RESUMEN
Depression is common in pregnant women. However, the rate of antidepressant treatment in pregnancy is significantly lower than in nonpregnant women. Although some antidepressants may cause potential risks to the fetus, not treating or withdrawing the treatment is associated with relapsing and adverse pregnancy outcomes such as preterm birth. Pregnancy-associated physiologic changes can alter pharmacokinetics (PK) and may impact dosing requirements during pregnancy. However, pregnant women are largely excluded from PK studies. Dose extrapolation from the nonpregnant population could lead to ineffective doses or increased risk of adverse events. To better understand PK changes during pregnancy and guide dosing decisions, we conducted a literature review to catalog PK studies of antidepressants in pregnancy, with a focus on maternal PK differences from the nonpregnant population and fetal exposure. We identified 40 studies on 15 drugs, with most data from patients taking selective serotonin reuptake inhibitors and venlafaxine. Most of the studies have relatively poor quality, with small sample sizes, reporting concentrations at delivery only, a large amount of missing data, and not including times and adequate dose information. Only four studies collected multiple samples following a dose and reported PK parameters. In general, there are limited data available regarding PK of antidepressants in pregnancy and deficiencies in data reporting. Future studies should provide accurate information on drug dosing and timing of dose, PK sample collection, and individual-level PK data.
Asunto(s)
Nacimiento Prematuro , Recién Nacido , Embarazo , Femenino , Humanos , Antidepresivos , Clorhidrato de Venlafaxina , Inhibidores Selectivos de la Recaptación de Serotonina , FetoRESUMEN
OBJECTIVE: To determine whether women know their own cervical cancer screening recommendations after hysterectomy, and to evaluate patients' understanding of hysterectomy terminology and cervical cancer screening. METHODS: A 19-item questionnaire was developed and administered to 413 women who had undergone minimally invasive hysterectomy with benign pathology between January 2008 and January 2012. RESULTS: A total of 190 women (46%) participated in the survey. The majority of respondents were Caucasian (61%) and had a college education (66%). Fifty-nine percent of respondents knew that a Pap test screens for cervical cancer, and 40% knew that HPV is related to cervical cancer. Eight-four percent understood that Pap screening is recommended if a woman still has a cervix after hysterectomy. Only 67% correctly identified if their cervix had been removed during their own surgery and if they needed future cervical cancer screening per current guidelines. Caucasian race and higher income were significant predictors of hysterectomy and screening knowledge. CONCLUSION: Knowledge regarding Pap tests, HPV, and implications of a supracervical hysterectomy is lacking, even among a post-hysterectomy population. PRACTICAL IMPLICATIONS: Patient educational information is needed to improve perioperative counseling regarding the type of hysterectomy performed and indications for future cervical cancer screening.