Фармакологическая безопасность при беременности: систематический обзор применения потенциально тератогенных лекарственных средств

Objective: To assess the prevalence of potentially teratogenic drug utilization by pregnant women: overall and in the periconceptional period. Methods: The electronic database PubMed/Medline was searched for the following keywords: «pharmacoepidemiology», «pregnancy», «drug use», «safety», «pregnancy risk category», «fetal risk», «teratogen». The systematic analysis included 28 studies published in English from January 2006 to 23 December 2015. Results. The review shows that the study designs and the choices for data analysis and presentation of results differ largely across published studies. In the USA and Canada, measured rates of maternal use of contraindicated drugs (FDA category X) during pregnancy ranged from 2.4% to 5.3% (1.1–5.0% in the first trimester).The use of drugs with positive evidence of risk (FDA category D) ranged from 5.8% to 39.6% (2.7–6.0%). In European countries, proportions of women using drugs of risk categories X and D ranged from 1.0% to 4.9% (0.31–3.2%) and from 2.0% to 5.9% (1.6–3.7%), respectively. In developing countries, respective proportions of women ranged within 0.2–2.1% and 1.9–11.4%. In early pregnancy (the first trimester), the proportion of women taking potentially teratogenic drugs was high if compared with the second and third trimesters. The use of contraindicated drugs during pregnancy fastly decreases compared with the period before conception. Although the reduction of use of drugs with positive evidence of risk is less marked, possibly, with relation of their efficacy for the treatment of chronic conditions. On the base of analyzed studies, the reference list of potentially teratogenic drugs was formed. Conclusion. The results of published literature confirm differences in study methods that make it difficult to compare the application of potentially teratogenic drugs in pregnancy. The fundamental challenge remains an insufficiency or lack of available information on the evidence of risk to fetus cuased by the drugs that are most widely used in pregnancy.Цель исследования: оценить распространенность использования потенциально тератогенных лекарственных средств (ЛС) женщинами на протяжении всей беременности и в периконцептуальном периоде. Методы. Поиск проводился в электронной базе данных Medline (PubMed) с использованием ключевых слов «pharmacoepidemiology», «pregnancy», «drug use», «safety», «pregnancy risk category», «fetal risk», «teratogen». В систематический обзор включали результаты исследований, опубликованных на английском языке в период с января 2006 по декабрь 2015 г. Результаты. Проанализированы результаты 28 исследований. Показано, что в США и Канаде доля беременных, принимавших противопоказанные препараты (категория X по классификации FDA), варьировала от 2,4 до 5,3% (1,1–5,0% в I триместре), а с доказанным риском (категория D) — от 5,8 до 39,6% (2,7–6,0). В европейских странах доля беременных, принимавших препараты категории X, варьировала в пределах 1,0–4,9% (0,3–3,2), препараты категории D — 2,0–5,9% (1,6–3,7), в развивающихся странах — в пределах 0,2–2,1 и 1,9–11,4% соответственно. Доля женщин, принимавших потенциально тератогенный препарат в I триместре, была выше по сравнению с величиной показателя во II и III триместрах. С наступлением беременности по сравнению с периодом до зачатия использование противопоказанных ЛС быстро уменьшается. Однако редукция в применении препаратов с доказанным риском менее выражена, возможно, из-за большей их востребованности для лечения хронических состояний. На основании полученных сведений сформирован рекомендательный перечень потенциально тератогенных ЛС. Заключение. Опубликованные данные подтверждают различия в методах исследования, затрудняющие сравнение оценки использования ЛС во время беременности. Фундаментальной проблемой остается недостаточность или отсутствие доступной информации о фетальной безопасности ЛС, часто используемых при беременности.

Pharmacological Safety in Pregnancy: A Systematic Review On the Use of Potentially Teratogenic Drugs

Objective: To assess the prevalence of potentially teratogenic drug utilization by pregnant women: overall and in the periconceptional period. Methods: The electronic database PubMed/Medline was searched for the following keywords: «pharmacoepidemiology», «pregnancy», «drug use», «safety», «pregnancy risk category», «fetal risk», «teratogen». The systematic analysis included 28 studies published in English from January 2006 to 23 December 2015. Results. The review shows that the study designs and the choices for data analysis and presentation of results differ largely across published studies. In the USA and Canada, measured rates of maternal use of contraindicated drugs (FDA category X) during pregnancy ranged from 2.4% to 5.3% (1.1–5.0% in the first trimester).The use of drugs with positive evidence of risk (FDA category D) ranged from 5.8% to 39.6% (2.7–6.0%). In European countries, proportions of women using drugs of risk categories X and D ranged from 1.0% to 4.9% (0.31–3.2%) and from 2.0% to 5.9% (1.6–3.7%), respectively. In developing countries, respective proportions of women ranged within 0.2–2.1% and 1.9–11.4%. In early pregnancy (the first trimester), the proportion of women taking potentially teratogenic drugs was high if compared with the second and third trimesters. The use of contraindicated drugs during pregnancy fastly decreases compared with the period before conception. Although the reduction of use of drugs with positive evidence of risk is less marked, possibly, with relation of their efficacy for the treatment of chronic conditions. On the base of analyzed studies, the reference list of potentially teratogenic drugs was formed. Conclusion. The results of published literature confirm differences in study methods that make it difficult to compare the application of potentially teratogenic drugs in pregnancy. The fundamental challenge remains an insufficiency or lack of available information on the evidence of risk to fetus cuased by the drugs that are most widely used in pregnancy

The Influence of Cationic Nitrosyl Iron Complex with Penicillamine Ligands on Model Membranes, Membrane-Bound Enzymes and Lipid Peroxidation

This paper shows the biological effects of cationic binuclear tetranitrosyl iron complex with penicillamine ligands (TNIC–PA). Interaction with a model membrane was assessed using a fluorescent probes technique. Antioxidant activity was studied using a thiobarbituric acid reactive species assay (TBARS) and a chemiluminescence assay. The catalytic activity of monoamine oxidase (MAO) was determined by measuring liberation of ammonia. Antiglycation activity was determined fluometrically by thermal glycation of albumine by D-glucose. The higher values of Stern–Volmer constants (KSV) obtained for the pyrene located in hydrophobic regions (3.9 × 104 M−1) compared to KSV obtained for eosin Y located in the polar headgroup region (0.9 × 104 M−1) confirms that TNIC–PA molecules prefer to be located in the hydrophobic acyl chain region, close to the glycerol group of lipid molecules. TNIC–PA effectively inhibited the process of spontaneous lipid peroxidation, due to additive contributions from releasing NO and penicillamine ligand (IC50 = 21.4 µM) and quenched luminol chemiluminescence (IC50 = 3.6 μM). High activity of TNIC–PA in both tests allows us to assume a significant role of its radical-scavenging activity in the realization of antioxidant activity. It was shown that TNIC–PA (50–1000 μM) selectively inhibits the membrane-bound enzyme MAO-A, a major source of ROS in the heart. In addition, TNIC–PA is an effective inhibitor of non-enzymatic protein glycation. Thus, the evaluated biological effects of TNIC–PA open up the possibility of its practical application in chemotherapy for socially significant diseases, especially cardiovascular diseases