which if left untreated may result in significant socio-psychological implications for those affected. Timely access to isotretinoin therapy is important to avoid the risks of potential physical and emotional scarring. However, due to its high risks of teratogenicity, isotretinoin must be used with care in females of childbearing potential. Since isotretinoin's introduction, numerous risk management programs have been implemented across the world in an attempt to prevent isotretinoin use in pregnancy. This paper aims to provide an evidence-based review of the risk management programs for isotretinoin in Australia, Europe, Singapore, New Zealand, and the United States of America. The effectiveness of these programs and the factors leading to isotretinoin exposure in pregnancy are critically analyzed in an effort to inform the future direction with respect to designing the ideal regulatory program. Stringent risk management programs, such as the iPLEDGE in the US and Pregnancy Prevention Program (PPP) in Europe, may not be effective in reducing the risks of fetal exposure to isotretinoin when used alone. There is evidence that such strenuous regulation results in increased fear of teratogenic risks but does not translate into a reduced rate of pregnancies exposed to isotretinoin. A successful program must prioritize education about effective contraception, while minimizing any extraneous requirements, to ensure that women are not inadvertently undertreated for acne.


Assuntos
Anormalidades Induzidas por Medicamentos/prevenção & controle , Fármacos Dermatológicos/efeitos adversos , Isotretinoína/efeitos adversos , Gestão de Riscos/métodos , Acne Vulgar/tratamento farmacológico , Austrália , Europa (Continente) , Feminino , Humanos , Nova Zelândia , Gravidez , Singapura , Teratogênios , Estados Unidos
18.
Pharm Res ; 35(4): 84, 2018 Mar 07.
Artigo em Inglês | MEDLINE | ID: mdl-29516182

RESUMO

Drug bioavailability to the developing brain is a major concern in the treatment of neonates and infants as well as pregnant and breast-feeding women. Central adverse drug reactions can have dramatic consequences for brain development, leading to major neurological impairment. Factors setting the cerebral bioavailability of drugs include protein-unbound drug concentration in plasma, local cerebral blood flow, permeability across blood-brain interfaces, binding to neural cells, volume of cerebral fluid compartments, and cerebrospinal fluid secretion rate. Most of these factors change during development, which will affect cerebral drug concentrations. Regarding the impact of blood-brain interfaces, the blood-brain barrier located at the cerebral endothelium and the blood-cerebrospinal fluid barrier located at the choroid plexus epithelium both display a tight phenotype early on in embryos. However, the developmental regulation of some multispecific efflux transporters that also limit the entry of numerous drugs into the brain through barrier cells is expected to favor drug penetration in the neonatal brain. Finally, drug cerebral bioavailability is likely to be affected following perinatal injuries that alter blood-brain interface properties. A thorough investigation of these mechanisms is mandatory for a better risk assessment of drug treatments in pregnant or breast-feeding women, and in neonate and pediatric patients.


Assuntos
Anormalidades Induzidas por Medicamentos/prevenção & controle , Encéfalo/efeitos dos fármacos , Aleitamento Materno , Troca Materno-Fetal/efeitos dos fármacos , Complicações na Gravidez/tratamento farmacológico , Anormalidades Induzidas por Medicamentos/etiologia , Disponibilidade Biológica , Encéfalo/embriologia , Encéfalo/crescimento & desenvolvimento , Encéfalo/metabolismo , Desenvolvimento Infantil/efeitos dos fármacos , Feminino , Desenvolvimento Fetal/efeitos dos fármacos , Humanos , Lactente , Recém-Nascido , Gravidez , Medição de Risco , Distribuição Tecidual
19.
Arch Womens Ment Health ; 21(6): 657-662, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-29569043

RESUMO

Schizophrenic or schizoaffective disorders often occur in early adulthood and thus affect women of childbearing age. For paliperidone information about reproductive safety is wanting. Therefore, we evaluated data from the German Embryotox pharmacovigilance institute regarding paliperidone therapy during pregnancy. The German Embryotox pharmacovigilance institute offers risk assessment on drug use in pregnancy and documents the outcome of more than 3500 drug-exposed pregnancies per year. In our study, we analyze the outcome of all pregnancies with paliperidone exposure, which have been assessed by our institute between January 2007 and June 2016. Of the 17 prospectively assessed pregnancies, 14 resulted in 15 live-born children (including one pair of twins). None of the infants presented with major congenital malformations. There were two spontaneous abortions at gestational weeks 6 and 11, respectively, and one elective termination due to personal reasons. Sixty-five percent of the pregnant women smoked cigarettes throughout pregnancy, 17% consumed alcohol. Five children were born prematurely (< 37 gestational weeks) and four were small for gestational age, each group including the twins. The results of our study suggest that paliperidone may be administered during pregnancy. The increased rate of prematurity and small for gestational age children can at least partially be explained by other risk factors. Psychiatric and obstetric close monitoring as well as additional medical and social support are recommended to ensure a healthy pregnancy course in patients with a severe mental illness.


Assuntos
Palmitato de Paliperidona , Complicações na Gravidez/tratamento farmacológico , Medição de Risco/métodos , Esquizofrenia/tratamento farmacológico , Anormalidades Induzidas por Medicamentos/etiologia , Anormalidades Induzidas por Medicamentos/prevenção & controle , Adulto , Antipsicóticos/administração & dosagem , Antipsicóticos/efeitos adversos , Monitoramento de Medicamentos/métodos , Feminino , Alemanha/epidemiologia , Humanos , Palmitato de Paliperidona/administração & dosagem , Palmitato de Paliperidona/efeitos adversos , Farmacovigilância , Gravidez , Resultado da Gravidez/epidemiologia , Fatores de Risco
20.
Curr Psychiatry Rep ; 20(3): 20, 2018 03 17.
Artigo em Inglês | MEDLINE | ID: mdl-29549608

RESUMO

PURPOSE OF REVIEW: The management of bipolar disorder during pregnancy requires difficult treatment decisions be made by both women and their clinicians. There is little consensus on management despite the high prevalence of bipolar disorder in reproductive-aged women. In this review, we have summarized the available literature and discuss the balancing of risks associated with treatment decisions. RECENT FINDINGS: Cohort studies have shown a high relapse rate in women with bipolar disorder who discontinue mood-stabilizing medications. The risks of fetal medication exposure have been assessed in multiple database studies. Management decisions of bipolar disorder in pregnancy have been made difficult by inconsistencies in study outcomes. There were many confounding factors in the studies of medication discontinuation relapse risk. Inconsistencies in the findings of fetal risks from mood-stabilizing medications have further complicated management decisions. Larger studies are needed to clarify the risks of bipolar disorder relapse in pregnancy with and without treatment.


Assuntos
Anormalidades Induzidas por Medicamentos/prevenção & controle , Antimaníacos/efeitos adversos , Antipsicóticos/efeitos adversos , Transtorno Bipolar/tratamento farmacológico , Complicações na Gravidez/tratamento farmacológico , Antimaníacos/uso terapêutico , Antipsicóticos/uso terapêutico , Transtorno Bipolar/psicologia , Estudos de Coortes , Feminino , Humanos , Hipoglicemia/induzido quimicamente , Hipoglicemia/embriologia , Compostos de Lítio/efeitos adversos , Compostos de Lítio/uso terapêutico , Gravidez , Complicações na Gravidez/psicologia , Recidiva
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