Drug use in pregnant women—a pilot study of the coherence between reported use of drugs and presence of drugs in plasma

Wolgast, Emelie; Josefsson, Ann; Josefsson, Martin; Lilliecreutz, Caroline; Reis, Margareta

doi:10.1007/s00228-017-2402-4

Cited by 6 publications

(3 citation statements)

References 13 publications

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“…The pregnant women in our study seemed to be more inclined to use medication that was necessary or strongly recommended since only a small percentage refrained from accepting such treatment. This finding is supported by results from a study showing a good coherence between self‐reported medication intake noted in the antenatal records and the medication found in blood samples . Agreement between medication use noted in medical antenatal records and information from a national pharmacy database concerning medications used for chronic conditions was also high …”

Section: Discussionsupporting

confidence: 57%

Women's perceptions of medication use during pregnancy and breastfeeding—A Swedish cross‐sectional questionnaire study

Wolgast

Lindh-Åstrand

Lilliecreutz

2019

Acta Obstet Gynecol Scand

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Introduction Use of medication for different kinds of symptoms and diseases during pregnancy is common. When counseling the pregnant woman, an understanding of her perceptions concerning the use of medication as well as possible associated anxiety and obstacles is important to ensure high adherence to the treatment regimen. Material and methods A questionnaire was developed regarding the use of medication, perceptions on use of medication, as well as perceptions about pregnancy outcomes in association with medication use during pregnancy. In total, 850 pregnant women in gestational weeks 25‐29 participated in the study. Results The response rate was 92.7% (n = 832/898). About 19.4% of the respondents (n = 160/824) were frequent users (medication use daily to several times a week) and 28.4% (n = 234/824) were non‐frequent users (medication use once a week to once a month). The majority perceived medication use during early pregnancy (61.4%, n = 501/816), late pregnancy (55.6%, n = 455/819) and breastfeeding (57.7%, n = 474/821) as probably harmful or harmful. These findings were more common in non‐users (medication used rarely or never) than frequent users (P‐value <0.001, <0.001 and 0.007). The pregnant women had great confidence in advice from a physician (83.8%, n = 666/795) or a midwife (77.0%, n = 620/805) concerning medication during pregnancy. Conclusions The majority of pregnant women in Sweden consider the use of medication during pregnancy either ‘probably harmful’ or ‘harmful’ and this perception is associated with non‐use of medication. The pregnant women in our study had high confidence in healthcare professionals when seeking advice; thus, actively asking about perceptions could lead to better counseling.

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Section: Discussionsupporting

confidence: 57%

Women's perceptions of medication use during pregnancy and breastfeeding—A Swedish cross‐sectional questionnaire study

Wolgast

Lindh-Åstrand

Lilliecreutz

2019

Acta Obstet Gynecol Scand

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“…There are few studies that compare plasma drug levels to self-reported drug use, to investigate drug use in pregnancy. One Swedish study performed by Wolgast et al (2018) showed good concordance between reported drug use and drugs detected by LC-TOF-MS, in contrast to most studies which find a high incidence of under-reported drug use. In the Wolgast study, drugs that are only occasionally used, such as anti-histamines and analgesics; were detected at the highest frequency.…”

Section: Types Of Screening For Illicit Drugs In Pregnant Womenmentioning

confidence: 87%

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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“…2010 ), Norway ( Harris et al. 2017 ), and Sweden ( Wolgast et al. 2017 ) and a multi-national study (Europe, North/South America, and Australia) ( Lupattelli et al.…”

Section: Discussionmentioning

confidence: 99%

Effects of Exposure to Acetaminophen and Ibuprofen on Fetal Germ Cell Development in Both Sexes in Rodent and Human Using Multiple Experimental Systems

Hurtado-Gonzalez

Anderson

Macdonald

et al. 2018

Environ Health Perspect

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Background:Analgesic exposure during pregnancy may affect aspects of fetal gonadal development that are targeted by endocrine disruptors.Objectives:We investigated whether therapeutically relevant doses of acetaminophen and ibuprofen affect germ cell (GC) development in human fetal testes/ovaries using in vitro and xenograft approaches.Methods:First-trimester human fetal testes/ovaries were cultured and exposed to acetaminophen or ibuprofen (7 d). Second-trimester human fetal testes were xenografted into mice and exposed to acetaminophen (1 or 7 d), or ibuprofen (7 d). To determine mechanism of action, a human GC tumor–derived cell line (NTera2) exhibiting fetal GC characteristics was used in addition to in vitro and in vivo rat models.Results and Discussion:Gonocyte (TFAP2C+) number was reduced relative to controls in first-trimester human fetal testes exposed in vitro to acetaminophen (–28%) or ibuprofen (–22%) and also in ovaries exposed to acetaminophen (–43%) or ibuprofen (–49%). Acetaminophen exposure reduced gonocyte number by 17% and 30% in xenografted second-trimester human fetal testes after treatment of host mice for 1 or 7 d, respectively. NTera2 cell number was reduced following exposure to either analgesic or prostaglandin normalE2 (PGE2) receptor antagonists, whereas PGE2 agonists prevented acetaminophen-induced reduction in NTera2 cell number. Expression of GC pluripotency genes, and genes that regulate DNA/histone methylation, also differed from controls following analgesic and PGE2 receptor antagonist exposures. Gene expression changes were observed in rat fetal testis/ovary cultures and after in vivo acetaminophen exposure of pregnant rats. For example, expression of the epigenetic regulator TET1, was increased following exposure to acetaminophen in human NTera2 cells, rat fetal testis/ovary cultures, and in fetal testes and ovaries after in vivo exposure of pregnant rats, indicating translatability across experimental models and species.Conclusions:Our results demonstrate evidence of PGE2-mediated effects of acetaminophen and ibuprofen on GC/NTera2 cells, which raises concerns about analgesic use during human pregnancy that warrant further investigation. https://doi.org/10.1289/EHP2307

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Drug use in pregnant women—a pilot study of the coherence between reported use of drugs and presence of drugs in plasma

Cited by 6 publications

References 13 publications

Women's perceptions of medication use during pregnancy and breastfeeding—A Swedish cross‐sectional questionnaire study

Women's perceptions of medication use during pregnancy and breastfeeding—A Swedish cross‐sectional questionnaire study

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

Effects of Exposure to Acetaminophen and Ibuprofen on Fetal Germ Cell Development in Both Sexes in Rodent and Human Using Multiple Experimental Systems

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