Risks versus benefits of medication use during pregnancy:What do women perceive?

Background: Understanding perception of risks and benefits is essential for informed patient choices regarding medical care. The primary aim of this study was to evaluate the perception of risks and benefits of 9 drug classes during pregnancy and associations with women's characteristics. Methods: Questionnaires were distributed to pregnant women who attended a Dutch Obstetric Care facility (first-and second-line care). Mean perceived risk and benefit scores were computed for 9 different drug classes (paracetamol, antacids, antibiotics, antifungal medication, drugs against nausea and vomiting, histamine-2 receptor antagonists/proton pump inhibitors, antidepressants, nonsteroidal anti-inflammatory drugs, and sedatives/anxiolytics). For each participant, we computed weighted risk and benefit sum scores with principal component analysis. In addition, major concerns regarding medication use were evaluated. Results: The questionnaire was completed by 136 women (response rate 77%). Pregnant women were most concerned about having a child with a birth defect (35%), a miscarriage (35%), or their child developing an allergic disease (23%), respectively, as a result of drug use. The majority of studied drug classes were perceived relatively low in risk and high in benefit. Higher risk scores were reported if women were in their first trimesters of pregnancy (p=0.007). Lower benefit scores were reported if women were single (p=0.014), smoking (p=0.028), nulliparous (p=0.006), or did not have a family history of birth defects (p=0.005). Conclusion: Pregnant women's concerns regarding potential drug adverse effects were not only focused on congenital birth defects but also included a wider range of adverse outcomes. This study showed that most of the studied drug classes were perceived relatively low in risk and high in benefit

A homozygous variant in growth and differentiation factor 2(GDF2)may cause lymphatic dysplasia with hydrothorax and nonimmune hydrops fetalis

The etiology of nonimmune hydrops fetalis is extensive and includes genetic disorders. We describe a term-born female neonate with late onset extensive nonimmune hydrops, that is, polyhydramnios, edema, and congenital bilateral chylothorax. This newborn was successfully treated with repetitive thoracocentesis, total parenteral feeding, octreotide intravenously and finally surgical pleurodesis and corticosteroids. A genetic cause seemed plausible as the maternal history revealed a fatal nonimmune hydrops fetalis. A homozygous truncating variant inGDF2(c.451C>T, p.(Arg151*)) was detected with exome sequencing. Genetic analysis of tissue obtained from the deceased fetal sibling revealed the same homozygous variant. The parents and two healthy siblings were heterozygous for theGDF2variant. Skin and lung biopsies in the index patient, as well as the revised lung biopsy of the deceased fetal sibling, showed lymphatic dysplasia and lymphangiectasia. To the best of our knowledge, this is the first report of an association between a homozygous variant inGDF2with lymphatic dysplasia, hydrothorax and nonimmune hydrops fetalis

The effect of maternal ketanserin use on the circulation of the neonate:a prospective, observational study

Objective: High ketanserin levels are found in the umbilical cord after maternal treatment. However, the effect on the circulation of the neonate has never been investigated. Study design: A prospective, observational study was performed at the neonate ward at the Medical Centre Leeuwarden, The Netherlands. All neonates exposed in utero to ketanserin administered to the mother, from May 2007 to December 2009 (n = 58), were included. We studied the effect of ketanserin exposure on the circulation of the neonate, by monitoring heart rate and blood pressure during the first 24 h of life. Non-parametric as well as parametric tests were used to analyze the effect of gestational age, birth weight, gender, various ketanserin factors (cumulative dosage, duration of therapy and last dosage rate), other maternal drug use and maternal diagnosis on the blood pressure of the neonate. Results: Eight neonates became hypotensive during the first 8 h of life (13.8%). The last dosage rate as well as the mean dosage rate (cumulative dosage divided by duration of therapy in hours) were significantly higher in the group with hypotension (P=.005 and P=.002, respectively). All hypotensive neonates were exposed to a last dosage rate of at least 8 mg/h. Maternal HELLP syndrome was diagnosed more often in hypotensive compared to normotensive neonates (P=.048). Conclusion: In utero exposure to ketanserin lowers the blood pressure of the neonate. The risk of hypotension is associated with the last dosage rate of maternal ketanserin treatment and the coexistence of maternal HELLP syndrome. (C) 2012 Elsevier Ireland Ltd. All rights reserved

Risks versus benefits of medication use during pregnancy: What do women perceive?

Background: Understanding risk perception is essential in designing good risk communication strategies. It has been reported that women overestimate the teratogenic risk of medication use, but these studies didn't include perceived benefits and major concerns of pregnant women regarding medication use. Objectives: The aim of this study was to evaluate the perception of risks, benefits and major concerns regarding medication use during pregnancy. Methods: Questionnaires were handed out to all pregnant women who attended a Dutch obstetric facility for first and second line care. Patients were asked to score the benefits of 7 drug groups on a scale from 1-7 (Benefit-score (BS)). Second, patients were asked to rate the probability and severity of an event occurring due to use of the 7 drug groups on a scale from 1-7. Risk scores (RS) were constructed by multiplication of the measures of perceived probability and severity. To make the RSs comparable to the BSs a square root extraction of the RS was performed. Third, patients were asked about the level of concern of different unfortunate events resulting from medication use. Results: Results are preliminary A total of 118 eligible women completed the questionnaire (response rate 77%). More than 80% of the women used medication during pregnancy. Paracetamol (RS = 2.0, BS = 4.7), antacids (RS = 2.8, BS = 4.2) and antibiotics(RS = 3.3, BS = 4.6) were perceived relatively low in risk and high in benefit. Sedatives (RS = 5.2, BS = 3.9) and NSAIDS (RS = 4.7, BS = 3.2) were perceived relatively high in risk and low in benefit. Pregnant women were most concerned about having a child with a congenital birth defect (38.1%), a miscarriage (36.0%) or having a child with an allergic disease (25.7%), respectively as a result of drug use. Conclusions: Though it has been reported that women overestimate teratogenic risk of medication use, this study showed that most of the drugs were perceived relatively low in risk and high in benefit. In addition this study shows the different concerns women have regarding medication use during pregnancy. Health care providers in first and second line care obstetric facilities can take this into account when counselling pregnant women