Medication decisions in pregnancy: A balancing act
Experts propose an ethics-based, evidence-backed approach to shared decision-making
2024-11-01
(Press-News.org)
Most women use medication during pregnancy. Yet, selecting appropriate drugs and doses is challenging. In a new The Lancet article, physicians and researchers from the Radboud university medical center, Maastricht UMC+, Imperial College London, and the University of Liverpool introduce a shared decision-making approach combining ethical principles and a pregnant woman’s values with existing evidence. They use the example of sertraline, a commonly prescribed antidepressant in pregnancy, to illustrate the advocated decision-making process.
Although pregnant women often need medication, data on drug safety and efficacy in pregnancy remains limited. Historically seen as vulnerable research subjects, pregnant women have been widely excluded from drug development and testing. The thalidomide scandal of the 1950s-60s, which caused severe birth defects in thousands of children, exposed the potential risks of administering medications to pregnant women without adequate evidence, prompting a highly cautious approach to prescribing drugs during pregnancy. However, withholding medication from a pregnant woman may indirectly harm both her and her child by compromising the mother’s health and well-being. Additionally, pregnant women may not receive balanced information about a medication’s risks and benefits or be fully involved in treatment decisions, potentially leading to suboptimal decision-making and avoidable harm.
‘The medical community urgently needs ethical and actionable models to help balance the benefits and risks of medications for individual pregnant patients and fetuses,’ says lead author Charlotte Koldeweij. The article outlines key ethical principles and provides practical steps to assist clinicians and pregnant women in making shared decisions on appropriate drug use and dosage, considering both available evidence and a woman’s personal values. This approach is exemplified for sertraline, an antidepressant that may be prescribed during pregnancy. Promoting the active participation of pregnant women in decisions about their treatment could help shift societal perceptions of their vulnerability and increase their inclusion in medical research, helping to address the current evidence gap.
This work is part of project MADAM (Model Adjusted Doses for All Mothers). In collaboration with the Dutch Teratology Information Service Lareb Moeders van Morgen, which compiles available information on medication safety during pregnancy and breastfeeding, researchers leverage virtual pregnancy models and insights from a multidisciplinary committee of experts and patients to develop tailored dose recommendations for pregnant women and fetuses for widely used medications. The project is supported by a grant from the Bill & Melinda Gates Foundation. ‘Our goal is to establish and promote the use of model-informed, pregnancy-adjusted doses, which requires gaining acceptance from clinicians and pregnant women,’ states project leader Saskia de Wildt.
About the publication
This article is published in The Lancet: Striving for balance in decisions on antenatal pharmacotherapy - Charlotte Koldeweij, Verna AAM Jans, Catriona Waitt, Rick Greupink, Kim LHE Vanden Auweele, Bryony D Franklin, Hubertina CJ Scheepers, Saskia N de Wildt.
Post-embargo link to the publication
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)02069-5/fulltext
END
ELSE PRESS RELEASES FROM THIS DATE:
2024-10-31
Summary:
Texas Tech’s Natasja van Gestel has been named Station Science Leader by the National Science Foundation (NSF), enabling her to lead and coordinate research at Antarctica’s Palmer Station while advancing her work on climate change’s impact on glaciers. As a leader, she will oversee multiple scientific initiatives, manage resources and ensure compliance with the Antarctic Treaty’s regulations.
Why This Matters:
Climate Study: Her research contributes vital data on climate change effects in Antarctica, crucial for global climate assessments.
International Collaboration: ...
2024-10-31
A low-sugar diet in utero and in the first two years of life can meaningfully reduce the risk of chronic diseases in adulthood, a new study has found, providing compelling new evidence of the lifelong health effects of early-life sugar consumption.
Published in Science, the study finds that children who experienced sugar restrictions during their first 1,000 days after conception had up to 35% lower risk of developing Type 2 diabetes and as much as 20% less risk of hypertension as adults. Low sugar intake by the mother prior to birth was enough to lower risks, but ...
2024-10-31
New Orleans - Ochsner Health physicians Dr. Richard Zweifler and Dr. Joseph Tarsia are co-authors on a post hoc analysis carried out in the ARCADIA randomized clinical trial, comparing the effectiveness of apixaban versus aspirin in preventing adverse clinical outcomes in patients with a history of cancer and cryptogenic stroke. The research found no significant difference in the risk of major ischemic and hemorrhagic events between those taking apixaban and aspirin. The ...
2024-10-31
Traditional solutions for sleep disorders, including medications and cognitive behavioral therapies, often provide insufficient relief for military personnel, a problem researchers from the University of Arizona College of Medicine – Tucson will be hoping to solve with a $3 million grant from the Department of Defense Congressionally Directed Medical Research Program.
Sleep problems are among the top health concerns of military personnel, with an estimated 85% meeting criteria for a clinically relevant sleep ...
2024-10-31
BALTIMORE, October 31, 2024— Kennedy Krieger Institute is proud to celebrate the 25th anniversary of the F.M. Kirby Research Center for Functional Brain Imaging at Kennedy Krieger Institute, a leader in advancements and research in understanding the human brain.
Established in 1999 in partnership with Johns Hopkins University School of Medicine, the center has transformed neuroscience and medical imaging by developing cutting-edge magnetic resonance imaging (MRI) techniques that allow researchers to examine and measure brain function and structure ...
2024-10-31
Researchers at the University of Arizona’s Mel and Enid Zuckerman College of Public Health received a $1.75 million Centers for Disease Control and Prevention grant to conduct a community-based, participatory research study designed to improve vaccine uptake in Arizona’s rural and border communities.
Vaccination is a highly effective public health intervention that saves millions of lives per year, yet vaccination rates have declined in recent years for a variety of reasons, ranging from safety concerns to religious and philosophical objections.
“Vaccination is a cornerstone of public health,” said co-principal investigator Tomas ...
2024-10-31
Macrophage cells are the immune system’s frontline soldiers, early on the scene to protect the body from foreign invaders. These cells answer the immune system's critical question for the rest of its troops: friend or foe?
As critical responders, macrophages can perceive helpful biotechnology as threats. If not created with the right materials or mechanical forces, these devices can trigger an immune response that can cause inflammation, scar tissue or device failure.
But what is the right material or the right mechanical force? In a meta-analysis co-led ...
2024-10-31
Beyond colorful coral reefs and diverse nearshore ecosystems, Pacific Ocean waters surrounding the Hawaiian Islands have comparatively little marine life and low biological productivity. New research published by University of Hawai‘i (UH) at Mānoa oceanographers showed that eddies on the leeward side of the Hawaiian Islands can supply nutrients, not only locally, but also to the opposite side of the island chain and stimulate blooms of phytoplankton, microscopic plant life that lives in the surface ocean.
The study, published in JGR Oceans, was selected by the American Geophysical Union’s editorial board as a featured article.
“While ...
2024-10-31
Rice University together with Baylor College of Medicine and the Houston Methodist Academic Institute has awarded seed grants in support of research on health equity and digital health.
Spearheaded by Rice’s Educational and Research Initiatives for Collaborative Health (ENRICH) office in collaboration with the two partnering institutions in the Texas Medical Center (TMC), the seed grant opportunity followed the Health Equity Workshop hosted earlier this year by Rice’s Digital Health Initiative.
“To achieve equitable health outcomes, a comprehensive approach is essential — one ...
2024-10-31
While many people believe that poor sleep during pregnancy is inevitable, new research has determined that cognitive behavioral therapy for insomnia (CBTi) while pregnant can not only improve sleep patterns but also address postpartum depression.
Researchers from UBC’s Okanagan and Vancouver campuses, as well as the University of Calgary, discovered that delivering CBTi during pregnancy significantly reduces postpartum depressive symptoms after a baby arrives.
“Early intervention is crucial for infant and parental mental health,” says Dr. Elizabeth Keys, an Assistant Professor in UBCO’s School of Nursing and a study co-author. “Our research explores how addressing ...
LAST 30 PRESS RELEASES:
[Press-News.org] Medication decisions in pregnancy: A balancing act
Experts propose an ethics-based, evidence-backed approach to shared decision-making