Analgesics in Pregnancy: An Update on Use, Safety and Pharmacokinetic Changes in Drug Disposition

Price, Hayley R.; Collier, Abby C.

doi:10.2174/1381612823666170825123754

Cited by 12 publications

(7 citation statements)

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“…Misunderstanding is based on a lack of addiction knowledge in primary healthcare providers as well as a lack of evidence-based knowledge of drugs in pregnancy and the neonate. Moreover, local, state and federal policies tend to focus on the (generally unproven) risks of illicit drugs, while ignoring the real need for medication and medical care for pregnant women, such as for medical pain at the end of pregnancy due to physiological stress (Price and Collier, 2017). And then, in a punitive legal atmosphere; drug use and misuse cannot be treated as a medical issue and becomes increasingly politicized, legalized and stigmatized in these pregnant women and for their children.…”

Section: General Discussion and Conclusionmentioning

confidence: 99%

Screening Pregnant Women and Their Neonates for Illicit Drug Use: Consideration of the Integrated Technical, Medical, Ethical, Legal, and Social Issues

2018

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North America is currently suffering from one of the worst epidemics of illicit drug use in recent history: the opioid crisis. Pregnant women are not immune to the ravages of substance misuse which affects themselves, their pregnancies, and the wider community. The prevalence of drug misuse in pregnancy is not well quantified due to the lack of good validated tests, cooperation between clinicians and scientists developing tests, and consensus as to who should be tested and how results should be used. A wide range of tissues can be tested for drug use, including maternal blood, urine, and hair; neonatal meconium, urine, and hair; and placenta and umbilical cord tissues. Testing methods range from simple spectrophotometry and clinical chemistry to sophisticated analytical HPLC or mass spectrometry techniques. The drive for ever greater accuracy and sensitivity must be balanced with the necessities of medical practice requiring minimally invasive sampling, rapid turnaround, and techniques that can be realistically utilized in a clinical laboratory. Better screening tests have great potential to improve neonatal and maternal medical outcomes by enhancing the speed and accuracy of diagnosis. They also have great promise for public health monitoring, policy development, and resource allocation. However, women can and have been arrested for positive drug screens with even preliminary results used to remove children from custody, before rigorous confirmatory testing is completed. Balancing the scientific, medical, public health, legal, and ethical aspects of screening tests for drugs in pregnancy is critical for helping to address this crisis at all levels.

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Section: General Discussion and Conclusionmentioning

confidence: 99%

Screening Pregnant Women and Their Neonates for Illicit Drug Use: Consideration of the Integrated Technical, Medical, Ethical, Legal, and Social Issues

2018

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“…While longterm treatment with opioids in pregnancy is not recommended, it may be necessary in the case of chronic pain or treatment of dependence. Methadone and buprenorphine may be used to prevent withdrawal syndrome 62 .…”

Section: Pharmacological Treatmentmentioning

confidence: 99%

Pregnancy-related lumbosacral pain

Aragão¹

2019

Brazilian Journal of Pain

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BACKGROUND AND OBJECTIVES: Pregnancy causes physiological and anatomical changes in the woman's body, affecting several systems such as the musculoskeletal. During pregnancy or in the postpartum period, these changes may cause low back pain or low pelvic pain, preventing the normal movement of these structures and causing suffering. The objective of this study was to discuss the diagnosis and treatment of pregnancy-related lumbosacral pain, focusing on terminology, epidemiology, risk factors, pathophysiology, prognosis, diagnosis, and treatment. CONTENTS: We searched the literature in Pubmed, Cochrane Library, Ovid and Google using the terms "low back pain", "pelvic girdle pain", "lumbopelvic pain", "posterior pelvic pain", "pregnancy-related low back pain", "pregnancy-related pelvic girdle pain" and "pregnancy-related lumbopelvic pain", for articles in English, Portuguese and Spanish in the last 20 years or older, where relevant. CONCLUSION: Pregnancy is one of the main causes of lumbosacral pain, and one of the most frequent diseases during gestation. The correct management of this pathology reduces negative impacts on the life of pregnant women.

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“…Over‐the‐counter medications used to treat common pregnancy‐related health problems such as pain are frequently used during pregnancy . Acetaminophen is the most common analgesic used during pregnancy …”

Section: Introductionmentioning

confidence: 99%

Associations of acetaminophen use during pregnancy and the first year of life with neurodevelopment in early childhood

Bertoldi

Rifas‐Shiman

Boing

et al. 2020

Paediatric Perinatal Epid

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Background: Over-the-counter analgesic use during pregnancy, particularly acetaminophen, may be associated with negative developmental outcomes in children.Objective: Estimate associations of prenatal and early-life exposure to acetaminophen in early childhood with cognitive, motor, and language skills in two birth cohorts. Methods: The American Project Viva cohort (1217 mother-child pairs enrolled 1999-2002) assessed cognition at approximately 3 years using the Peabody Picture Vocabulary Test and the Wide Range Achievement of Visual Motor Abilities (WRAVMA). The Brazilian 2015 Pelotas Birth Cohort (3818 mother-child pairs) assessed cognition at 2 years using the INTERGROWTH-21st NeurodevelopmentAssessment. We used linear regression to estimate associations of acetaminophen use during pregnancy (Project Viva and Pelotas) and infancy (Project Viva) with children's cognitive scores adjusted for maternal age, pre-pregnancy body mass index, education, parity, race/ethnicity, smoking and alcohol use during pregnancy, depression during pregnancy, antibiotic and ibuprofen use during pregnancy, household income, and child's sex. Results:In Project Viva, exposure to acetaminophen in both the 1st and 2nd trimester of pregnancy was associated with lower WRAVMA drawing scores (β −1.51, 95% CI −2.92, −0.10). However, in Pelotas, exposure to acetaminophen in both the 1st and 2nd trimester of pregnancy was not associated with INTER-NDA motor scores (β 0.02; 95% CI −0.05, 0.09) and was associated with higher INTER-NDA total scores (β 0.08, 95% CI 0.01, 0.16). Other comparisons did not show evidence for any associations. Conclusions:Inconsistencies and lack of specificity of the findings did not clarify the research question considering that we still have a large variability and uncertainty to define the risk or safety in the use of acetaminophen related to cognition in early childhood. More studies using better exposure assessment and better confounding variables are needed to clarify these associations.

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Analgesics in Pregnancy: An Update on Use, Safety and Pharmacokinetic Changes in Drug Disposition

Cited by 12 publications

References 0 publications

Screening Pregnant Women and Their Neonates for Illicit Drug Use: Consideration of the Integrated Technical, Medical, Ethical, Legal, and Social Issues

Screening Pregnant Women and Their Neonates for Illicit Drug Use: Consideration of the Integrated Technical, Medical, Ethical, Legal, and Social Issues

Pregnancy-related lumbosacral pain

Associations of acetaminophen use during pregnancy and the first year of life with neurodevelopment in early childhood

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