CC BY-NC-ND 4.0 · Am J Perinatol 2017; 34(08): 826-832
DOI: 10.1055/s-0037-1598070
Commentary
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Improving Safe and Effective Use of Drugs in Pregnancy and Lactation: Workshop Summary

Laura E. Riley
1   Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
,
Alison G. Cahill
2   Department of Obstetrics and Gynecology, Washington University, St. Louis, Missouri
,
Richard Beigi
3   Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh Medical Center, Magee-Women's Hospital, Pittsburgh, Pennsylvania
,
Renate Savich
4   Division of Newborn Medicine and Neonatal Intensive Care Unit, University of Mississippi Medical Center, Jackson, Mississippi
,
George Saade
5   Department of Obstetrics and Gynecology, University of Texas Medical Branch at Galveston, Galveston, Texas
› Institutsangaben
Weitere Informationen

Publikationsverlauf

07. November 2016

27. Dezember 2016

Publikationsdatum:
31. Januar 2017 (online)

Abstract

In February 2015, given high rates of use of medications by pregnant women and the relative lack of data on safety and efficacy of many drugs utilized in pregnancy, the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), the Society for Maternal-Fetal Medicine (SMFM), the American College of Obstetricians and Gynecologists (ACOG), and the American Academy of Pediatrics (AAP) convened a group of experts to review the “current” state of the clinical care and science regarding medication use during the perinatal period. The expert panel chose select medications to demonstrate what existing safety and efficacy data may be available for clinicians and patients when making decisions about use in pregnancy or lactation. Furthermore, these example medications also provided opportunities to highlight where data are lacking, thus forming a list of research gaps. Last, after reviewing the existing vaccine safety surveillance system as well as the legislative history surrounding the use of drugs for pediatric diseases, the expert panel made specific recommendations concerning policy efforts to stimulate more research and regulatory attention on drugs for pregnant and lactating women.

Note

Workshop occurred at the Annual Meeting of the Society for Maternal-Fetal Medicine in February 2015 in San Diego, California.


Expert panelists:


Richard Beigi, MD, MSc—Magee-Women's Hospital of UPMC


David Burchfield, MD—COFN/AAP


Cheryl Broussard, PhD—CDC


Alison Cahill, MD—Washington University School of Medicine


Steve Caritis, MD—Magee-Women's Hospital of UPMC


Christina Chambers, MD—UC San Diego School of Medicine


Shannon M. Clark, MD—University of Texas Medical Branch


Michael Cohen-Wolkoweiz, MD—Duke University Medical Center


Maged Milad Costantine, MD—University of Texas Medical Branch


Jonathan Davis, MD—Floating Hospital for Children at Tufts Medical Center


Maisa Feghali, MD—University of Pittsburgh


Michael F. Greene, MD—Massachusetts General Hospital


Thomas W. Hale, RPh, PhD—Texas Tech University Health Sciences Center


Susan McCune, MD, MA Ed—FDA


Mirjana Nesin, MD—DMID/NIAID/NIH


Tonse Raju, MD—NIH


Sonja Rasmussen, MD—CDC


Adelaide Robb, MD—Children's National Medical Center


George Saade, MD—University of Texas Medical Branch


Melissa S. Tassinari, PhD, DABT—FDA


Barbara Wesley, MD, MPH—FDA


Amina White, PhD—NIH, Department of Bioethics


Chris Zahn, MD—ACOG


Anne Zajicek, MD, PharmD, FAAP—NICHD


 
  • References

  • 1 Kuklina E, Callaghan W. Chronic heart disease and severe obstetric morbidity among hospitalisations for pregnancy in the USA: 1995–2006. BJOG 2011; 118 (03) 345-352
  • 2 Campbell KH, Savitz D, Werner EF. , et al. Maternal morbidity and risk of death at delivery hospitalization. Obstet Gynecol 2013; 122 (03) 627-633
  • 3 Small MJ, James AH, Kershaw T, Thames B, Gunatilake R, Brown H. Near-miss maternal mortality: cardiac dysfunction as the principal cause of obstetric intensive care unit admissions. Obstet Gynecol 2012; 119 (2 Pt 1): 250-255
  • 4 Kaaja RJ, Greer IA. Manifestations of chronic disease during pregnancy. JAMA 2005; 294 (21) 2751-2757
  • 5 Bateman BT, Bansil P, Hernandez-Diaz S, Mhyre JM, Callaghan WM, Kuklina EV. Prevalence, trends, and outcomes of chronic hypertension: a nationwide sample of delivery admissions. Am J Obstet Gynecol 2012; 206 (02) 134.e1-134.e8
  • 6 Farr SL, Hayes DK, Bitsko RH, Bansil P, Dietz PM. Depression, diabetes, and chronic disease risk factors among US women of reproductive age. Prev Chronic Dis 2011; 8 (06) A119–A119
  • 7 Rooney BL, Schauberger CW, Mathiason MA. Impact of perinatal weight change on long-term obesity and obesity-related illnesses. Obstet Gynecol 2005; 106 (06) 1349-1356
  • 8 Tyer-Viola LA, Lopez RP. Pregnancy with chronic illness. J Obstet Gynecol Neonatal Nurs 2014; 43 (01) 25-37
  • 9 Dunlop AL, Jack BW, Bottalico JN. , et al. The clinical content of preconception care: women with chronic medical conditions. Am J Obstet Gynecol 2008; 199 (6, Suppl 2): S310-S327
  • 10 Josephson MA, McKay DB. Pregnancy and kidney transplantation. Semin Nephrol 2011; 31 (01) 100-110
  • 11 Mitchell AA, Gilboa SM, Werler MM, Kelley KE, Louik C, Hernández-Díaz S. ; National Birth Defects Prevention Study. Medication use during pregnancy, with particular focus on prescription drugs: 1976–2008. Am J Obstet Gynecol 2011; 205 (01) 51.e1-51.e8
  • 12 Werler MM, Mitchell AA, Hernandez-Diaz S, Honein MA. Use of over-the-counter medications during pregnancy. Am J Obstet Gynecol 2005; 193 (3 Pt 1): 771-777
  • 13 American Academy of Pediatrics Committee on Drugs. Transfer of drugs and other chemicals into human milk. Pediatrics 2001; 108 (03) 776-789
  • 14 Ryan AS, Wenjun Z, Acosta A. Breastfeeding continues to increase into the new millennium. Pediatrics 2002; 110 (06) 1103-1109
  • 15 Stultz EE, Stokes JL, Shaffer ML, Paul IM, Berlin CM. Extent of medication use in breastfeeding women. Breastfeed Med 2007; 2 (03) 145-151
  • 16 Anderson PO, Pochop SL, Manoguerra AS. Adverse drug reactions in breastfed infants: less than imagined. Clin Pediatr (Phila) 2003; 42 (04) 325-340
  • 17 Moore KL, Persaud TVN, Torchia MG. The Developing Human: Clinically Oriented Embryology. 10th ed. Philadelphia, PA: Elsevier; 2015
  • 18 Feghali M, Venkataramanan R, Caritis S. Pharmacokinetics of drugs in pregnancy. Semin Perinatol 2015; 39 (07) 512-519
  • 19 Gabbe SG, Neibyl JR, Simpson LJ. , et al. Obstetrics Normal and Problem Pregnancies. 6th ed. Philadelphia, PA: Elsevier Saunders; 2012
  • 20 Kim JH, Scialli AR. Thalidomide: the tragedy of birth defects and the effective treatment of disease. Toxicol Sci 2011; 122 (01) 1-6
  • 21 Tabacova S, Little R, Tsong Y, Vega A, Kimmel CA. Adverse pregnancy outcomes associated with maternal enalapril antihypertensive treatment. Pharmacoepidemiol Drug Saf 2003; 12 (08) 633-646
  • 22 Cooper WO, Hernandez-Diaz S, Arbogast PG. , et al. Major congenital malformations after first-trimester exposure to ACE inhibitors. N Engl J Med 2006; 354 (23) 2443-2451
  • 23 Briggs GG. Drug effects on the fetus and breast-fed infant. Clin Obstet Gynecol 2002; 45 (01) 6-21
  • 24 Sachs HC. ; Committee On Drugs. The transfer of drugs and therapeutics into human breast milk: an update on selected topics. Pediatrics 2013; 132 (03) e796-e809
  • 25 Hale TW. Maternal medications during breastfeeding. Clin Obstet Gynecol 2004; 47 (03) 696-711
  • 26 Berlin Jr CM, Paul IM, Vesell ES. Safety issues of maternal drug therapy during breastfeeding. Clin Pharmacol Ther 2009; 85 (01) 20-22
  • 27 Stover MW, Davis JM. Opioids in pregnancy and neonatal abstinence syndrome. Semin Perinatol 2015; 39 (07) 561-565
  • 28 Chambers C. Over-the-counter medications: risk and safety in pregnancy. Semin Perinatol 2015; 39 (07) 541-544
  • 29 Clark SM, Dunn HE, Hankins GD. A review of oral labetalol and nifedipine in mild to moderate hypertension in pregnancy. Semin Perinatol 2015; 39 (07) 548-555
  • 30 Beigi RH. The importance of studying antimicrobials in pregnancy. Semin Perinatol 2015; 39 (07) 556-560
  • 31 Temming LA, Cahill AG, Riley LE. Clinical management of medications in pregnancy and lactation. Am J Obstet Gynecol 2016; 214 (06) 698-702
  • 32 Zimmerman K, Gonzalez D, Swamy GK, Cohen-Wolkowiez M. Pharmacologic studies in vulnerable populations: using the pediatric experience. Semin Perinatol 2015; 39 (07) 532-536
  • 33 White A. Accelerating the paradigm shift toward inclusion of pregnant women in drug research: ethical and regulatory considerations. Semin Perinatol 2015; 39 (07) 537-540
  • 34 Coverdale JH, McCullough LB, Chervenak FA. The ethics of randomized placebo-controlled trials of antidepressants with pregnant women: a systematic review. Obstet Gynecol 2008; 112 (06) 1361-1368
  • 35 Blehar MC, Spong C, Grady C, Goldkind SF, Sahin L, Clayton JA. Enrolling pregnant women: issues in clinical research. Womens Health Issues 2013; 23 (01) e39-e45
  • 36 Nesin M, Sparer O. Vaccine monitoring systems: a potential model for medications in pregnancy. Semin Perinatol 2015; 39 (07) 524-529
  • 37 American Academy of Allergy, Asthma & Immunology website. The Vaccines and Medications in Pregnancy Surveillance System (VAMPSS). http://www.aaaai.org/about-aaaai/strategic-relationships/vampss . Accessed December 19, 2016
  • 38 Ren Z, Zajicek A. Review of the Best Pharmaceuticals for Children Act and the Pediatric Research Equity Act: what can the obstetric community learn from the pediatric experience?. Semin Perinatol 2015; 39 (07) 530-531
  • 39 Institute of Medicine. Addressing the Barriers to Pediatric Drug Development: Workshop Summary. Washington, DC: The National Academies Press; 2008
  • 40 Broussard CS, Frey MT, Hernandez-Diaz S. , et al. Developing a systematic approach to safer medication use during pregnancy: summary of a Centers for Disease Control and Prevention–convened meeting. Am J Obstet Gynecol 2014; 211 (03) 208-214.e1