scholarly journals The risk of polypharmacy, comorbidities and drug–drug interactions in women of childbearing age with multiple sclerosis

2020 ◽  
Vol 13 ◽  
pp. 175628642096950
Author(s):  
Niklas Frahm ◽  
Michael Hecker ◽  
Silvan Elias Langhorst ◽  
Pegah Mashhadiakbar ◽  
Marie-Celine Haker ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Drug Interactions ◽  
Clinical Decision ◽  
Women Of Childbearing Age ◽  
Potential Ddis ◽  
Childbearing Age ◽  
Exact Test ◽  
Patient Interviews ◽  
Concurrent Use ◽  
Degree Of Disability

Background and Aims: Multiple sclerosis (MS) is the most common neuroimmunological disease of the central nervous system in young adults. Despite recommended contraception, unplanned pregnancies can occur in women of childbearing age with MS. MS- and comorbidities-related multimedication in these patients represents a potential risk. We aimed to raise awareness regarding the frequency of polypharmacy and drug–drug interactions (DDIs) in female MS patients of childbearing age. Methods: Sociodemographic, clinical and pharmaceutical data were collected through patient records, clinical investigations and structured patient interviews of 131 women with MS. The clinical decision support software MediQ was used to identify potential DDIs. A medication and DDI profile of the study population was created by statistical analysis of the recorded data. Results: Of the 131 female MS patients, 41.2% were affected by polypharmacy (concurrent use of ⩾5 drugs). Polypharmacy was associated with higher age, higher degree of disability, chronic progressive MS disease course and comorbidities. With an average intake of 4.2 drugs per patient, a total of 1033 potential DDIs were identified. Clinically relevant DDIs were significantly more frequent in patients with polypharmacy than in patients without polypharmacy (31.5% versus 5.2%; Fisher’s exact test: p < 0.001). Conclusion: For the first time, a comprehensive range of potential DDIs in women of childbearing age with MS is presented. Polypharmacy is associated with the occurrence of clinically relevant DDIs. This shows the need for effective and regular screening for such interactions in order to prevent avoidable adverse effects.

scholarly journals The Role of Postpartum Intravenous Corticosteroids in the Prevention of Relapses in Multiple Sclerosis

2011 ◽  
Vol 13 (2) ◽  
pp. 91-93 ◽  
Author(s):  
Jose Avila-Ornelas ◽  
Mirla Avila ◽  
Milena Stosic ◽  
Liliana Robles ◽  
Pilar Guillermo Prieto ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Retrospective Study ◽  
Relapse Rate ◽  
Women Of Childbearing Age ◽  
Childbearing Age ◽  
Intravenous Methylprednisolone ◽  
Secondary Progressive ◽  
Relapsing Remitting ◽  
The Difference

Multiple sclerosis (MS) is most prevalent in women of childbearing age. It is well established that the relapse rate decreases during pregnancy but increases significantly during the first postpartum trimester. The objective of this retrospective study was to evaluate the effectiveness of the administration of 1 g of intravenous methylprednisolone (IVMP) after delivery in the prevention of MS relapses. The study involved 47 women with one or more documented pregnancies; each pregnancy was treated as a separate case. There were 50 cases with relapsing-remitting MS and 2 with secondary progressive MS. The cases were divided into two groups: the IVMP group (those who received 1 g of IVMP after delivery) and the no-IVMP group (those who did not receive IVMP after delivery). There were 39 cases in the IVMP group and 13 in the no-IVMP group. During the first postpartum trimester, relapses occurred in 17.9% of the IVMP group, compared with 46.2% of the no-IVMP group (P = .0448). The difference in relapse percentage between the two groups during the second and third postpartum trimesters was not statistically significant. Our study shows a statistically significant benefit of postpartum IVMP administration in reducing MS relapses.

Pharmacotherapeutic Issues for Women of Childbearing Age with Epilepsy

1998 ◽  
Vol 32 (7-8) ◽  
pp. 794-801 ◽  
Author(s):  
Shu-Ing Chang ◽  
James W McAuley
Keyword(s):  
Drug Interactions ◽  
Antiepileptic Drug ◽  
Antiepileptic Drugs ◽  
Seizure Activity ◽  
Clinical Symptoms ◽  
Pharmacy Practice ◽  
Women Of Childbearing Age ◽  
Childbearing Age ◽  
Medline Search ◽  
Drug Concentrations

James W McAuley BSPharm PhD, Assistant Professor of Pharmacy Practice and Administration and Neurology, Colleges of Pharmacy and Medicine, The Ohio State University OBJECTIVE: To provide an overview of key pharmacotherapeutic issues in epilepsy for the woman of childbearing potential. DATA SOURCES: A MEDLINE search (1966–1997) was done to identify pertinent literature. Chapters in epilepsy textbooks, pregnancy registries, and their respective bibliographies were also evaluated. STUDY SELECTION AND DATA EXTRACTION: All identifiable sources written in English were evaluated. DATA SYNTHESIS: Epilepsy is a common neurologic disorder. It is estimated that nearly 1 million American women of childbearing age have epilepsy. There are many women's health issues in epilepsy. These include menstrual cycle influences on seizure activity, contraceptive–antiepileptic drug interactions, pharmacokinetic changes during pregnancy, teratogenicity of antiepileptic drugs, breast-feeding, and quality of life. These issues challenge both the woman with epilepsy and the many healthcare providers involved in her care. This article reviews these issues and makes recommendations. It addresses both the first-generation antiepileptic drugs (phenobarbital, phenytoin, carbamazepine, valproic acid) and the newer or second-generation agents (felbamate, gabapentin, lamotrigine, topiramate, tiagabine). CONCLUSIONS/RECOMMENDATIONS: Drug interactions between enzyme-inducing antiepileptic drugs and contraceptives are well documented. Higher doses of oral contraceptives or a second contraceptive method are suggested if epileptic women use an enzyme-inducing antiepileptic drug. Planned pregnancy is highly recommended and counseling before conception is crucial. Prepregnancy counseling should include, but is not limited to, folic acid supplementation, optimal control of seizure activity, monotherapy with the lowest effective antiepileptic drug dose, and medication adherence. Patient information should be provided about the risk of teratogenicity and the importance of prenatal care. Antiepileptic drug dosage adjustments may be necessary and should be based on clinical symptoms, not solely on serum drug concentrations. While the future holds promise for many aforementioned women's issues in epilepsy, many questions remain to be answered.

scholarly journals Assessing Drug-Drug Interaction Potential among Patients Admitted to Surgery Departments in Three Palestinian Hospitals

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Abdullah K. Rabba ◽  
Ayeshe M. Abu Hussein ◽  
Bayan K. Abu Sbeih ◽  
Somaya I. Nasser
Keyword(s):  
Drug Interactions ◽  
Clinical Decision ◽  
Cross Sectional Study ◽  
Study Patient ◽  
Bivariate Analysis ◽  
Potential Ddis ◽  
Cross Sectional ◽  
Surgical Department ◽  
Hospitalization Period ◽  
Hospital Patients

Background. Drug-drug interactions (DDIs) are a common issue that leads to adverse drug reactions in hospitals. Patients in the surgical department are expected to have potential DDIs that may lead to morbidity and mortality. Objectives. To study potential DDI prevalence in the surgery departments in 3 hospitals in Palestine. Moreover, to identify pertinent factors that are associated with drug-drug interactions. Method. A cross-sectional study in 3 governmental Palestinian hospitals: Palestine Medical Complex, Rafidia Hospital, and Beit Jala Hospital. Patients who are 20 years old or above and admitted to the surgical wards between September 2017 and February 2018 were included in the study. Patient demographics, all medications given in the hospital, and hospitalization period were obtained from medical files. The digital clinical decision support system Micromedex® was used for analysis and classification of possible drug interactions. Bivariate analysis and logistic regression were used to study the risk factors for developing DDIs. Results. 502 patients were included in this report. The prevalence of potential DDIs among patients admitted to surgery wards in three Palestinian hospitals was 56%. The number of detected potential DDIs per patient was 2.22±3.76. The number of prescribed medications (P<0.001) was found to increase the possibility of having drug interactions. Conclusions. DDIs in Palestinian hospitals are a prevalent problem, and caution should be taken when ordering medications to hospitalized patients in surgery departments.

scholarly journals Hubungan Pemanfaatan Sumber Informasi Dengan Sikap Wanita Usia Subur Tentang Kesehatan Reproduksi

2021 ◽  
Vol 10 (1) ◽  
pp. 1
Author(s):  
Ekawaty Prasetya ◽  
Siti Surya Indah Nurdin ◽  
Zul Fikar Ahmad
Keyword(s):  
Reproductive Health ◽  
Health Information ◽  
Information Sources ◽  
Cross Sectional Study ◽  
P Value ◽  
Women Of Childbearing Age ◽  
Childbearing Age ◽  
Cross Sectional ◽  
Exact Test ◽  
Health Information Sources

Reproductive health is a state of complete physical, mental and social well-being all aspects related to the reproductive system, its functions and processes. This study aims of the study to determine the relationship between the use of information sources and the attitudes of women of childbearing age about reproductive health. This study was conducted in the Working Area of the East City Health Center in 2020. This study is a quantitative analytic with a cross sectional study design. Samples was selected used purposive sampling. Sample sizes is 67 woman. Data analysis used Fisher's Exact Test. The results showed that out of 67 respondents, those who did not utilize health information sources had the highest distribution of 74.1%. Unfavorable attitudes towards reproductive health have the highest distribution of 46.3%. The results of the bivariate analysis showed that there was a significant relationship between the use of health information sources and the attitudes of women of childbearing age about reproductive health (p-Value = 0.000). Utilization of health information sources should be maximized to increase positive attitudes towards reproductive health.Kesehatan Reproduksi merupakan keadaan kesejahteraan fisik, mental, dan sosial yang utuh dalam segala aspek yang berhubungan dengan sistem reproduksi, fungsi, serta prosesnya. Penelitian ini bertujuan untuk mengetahui hubungan pemanfaatan sumber informasi dengan sikap wanita usia subur tentang kesehatan reproduksi. Penelitian ini dilaksanakan di Wilayah Kerja Puskesmas Kota Timur pada tahun 2020. Penelitian ini merupakan penelitian analitik kuantitatif dengan rancangan cross sectional study. Sampel penelitian dipilih dengan menggunakan purposive sampling. Jumlah sampel sebanyak 67 orang. Analisis data menggunakan Fishert Exact Test. Hasil penelitian menunjukkan bahwa dari 67 orang responden bahwa yang tidak memanfaatkan sumber informasi kesehatan memiliki distribusi tertinggi yaitu sebesar 74,1%. Sikap kurang baik terhadap kesehatan reproduksi memiliki distribusi tertinggi yaitu sebesar 46,3%. Hasil analisis bivariat menunjukkan bahwa terdapat hubungan yang signifikan anatar pemanfaatan sumber informasi kesehatan dengan sikap wanita usia subur tentang kesehatan reproduksi (p-Value = 0,000).  Pemanfaatkan sumber informasi kesehatan harus dimaksimalkan untuk meningkatkan sikap positif terhadap kesehatan reproduksi.

Pregnancy outcome in women with multiple sclerosis: results from a prospective nationwide study in Finland

2010 ◽  
Vol 16 (8) ◽  
pp. 950-955 ◽  
Author(s):  
A. Jalkanen ◽  
A. Alanen ◽  
L. Airas ◽  
Keyword(s):  
Multiple Sclerosis ◽  
Early Pregnancy ◽  
Artificial Insemination ◽  
Pregnancy Complications ◽  
Expanded Disability Status Scale ◽  
Women Of Childbearing Age ◽  
Childbearing Age ◽  
Nationwide Study ◽  
Medical Birth Register ◽  
Disability Status

The majority of individuals obtaining the diagnosis of multiple sclerosis are women of childbearing age. They are naturally concerned as to how multiple sclerosis affects the course of pregnancy and the developing foetus. The objective of this study was to prospectively evaluate the incidence of pregnancy complications and delivery risks, and to follow the natural course of multiple sclerosis during and after pregnancy in a cohort of Finnish patients with multiple sclerosis. Sixty-one patients with multiple sclerosis who became pregnant during the years 2003—2005 were prospectively followed-up from early pregnancy until 6 months postpartum. Multiple sclerosis relapses, Expanded Disability Status Scale rates and obstetric details were recorded. The results were compared with the statistics obtained from Finnish Medical Birth Register from the year 2004. We found that patients with multiple sclerosis were no more likely to experience pregnancy complications than Finnish pregnant women generally, but they had a greater likelihood for a need of artificial insemination (4.9% vs. 0.9%; p = 0.0009). Subjects with multiple sclerosis were more likely to undergo assisted vaginal delivery than the at-large cohort(16.4% vs. 6.5%; p = 0.0017). We conclude that pregnancy does not seem to pose a woman with multiple sclerosis to a greater risk for pregnancy complications when compared with women in general. The potential need for instrumental delivery should, however, be taken into account when planning the delivery of a mother with multiple sclerosis.

scholarly journals PENGGUNAAN METODE KONTRASEPSI PADA WANITA USIA SUBUR DENGAN SIKLUS MENSTRUASI DI PUSKESMAS

2019 ◽  
Vol 7 (2) ◽  
Author(s):  
Novia Purwaningsih Sailan ◽  
Gresty Masi ◽  
Rina Kundre
Keyword(s):  
Menstrual Cycle ◽  
Health Center ◽  
Survey Design ◽  
Women Of Childbearing Age ◽  
Contraceptive Methods ◽  
Childbearing Age ◽  
Exact Test ◽  
Cycle Disorders ◽  
Relationship Of ◽  
The Relationship

Abstrack : A number of women complained that of use contraceptive methods causedmenstrual problems. These problem can include having no periods at all until heavy andprolonged periods. The Purpose : this study to determine the relationship of the use ofcontraceptive methods in women of cycle. In the health center of Balehumara, KelurahanBalehumara Kecamatan Tagulandang. The Research Design : the analytical survey that isused is with the cohort survey design. This research was conducted at the Balehumara PublicHealth Center in February – March 2109. The number of samples was 53 respondents, theresearch instrument used observetion sheets. The Results Research : based on result the tetsstatitic with use result fisher exact tets in the get the user cpntraception methods that toexperience change cycle menstrual as much (68,8%) and not experince change cycly menstrualas much (31,3%) and in where scrore p =0,005 < a 0,05. The Conclusion: there is significantrelationship between the use of contraceptive methods in women of childbearing age withmenstrual cycle disorders in Balehumara Health Center.Keywords : Menstrual Cycle Disorsers, Contraceptive Methode UsersAbstrak : Sejumlah perempuan mengeluhkan pemakaian metode kontrasepsi menyebabkanmasalah menstruasi. Masalah tersebut dapat berupa tidak mengalami menstruasi sama sekalisampai menstruasi berat dan berkepanjang. Tujuan : penelitian ini untuk mengetahuiHubungan Penggunaan Metode Kontrasepsi Pada Wanita Usia Subur Dengan SiklusMenstruasi Di Puskesmas Balehumara Kelurahan Balehumara Kecamatan Tagulandang Induk.Desain Penelitian : yang di gunakan yaitu survei analitik dengan rancangan Survei Cohort.Penelitian ini di lakukan di Puskesmas Balehumara pada bulan Februari – Maret 2019. Jumlahsampel 53 orang responden, Instrumen penelitian menggunakan lembar Observasi. HasilPenelitian : Berdasarkan hasil uji statistik dengan mengunkan uji Fisher’s Exact Test didapatkan penggunaan alat kontrasepsi yang mengalami perubahan siklus menstruasi sebanyak(68,8%), dan tidak mengalami perubahan sebanyak (31,3%), dan di mana nilai p = 0,005 < a0,05. Kesimpulan : terdapat hubungan yang signifikan antara penggunaan metode kontrasepsipada wanita usia subur dengan gangguan siklus menstruasi di Puskesmas Balehumara.Kata Kunci : Gangguan Siklus Menstruasi, Penggunaan Metode Kontrasepsi

Multiple Sclerosis

2017 ◽  
Author(s):  
Tamara B. Kaplan ◽  
Marcelo Matiello
Keyword(s):  
Multiple Sclerosis ◽  
Breast Feeding ◽  
Relapse Rate ◽  
Large Scale ◽  
First Trimester ◽  
Women Of Childbearing Age ◽  
Childbearing Age ◽  
Third Trimester ◽  
Disease Modifying Therapies ◽  
Animal Data

Multiple sclerosis (MS) often affects women of childbearing age. There are many issues to consider when counseling women about their disease and treatment during this time. The Pregnancy in Multiple Sclerosis (PRIMS) study, published in 1998, is the best large-scale prospective study published to date. Based on this trial, and those that followed, it is recognized that the rate of relapse in MS decreases during pregnancy, especially during the third trimester, but there is a significant increase in relapse rate in the first three months postpartum. If relapses do occur during pregnancy, women are often treated with methylprednisolone, but this is generally avoided in the first trimester. Disease-modifying therapies (DMTs) are usually discontinued during preconception, pregnancy, and while breast-feeding. DMTs are classified under different FDA pregnancy categories based on human and animal data. Breast-feeding may influence postpartum relapse rate, but the true effect continues to be debated.

Pregnancy and Multiple Sclerosis

2013 ◽  
Author(s):  
Aaron E. Miller ◽  
Teresa M. DeAngelis
Keyword(s):  
Multiple Sclerosis ◽  
Family Planning ◽  
Disease Management ◽  
Postpartum Period ◽  
Key Management ◽  
Psychosocial Support ◽  
Women Of Childbearing Age ◽  
Childbearing Age ◽  
Management Issues

The risk of MS relapse is lower during pregnancy but significantly higher in the postpartum period. There are several key management issues to address in women of childbearing age with multiple sclerosis who are pregnant or in family planning. In this chapter, we review important therapeutic issues regarding peripartum and postpartum disease management, data regarding the prospect of breastfeeding, and the psychosocial support and counseling to help patients and their families navigate these decisions.

scholarly journals Multiple sclerosis and related challenges to young women's health: Canadian expert review

2020 ◽  
Vol 10 (2s) ◽  
pp. 1-13
Author(s):  
Galina Vorobeychik ◽  
Denise Black ◽  
Paul Cooper ◽  
Ashley Cox
Keyword(s):  
Multiple Sclerosis ◽  
Young Women ◽  
Neurological Diseases ◽  
Holistic Approach ◽  
Variable Degree ◽  
Childbearing Age ◽  
Permanent Disability ◽  
Expert Review ◽  
Degree Of Disability

Multiple sclerosis (MS) is among the most common chronic neurological diseases, with a highly variable degree of disability during its long-term course. The majority of patients develop significant permanent disability later in life. MS is often diagnosed in women of childbearing age, with a 3:1 ratio of young women to young men with MS. Comorbidities such as depression, anxiety, migraines and reproductive, urological and bowel issues are common and negatively impact patients' quality of life. The objective of this supplement is to review the most common comorbidities occurring in young women with MS, and to propose a multidisciplinary, holistic approach to management.

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