Skip to main content Accessibility help
×
Hostname: page-component-78c5997874-fbnjt Total loading time: 0 Render date: 2024-11-04T21:50:20.747Z Has data issue: false hasContentIssue false

Chapter 4 - Pharmacology and Pharmacokinetics in Obstetric Practice

from Section 1 - Basic Sciences in Obstetrics

Published online by Cambridge University Press:  20 November 2021

Tahir Mahmood
Affiliation:
Victoria Hospital, Kirkcaldy
Charles Savona Ventura
Affiliation:
University of Malta, Malta
Ioannis Messinis
Affiliation:
University of Thessaly, Greece
Sambit Mukhopadhyay
Affiliation:
Norfolk & Norwich University Hospital, UK
Get access

Summary

Pharmaceutical agents have become an essential tool in the medical armamentarium. Pharmaceutical companies over the past century not only have developed more consistently effective agents that are used to manage acute-onset conditions, but also have improved the quality of life of those suffering from chronic progressive disease. The use of any medication must be tempered by its potential side effects. Thus, the clinician must assess the benefit-risk ratio between therapeutic efficacy and safety risks before resorting to any therapeutic intervention in any patient. The benefit-risk assessment (BRA) is made on the weight of randomized evidence obtained from formal clinical trials and observations collected from pharmacovigilance activities after the drug is put on the market [1]. In obstetric practice, the benefit-risk ratio assessment for a pharmaceutical agent must further consider the specific benefit-risk ratio assessment relevant to the developing fetus. The fetal risk assessment presented by a particular agent may not be immediately possible since adverse effects may not be specific and easily linked to the agent, or may present themselves later on in life.

Type
Chapter
Information
The EBCOG Postgraduate Textbook of Obstetrics & Gynaecology
Obstetrics & Maternal-Fetal Medicine
, pp. 30 - 37
Publisher: Cambridge University Press
Print publication year: 2021

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Curtin, F, Schulz, P. Assessing the benefit: risk ratio of a drug – randomized and naturalistic evidence. Dialogues Clin Neurosci. 2011;13(2):183–90.CrossRefGoogle ScholarPubMed
Vargesson, N. Thalidomide-induced teratogenesis: History and mechanisms. Birth Defects Res C Embryo Today. 2015;105(2):140–56.CrossRefGoogle ScholarPubMed
Götz, F, Thieme, S, Dörner, G. Female infertility–effect of perinatal xenoestrogen exposure on reproductive functions in animals and humans. Folia Histochem Cytobiol. 2001;39(Suppl 2):40–3.Google ScholarPubMed
Wilson, RD, Davies, G, Désilets, V, et al. The use of folic acid for the prevention of neural tube defects and other congenital anomalies. J Obstet Gynaecol Can. 2003;25(11):959–73.Google ScholarPubMed
Ornoy, A. Embryonic oxidative stress as a mechanism of teratogenesis with special emphasis on diabetic embryopathy. Reprod Toxicol. 2007;24(1):3141.CrossRefGoogle ScholarPubMed
El Hachem, H, Crepaux, V, May-Panloup, P, et al. Recurrent pregnancy loss: current perspectives. Int J Womens Health. 2017;9:331–45.Google Scholar
Sugiura-Ogasawara, M, Ozaki, Y, Suzumori, N. Management of recurrent miscarriage. J Obstet Gynaecol Res. 2014;40(5):1174–9.Google Scholar
Martin, KL. Nutritional and metabolic requirements of early cleavage stage embryos and blastocysts. Hum Fertil. 2000;3(4):247–54.CrossRefGoogle ScholarPubMed
Eckert, JJ, Fleming, TP. The effect of nutrition and environment on the preimplantation embryo. Obstet Gynaecol. 2011;13:43–8.CrossRefGoogle Scholar
Chen, CH, Xirasagar, S, Lin, CC, et al. Risk of adverse perinatal outcomes with antithyroid treatment during pregnancy: a nationwide population-based study. BJOG. 2011;118(11):1365–73.Google Scholar
Polańska, K, Jurewicz, J, Hanke, W. Smoking and alcohol drinking during pregnancy as the risk factors for poor child neurodevelopment – A review of epidemiological studies. Int J Occup Med Environ Health. 2015;28(3):419–43.CrossRefGoogle ScholarPubMed
Savona-Ventura, C, Sammut, M, Sammut, C. Pethidine blood concentrations at time of birth. Int J Gynecol Obstet. 1991;36:103–7.Google Scholar
Iqbal, MM, Sobhan, T, Ryals, T. Effects of commonly used benzodiazepines on the fetus, the neonate, and the nursing infant. Psychiatric Services. 2002;53(1):3949.CrossRefGoogle ScholarPubMed
Chinedu, E, Arome, D, Ameh, FS. A new method for determining acute toxicity in animal models. Toxicol Int. 2013;20(3):224–6.Google Scholar
McColl, JD. Drug toxicity in the animal fetus. Appl Ther. 1967;9(11):915–17.Google Scholar
Rengasamy, P. Congenital malformations attributed to prenatal exposure to cyclophosphamide. Anticancer Agents Med Chem. 2017;17(9):1211–27.Google Scholar
Murphy, ML. Teratogenic effects in rats of growth inhibiting chemicals, including studies on thalidomide. Clin Proc Child Hosp Dist Columbia. 1962;18:307–22.Google ScholarPubMed
Ma, A, Xu, H, Du, W, Liu, Y. Effect of folic acid and supplemented with vitamin A and vitamin E on depressing teratogenesis induced by cyclophosphamide. Wei Sheng Yan Jiu. 2001;30(6):343–6.Google Scholar
Adjei, AA, Gaedigk, A, Simon, SD, Weinshilboum, RM, Leeder, JS. Interindividual variability in acetaminophen sulfation by human fetal liver: implications for pharmacogenetic investigations of drug-induced birth defects. Birth Defects Res A Clin Mol Teratol. 2008;2(3):155665.Google Scholar
Cassina, M, Cagnoli, GA, Zuccarello, D, Di Gianantonio, E, Clementi, M. Human teratogens and genetic phenocopies. Understanding pathogenesis through human genes mutation. Eur J Med Genet. 2017;60(1):2231.Google Scholar
Needleman, S, Powell, M. Radiation hazards in pregnancy and methods of prevention. Best Pract Res Clin Obstet Gynaecol. 2016;33:108–16.Google Scholar
UNSCEAR. Sources and Effects of Ionizing Radiation. Vol. 1 of UNSCEAR 2008 Report to the General Assembly. New York: United Nations; 2011.Google Scholar
Wu, D, Qiang, R, Chen, J, et al. Possible overexposure of pregnant women to emissions from a walk-through metal detector. Phys Med Biol. 2007;52(19):5735–48.Google Scholar
Shaw, P, Duncan, A, Vouyouka, A, Ozsvath, K. Radiation exposure and pregnancy. J Vascular Surgery. 2011;53(Suppl 15):28S34S.Google Scholar
Safety Group of the BMUS. Guidelines for the safe use of diagnostic ultrasound equipment. Ultrasound. 2010;18:52–9.Google Scholar
Cockroft, DL, Trevor New, DA. Effects of hyperthermia on rat embryos in culture. Nature. 1975;258:604–6.Google Scholar
Sudan, M, Birks, LE, Aurrekoetxea, JJ, et al. Maternal cell phone use during pregnancy and child cognition at age 5 years in 3 birth cohorts. Environ Int. 2018;120:155–62.CrossRefGoogle ScholarPubMed
Bulas, D, Egloff, A. Benefits and risks of MRI in pregnancy. Semin Perinatol. 2013;37(5):301–4.CrossRefGoogle ScholarPubMed
Ray, JG, Vermeulen, MJ, Bharatha, A, Montanera, WJ, Park, AL. Association between MRI exposure during pregnancy and fetal and childhood outcomes. JAMA. 2016;316(9):952–61.Google Scholar
FDA. Content and format of labeling for human prescription drug and biological products; Requirements for pregnancy and lactation labeling. Federal Register. 2014;79(233):72064–103.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×