Biomedical subjects
Publications and source records attributed to Motherisk Team.
QUESTION: I have several patients whom I suspect are drinking during pregnancy. How can I find out for sure if they are? ANSWER: You can use one of the validated tools to screen for problem drinking. Motherisk uses the TWEAK test, but others are just as good. Following birth, you can test infants' meconium for metabolites of ethanol to detect whether they were exposed in utero to excessive drinking.
QUESTION: In light of recent negative media attention to antidepressant use during late pregnancy, several of my patients have either discontinued or are considering discontinuing their antidepressant medications. How can I best counsel these patients on taking antidepressants during late pregnancy? ANSWER: Antidepressant use during the third trimester has been associated occasionally with a transient neonatal withdrawal-like syndrome characterized by jitteriness, self-limiting respiratory difficulties, and problems with feeding. When counseling patients, the risk of these adverse effects must be weighed against the risks associated with untreated depression during late pregnancy. Abrupt discontinuation of psychotropic medications has been associated with both physical (eg, withdrawal) and psychological (eg, suicidal thoughts) symptoms.
QUESTION: A 23-year-old patient of mine has been taking St John's wort for postpartum depression for about 2 years. She is now planning her second pregnancy. Is she or her fetus at risk if she continues to take the herbal therapy? ANSWER: Despite the widespread availability and use of St John's wort and extensive research on the herb, there are almost no data on reproductive safety. At this stage, therefore, St John's wort cannot be recommended as safe therapy during pregnancy.
QUESTION: Several men with psoriatic arthritis have asked whether the methotrexate they take for rheumatoid arthritis will affect their fertility or the outcome of any of their partners' future pregnancies. What is known regarding risks to fertility and to fetuses? ANSWER: To date, there are no reports of adverse pregnancy outcomes among men exposed to methotrexate before conception. Opinions in the literature differ on the effects of methotrexate on male fertility. Several case reports and studies report no effect; others report reversible sterility. One limitation to several of these studies is the concurrent administration of other chemotherapeutic agents. Small studies reporting on methotrexate use with no other agents suggest no increased infertility. Motherisk is currently following men who are taking methotrexate alone for psoriatic arthritis to see whether it affects fertility.
QUESTION: One of my patients had a computed tomography scan of her abdomen a week ago and has just found out she is 7 weeks pregnant. What should I tell her about the pregnancy and the risk to her fetus? ANSWER: Your patient is not at increased risk of miscarriage or major congenital fetal malformations due to radiation exposure. Her risk is similar to that of the general population (ie, 1% to 3%).
QUESTION: A 27-year-old patient in our clinic with familial Mediterranean fever (FMF) has been treated with colchicine for the last decade. She is planning her first pregnancy. What recommendations should we give her regarding use of colchicine before and during pregnancy, bearing in mind that discontinuation of colchicine could lead to complications from amyloidosis? ANSWER: Colchicine passes through the placenta in humans, is teratogenic in animals, and raises rates of male and female infertility. Based on several patients with chromosomal anomalies, some authorities recommend that patients who require colchicine therapy during pregnancy undergo amniocentesis with karyotyping. In contrast, an increasing body of evidence suggests that colchicine use throughout pregnancy carries no substantial teratogenic or mutagenic risk when used at recommended doses. Its use prevents febrile attacks of FMF and reduces the frequency of renal complications.
QUESTION: One of my patients presented with bacteriuria early in her pregnancy. Urine culture was positive for Escherichia coli. I would like to prescribe a trimethoprim-sulfamethoxazole combination because it worked well for her in the past. What is known about the safety of this medication during early pregnancy? ANSWER: Evidence-based studies report an association between trimethoprim-sulfonamide combinations in early pregnancy and several major malformations, such as neural tube defects and cardiovascular defects. If clinically possible, physicians are advised to use alternative antimicrobial medications for treatment of urinary tract infections during early pregnancy.