Drug Therapy in Pregnancy and Lactation

1989 ◽  
Vol 2 (1) ◽  
pp. 2-12 ◽  
Author(s):  
Bruce M. Frey ◽  
James O'Donnell
Keyword(s):  
Breast Milk ◽  
Drug Exposure ◽  
Placental Transfer ◽  
Dynamic Changes ◽  
Potential Harm ◽  
Extreme Caution ◽  
Pregnancy And Lactation ◽  
Fetal Drug Exposure ◽  
Almost All ◽  
Pharmacologic Agents

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.

Methodological Approaches to Evaluate Fetal Drug Exposure

2019 ◽  
Vol 25 (5) ◽  
pp. 496-504 ◽  
Author(s):  
Naïm Bouazza ◽  
Frantz Foissac ◽  
Déborah Hirt ◽  
Saïk Urien ◽  
Sihem Benaboud ◽  
...  
Keyword(s):  
Cord Blood ◽  
Drug Exposure ◽  
Placental Transfer ◽  
Ex Vivo ◽  
Pharmacokinetic Analysis ◽  
Population Pharmacokinetic ◽  
Pbpk Models ◽  
Drug Concentrations ◽  
Fetal Drug Exposure

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.

Modeling COVID-19 Growing Trends to Reveal the Differences in the Effectiveness of Non-Pharmaceutical Interventions among Countries in the World (Preprint)

2020 ◽  
Author(s):  
You Chen ◽  
Yubo Feng ◽  
Chao Yan ◽  
Xinmeng Zhang ◽  
Cheng Gao
Keyword(s):  
Secondary Analysis ◽  
Reproduction Rate ◽  
Cumulative Number ◽  
Linear Regression Models ◽  
Growth Data ◽  
Dynamic Changes ◽  
The World ◽  
Four Levels ◽  
Almost All ◽  
Pharmaceutical Interventions

BACKGROUND Adopting non-pharmaceutical interventions (NPIs) can affect COVID-19 growing trends, decrease the number of infected cases, and thus reduce mortality and healthcare demand. Almost all countries in the world have adopted non-pharmaceutical interventions (NPIs) to control the spread rate of COVID-19; however, it is unclear what are differences in the effectiveness of NPIs among these countries. OBJECTIVE We hypothesize that COVID-19 case growth data reveals the efficacy of NPIs. In this study, we conduct a secondary analysis of COVID-19 case growth data to compare the differences in the effectiveness of NPIs among 16 representative countries in the world. METHODS This study leverages publicly available data to learn patterns of dynamic changes in the reproduction rate for sixteen countries covering Asia, Europe, North America, South America, Australia, and Africa. Furthermore, we model the relationships between the cumulative number of cases and the dynamic reproduction rate to characterize the effectiveness of the NPIs. We learn four levels of NPIs according to their effects in the control of COVID-19 growth and categorize the 16 countries into the corresponding groups. RESULTS The dynamic changes of the reproduction rate are learned via linear regression models for all of the studied countries, with the average adjusted R-squared at 0.96 and the 95% confidence interval as [0.94 0.98]. China, South Korea, Argentina, and Australia are at the first level of NPIs, which are the most effective. Japan and Egypt are at the second level of NPIs, and Italy, Germany, France, Netherlands, and Spain, are at the third level. The US and UK have the most inefficient NPIs, and they are at the fourth level of NPIs. CONCLUSIONS COVID-19 case growth data provides evidence to demonstrate the effectiveness of the NPIs. Understanding the differences in the efficacy of the NPIs among countries in the world can give guidance for emergent public health events. CLINICALTRIAL NA

Eplerenone levels in maternal serum, cord blood, and breast milk during pregnancy and lactation

2021 ◽  
Author(s):  
Jumpei Saito ◽  
Asako Mito ◽  
Naho Yakuwa ◽  
Kayoko Kaneko ◽  
Hiroyo Kawasaki ◽  
...  
Keyword(s):  
Breast Milk ◽  
Cord Blood ◽  
Maternal Serum ◽  
Pregnancy And Lactation

scholarly journals Lutein concentration in human milk during early lactation and its relationship with dietary lutein intake

2009 ◽  
Vol 12 (10) ◽  
pp. 1878-1884 ◽  
Author(s):  
Hellas Cena ◽  
Anna Maria Castellazzi ◽  
Amedeo Pietri ◽  
Carla Roggi ◽  
Giovanna Turconi
Keyword(s):  
Breast Milk ◽  
Human Milk ◽  
Maternal Plasma ◽  
Cross Sectional Study ◽  
Early Lactation ◽  
Dietary Recommendations ◽  
Mature Milk ◽  
Cross Sectional ◽  
Pregnancy And Lactation ◽  
Age Range

AbstractObjectiveThe present study aimed to estimate the lutein concentration in human milk during early lactation and its relationship with dietary lutein intake measured through the administration of a short FFQ.DesignA cross-sectional study in which an FFQ was administered twice: on day 3 (T0) and day 30 (T1) postpartum; meanwhile two breast milk samples were collected. Maternal plasma samples were obtained at T0. The comparison of dietary lutein intakes and likewise lutein concentrations in breast milk at T0 and T1 were analysed with Student’sttest. Pearson’s correlation coefficient was used to determine the association between dietary lutein intake and lutein concentration in milk and plasma, respectively, as well as the correlation between breast milk and plasma lutein concentrations at T0.SettingPavia, northern Italy.SubjectsTwenty-one pregnant women, age range 24–42 years, were recruited during their last trimester on a voluntary basis.ResultsBoth breast milk and plasma lutein concentrations were significantly correlated with dietary lutein intake (r= 0·86,P= 0·0001 andr= 0·94,P= 0·0001, respectively). There was a clear significant correlation between milk and plasma lutein concentrations (r= 0·87,P= 0·0001). Mature milk lutein concentration, although significantly reduced at T1 (P< 0·01), maintained a fairly high correlation with dietary lutein intake (r= 0·82,P= 0·0001).ConclusionsEven though milk lutein concentration decreased during early lactation, it remained significantly correlated with daily lutein intake. Therefore, while awaiting further research, dietary recommendations advising intake of fresh fruit and vegetables rich in lutein, throughout the whole duration of pregnancy and lactation, are extremely useful.

The Placenta as a Functional Barrier to Fetal Drug Exposure

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

Psychotropic Drugs in Pregnancy and Lactation

PEDIATRICS ◽  
1982 ◽  
Vol 69 (2) ◽  
pp. 241-244
Author(s):  
Sydney Segal ◽  
Albert W. Pruitt ◽  
Walter R. Anyan ◽  
Reba M. Hill ◽  
Ralph E. Kauffman ◽  
...  
Keyword(s):  
Psychotropic Drugs ◽  
Structural Changes ◽  
Drug Exposure ◽  
Final Decision ◽  
Behavioral Alterations ◽  
Drug Dosing ◽  
Behavioral Studies ◽  
Increased Risk ◽  
Pregnancy And Lactation

Accurate prediction of fetal/neonatal risks following maternal psychotropic drug consumption by the human will require much additional study. Based upon our present understanding of fetal exposure to psychotropic drugs, there would appear to be an increased risk for spontaneous malformations in the case of lithium. There have been inconsistent reports of structural abnormalities following exposure to phenothiazines and benzodiazepines. In animal models that demonstrate structural changes due to neuroleptic exposure, in general, extremely large dosages of medication had been given. Thus, their correlative value is limited. Behavioral alterations in animals following drug exposure during pregnancy tend to support increased concerns about the safety of psychotropic drugs for the fetus but cannot be used alone in making a final decision. Behavioral studies evaluating drugs in breast milk have been restricted to experimental animals; hence, the associated risks from this form of drug dosing in man remain unknown. At present, neither gross anatomic nor motor side effects have been apparent in the infant. The question of the development of subtle behavioral changes as a long-term consequence will remain undetermined until careful assessments have been completed.

scholarly journals #25 Transfer of triptans into human breast milk and estimation of infant drug exposure through breastfeeding

2019 ◽  
Vol 88 ◽  
pp. 141
Author(s):  
Siri Amundsen ◽  
Hedvig Nordeng ◽  
Ole-Martin Fuskevåg ◽  
Elisabet Nordmo ◽  
Georg Sager ◽  
...  
Keyword(s):  
Breast Milk ◽  
Drug Exposure ◽  
Human Breast Milk ◽  
Human Breast

scholarly journals Maternal Intake of Cow’s Milk during Lactation Is Associated with Lower Prevalence of Food Allergy in Offspring

Nutrients ◽  
2020 ◽  
Vol 12 (12) ◽  
pp. 3680
Author(s):  
Mia Stråvik ◽  
Malin Barman ◽  
Bill Hesselmar ◽  
Anna Sandin ◽  
Agnes E. Wold ◽  
...  
Keyword(s):  
Food Allergy ◽  
Breast Milk ◽  
Maternal Diet ◽  
Maternal Blood ◽  
Cow’S Milk ◽  
Lower Prevalence ◽  
Food Frequency ◽  
Lactating Women ◽  
Cow's Milk ◽  
Pregnancy And Lactation

Maternal diet during pregnancy and lactation may affect the propensity of the child to develop an allergy. The aim was to assess and compare the dietary intake of pregnant and lactating women, validate it with biomarkers, and to relate these data to physician-diagnosed allergy in the offspring at 12 months of age. Maternal diet during pregnancy and lactation was assessed by repeated semi-quantitative food frequency questionnaires in a prospective Swedish birth cohort (n = 508). Fatty acid proportions were measured in maternal breast milk and erythrocytes. Allergy was diagnosed at 12 months of age by a pediatrician specialized in allergy. An increased maternal intake of cow’s milk during lactation, confirmed with biomarkers (fatty acids C15:0 and C17:0) in the maternal blood and breast milk, was associated with a lower prevalence of physician-diagnosed food allergy by 12 months of age. Intake of fruit and berries during lactation was associated with a higher prevalence of atopic eczema at 12 months of age. Our results suggest that maternal diet modulates the infant’s immune system, thereby influencing subsequent allergy development.

Exercise and Lactation: Are They Compatible?

2001 ◽  
Vol 26 (1) ◽  
pp. 55-74 ◽  
Author(s):  
Gale B. Carey ◽  
Timothy J. Quinn
Keyword(s):  
Breast Milk ◽  
Maternal Health ◽  
Growth And Development ◽  
Well Being ◽  
Milk Composition ◽  
Infant Growth ◽  
Cardiovascular Fitness ◽  
Milk Volume ◽  
Exercising Women ◽  
Pregnancy And Lactation

Lactation is an energy-demanding physiological process for the maternal organism and life-giving for the offspring. Likewise, exercise is an energy-demanding process. This review addresses the Compatibility of exercise during lactation. Human studies suggest no detrimental effect of exercise during lactation on milk composition and volume, infant growth and development, or maternal health. Studies also demonstrate improved cardiovascular fitness in lactating, exercising women and suggest a quicker return to pre-pregnancy body weight and a more positive sense of well-being, compared to sedentary controls. Findings from rodent studies, although of questionable value for humans, have generally shown no detrimental influence of exercise during pregnancy and lactation on pup growth and development. To date, findings suggest that exercise and lactation are compatible activities. Key words: maternal health, infant growth, breast milk composition, breast milk volume, cardiovascular fitness

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