RESUMEN
PURPOSE: To elucidate the status of medication use among pregnant women in Japan, by means of a multigenerational genome and birth cohort study: the Tohoku Medical Megabank Project Birth and Three-Generation Cohort Study (TMM BirThree Cohort Study). METHODS: Questionnaires were distributed to pregnant women participating in the TMM BirThree Cohort Study (from July 2013 to March 2017) around 12 weeks (early pregnancy) and 26 weeks (middle pregnancy). We analysed medication use over three periods: (1) 12 months prior to pregnancy diagnosis, (2) the period between pregnancy diagnosis and around week 12 of pregnancy, and (3) post around week 12 of pregnancy. RESULTS: In total, 19,297 women were included in the analysis. The proportion of pregnant women using medications was 49.0% prior to pregnancy diagnosis, 52.1% from diagnosis to week 12, and 58.4% post week 12 of pregnancy. The most frequently prescribed medications were loxoprofen sodium hydrate (5.5%) prior to pregnancy diagnosis, magnesium oxide (5.9%) from diagnosis to week 12, and ritodrine hydrochloride (10.5%) post week 12 of pregnancy. The number of women who used suspected teratogenic medications during early pregnancy was 96 prior to pregnancy diagnosis, 48 from diagnosis to week 12, and 54 post week 12 of pregnancy. CONCLUSION: We found that ~ 50% of the pregnant women used medications before and during pregnancy and some took potential teratogenic medications during pregnancy. In birth genomic cohort study, it is expected that investigations into the safety and effectiveness of medications used during pregnancy will advance.
Asunto(s)
Preparaciones Farmacéuticas , Adulto , Femenino , Humanos , Embarazo , Estudios de Cohortes , Japón , Encuestas y CuestionariosRESUMEN
OBJECTIVES: (1) Describe contraception use in women with systemic lupus erythematosus (SLE); (2) characterize the types of contraception used by this population; (3) determine factors affecting the documentation of contraception use; (4) identify if contraception counseling was received in this population at risk for adverse pregnancy outcomes. STUDY DESIGN: This cross-sectional study analyzed data from clinic visits from 2016 - 2018 among 453 women of reproductive age who have SLE. Documentation of contraception use, contraception method, contraception counseling, and other medication use were abstracted from the medical record and analyzed with percentage based statistics, chi-squared test, t-test, and logistic regression. RESULTS: Of the 453 women included in the analysis, 71% had a method of contraception documented within 2 years of the study period. Only 37% were using highly effective contraception. 78% had documentation of contraception counseling. Half (50%) were using teratogenic medications; patients on teratogenic medications had higher odds of having a contraceptive method documented (OR 1.56, 95% CI 1.04 - 2.36) however 24% did not have any contraception documented. 28% of patients were using contraception for which they had a possible or absolute contraindication. CONCLUSIONS: Given a substantial proportion of women with SLE did not have any contraception or contraceptive counseling documented, these findings suggest the need to improve universal reproductive health counseling in patients with SLE. IMPLICATIONS: There is room to improve reproductive health care in patients with SLE through provider training to help optimize pregnancy outcomes in this high-risk population.
Asunto(s)
Anticonceptivos , Lupus Eritematoso Sistémico , Anticoncepción , Consejo , Estudios Transversales , Servicios de Planificación Familiar , Femenino , Humanos , EmbarazoRESUMEN
Women with chronic kidney disease (CKD) are faced with complex decisions and significant challenges during their reproductive years. Contraceptive choices have a variety of side effects that can disproportionately affect women with CKD, limiting choice. CKD itself and the therapies needed to treat severe disease can affect future fertility. When conception is desired, young women with CKD must plan meticulously because an ill-timed pregnancy can result in disease progression or flare and exposure of an unborn child to potentially teratogenic medications. Among women with CKD, pregnancy risks are substantial, with up to 10-fold higher risk for preeclampsia and 6-fold higher risk for preterm delivery. These pregnancy complications associated with inadequate placentation also increase maternal and newborn risks for cardiovascular morbidity and mortality and progression to kidney failure later in life. As such, it is the obligation of every nephrologist caring for women of reproductive age to provide guidance in the choice of methods to prevent unplanned pregnancies, to choose treatments that preserve fertility, and to participate in shared decision making that optimizes pregnancy timing and outcomes. In this perspective, we review the many challenges associated with reproductive counseling in women with CKD.
Asunto(s)
Servicios de Planificación Familiar/métodos , Nefrólogos , Complicaciones del Embarazo/epidemiología , Insuficiencia Renal Crónica/epidemiología , Salud Reproductiva/normas , Salud de la Mujer , Femenino , Salud Global , Humanos , Morbilidad , EmbarazoRESUMEN
BACKGROUND: Teratogenic medications increase risks of miscarriage, fetal death, and/or birth defects. It is important to identify whether women of childbearing potential are taking these medications and to minimize exposure to these agents through change in drug therapy before conception and/or use of effective contraception to prevent conception. OBJECTIVE: To determine the utility of reproductive life plans as tools to identify women using potentially teratogenic medications. METHODS: A retrospective review was conducted on reproductive life plans completed by women receiving services as part of the Toledo-Lucas County Healthy Start program. The medication section of the reproductive life plan was reviewed to determine: if it was completed; categories of medications reported (prescription, over-the-counter, vitamin/herbal); potentially teratogenic medications listed; contraception use and method. RESULTS: Medication lists were completed for 437 of the 580 reproductive life plans reviewed (75%). Thirty-five women (8%) reported use of a potentially teratogenic medication; most commonly reported agents included blood pressure medications and antidepressants. Only 10 women taking a potentially teratogenic medication (29%) reported using some form of contraception, half of which reported use of a less effective method such as condoms. CONCLUSION: The reproductive life plan can be a useful tool to identify women of childbearing age who require intervention due to use of potentially teratogenic medications. Efforts are needed to ensure complete and accurate reporting of medication use in reproductive life plans, and to promote effective contraceptive use among women taking potentially teratogenic medications.