Physician perceptions of and management practices for significant fetal drug exposure

1990 ◽  
Vol 4 (4) ◽  
pp. 315-320
Author(s):  
Don C. Van Dyke ◽  
Lee Ann Grisolano ◽  
James Hulbert
2019 ◽  
Vol 25 (5) ◽  
pp. 496-504 ◽  
Author(s):  
Naïm Bouazza ◽  
Frantz Foissac ◽  
Déborah Hirt ◽  
Saïk Urien ◽  
Sihem Benaboud ◽  
...  

Background: Drug prescriptions are usual during pregnancy, however, women and their fetuses still remain an orphan population with regard to drugs efficacy and safety. Most xenobiotics diffuse through the placenta and some of them can alter fetus development resulting in structural abnormalities, growth or functional deficiencies. Methods: To summarize the different methodologies developed towards the prediction of fetal drug exposure. Results: Neonatal cord blood concentration is the most specific measurement of the transplacental drug transfer at the end of pregnancy. Using the cord blood and mother drug concentrations altogether, drug exchanges between the mother and fetus can be modeled and quantified via a population pharmacokinetic analysis. Thereafter, it is possible to estimate the fetus exposure and the fetus-to-mother exposure ratio. However, the prediction of placental transfer before any administration to pregnant women is desirable. Animal studies remain difficult to interpret due to structural and functional inter-species placenta differences. The ex-vivo perfusion of the human placental cotyledon is the method of reference to study the human placental transfer of drugs because it is thought to mimic the functional placental tissue. However, extrapolation of data to in vivo situation remains difficult. Some research groups have extensively worked on physiologically based models (PBPK) to predict fetal drug exposure and showed very encouraging results. Conclusion: PBPK models appeared to be a very promising tool in order to predict fetal drug exposure in-silico. However, these models mainly picture the end of pregnancy and knowledge regarding both, development of the placental permeability and transporters is strongly needed.


The Placenta ◽  
2011 ◽  
pp. 303-309
Author(s):  
Tatiana N. Nanovskaya ◽  
Gary D. V. Hankins ◽  
Mahmoud S. Ahmed

1989 ◽  
Vol 2 (1) ◽  
pp. 2-12 ◽  
Author(s):  
Bruce M. Frey ◽  
James O'Donnell

The use of drugs in pregnant and lactating women requires a thorough understanding of the unique interactions between the mother, fetus/infant, and the pharmacologic agents that are used in therapy. Any agent that is consumed by a woman may have adverse effects on the fetus/infant. This article will summarize those factors that should be considered. There exists a paucity of data and information for most drugs relative to pregnancy and lactation. Conclusions that can be drawn remain speculative, and the use of any drug during pregnancy and lactation requires extreme caution. Factors involved in fetal drug exposure include the dynamic changes of maternal physiology related to drug absorption, distribution, metabolism, and excretion. Placental transfer of drug occurs with almost all agents, each to varying degrees. The notion that the placenta provides an impervious barrier must be dismissed. The least understood of factors involving potential fetal harm is teratogenicity. The mechanisms and types of teratogenic agents, poorly understood in humans, is discussed. Most drugs appear in the breast milk and, therefore, carry some degree of potential harm. Minimizing exposure is a goal that can be obtained when taking into account the maternal physiology, basic pharmacokinetic factors, physiochemical interactions between drug and membranes, and the chemical composition of breast milk.


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