Given the unique nature of pregnancy with respect to obtaining safety data regarding medication exposures, developing comprehensive information on the wide variety of medications that might be of clinical benefit during pregnancy is a challenging and on-going task. For many of the most commonly used asthma and allergy medications that were covered in this article, there is at least limited human data are available. Even for relatively well-studied medications, there are many unanswered questions, and few studies exist that are large enough to rule out at least a doubling of risk for specific outcomes, particularly congenital anomalies. This challenge becomes even more daunting when evaluating risks of individual products is considered the optimal goal, as opposed to "lumping" all medication exposures within a class. All of these issues call for more human pregnancy data that are collected more efficiently so that the answers that clinicians and pregnant women need are available more readily. In the meantime, health care providers and pregnant women must work with the information that is available to evaluate the risks and benefits of a particular medication and alternative choices for treatment of asthma or allergy during pregnancy, while considering the potential for adverse effects if the woman with severe or uncontrolled asthma is under-treated. To assist in making a risk/benefit assessment, the clinician can draw on existing resources that provide systematic periodic review of new data on medications in pregnancy as it becomes available, and synthesize the entire body of data on a particular drug into concise summary statements. Two such resources are TERIS (TeratogenInformation System) [38] and Reprotox [39]; both on-line services are managed by experts in the field of teratology. An additional resource for clinicians and pregnant women is the Organization of Teratology Information Specialists [40], a network of risk-assessment counselors in the United States and Canada who specialize in research and the communication of risks that are associated with exposures in pregnancy.

Adrenal Cortex Hormones↗

PubMed2005

A survey of pregnant women using isotretinoin.

BACKGROUND: Isotretinoin is a known human teratogen, causing birth defects and/or subnormal cognitive performance in prenatally-exposed children. METHODS: A survey was conducted among women who called teratology information services throughout North America. Using a structured questionnaire, women with an isotretinoin-exposed pregnancy were prospectively interviewed before the outcome of the pregnancy was known. RESULTS: Almost 1/4 of the women surveyed (24%; 8/34) did not recall having contraception counseling before starting their medications. Once therapy was initiated, 62% (21/34) recalled using a birth control method, but only 29% (6/21) recalled using 2 forms of birth control, as specified by the voluntary pregnancy prevention programs. Monthly pregnancy tests were not always conducted during treatment, as recalled by the surveyed women (56%; 19/34). As many as 24% (8/34) of the women surveyed recalled that they were not screened using 2 pregnancy tests before receiving a prescription, another recommendation of the programs. Only a small number of the women (30%; 6/20) in the United States recalled being enrolled in any manufacturers' voluntary pregnancy prevention survey. CONCLUSIONS: Results demonstrate that essential components of voluntary pregnancy prevention programs were not consistently followed, which resulted in fetal exposures.

Abnormalities, Drug-Induced↗

PubMed2003

Avoiding the sequela associated with deformational plagiocephaly.

Over the last decade, infants with deformities in the craniofacial skeleton have been seen at our craniofacial center, and similar observations have been noted in infants seen for evaluation and management after birth, where there are not any evident pathological findings such as craniosynostosis or another known genetic disorder. The known condition of deformational plagiocephaly has been related to a sequela of the infants being placed on their back for sleep. The change in the position of the infants to sleep on their back was altered from the traditional position, where infants were placed in the prone position for many decades in the past in the Western world. A special study was initiated to compile meaningful data to help those in the field pursue their treatment of affected children in a systematic and comprehensive manner. Avoidance of unnecessary surgery was essential in those children unless the deformational condition persisted and was not resolvable by nonsurgical means and change in the cultural habitat.

Adolescent↗