Before marketing a new drug, the manufacturer almost never tests the product in pregnant women to determine its effects on the fetus. Consequently, most drugs are not labeled for use during pregnancy. Typically, descriptions of drugs that appear in the Physicians' Desk Reference and similar sources contain statements such as, “Use in pregnancy is not recommended unless the potential benefits justify the potential risks to the fetus.” Since the risk has been adequately established for only a few drugs, physicians caring for pregnant women have very little information to help them decide whether the potential benefits to the mother outweigh . . .

Drugs in Pregnancy

Guidelines for computed tomography and magnetic resonance imaging use during pregnancy and lactation

Background Perception of risk may impact a woman’s decision to take a needed drug during pregnancy. There is a paucity of research on this topic in the literature. Objectives (1) To evaluate the perception of risk of 17 commonly used drugs and other substances by pregnant women. (2) To investigate which sources of information regarding exposures during pregnancy were most commonly used by women. Methods A questionnaire was developed through the University of Oslo’s website for Internet surveys and posted on four Web pages used by pregnant women and mothers, from mid-September 2008 through October 2008. The inclusion criteria included women who were (1) pregnant or 2) a mother of a child less than 5 years old. Results A total of 1,793 eligible women completed the questionnaire. Most women overestimated the teratogenic risk associated with all the drugs during pregnancy. Characteristics of the women that were associated with a high perception of risk were primiparity, higher age, higher education, and choosing not to use a drug during pregnancy. More than 80% of the women had used drugs during pregnancy, mostly paracetamol, penicillins and reflux medications. The physician, the product information leaflet and the pharmacist were the three most frequently used sources of information. Conclusion Women overestimate the risk of drug use and other exposures during pregnancy. Therefore, it is important for health care providers to use evidence-based information, to reduce unnecessary anxiety, and to ensure safe and appropriate treatment during pregnancy.

Perception of risk regarding the use of medications and other exposures during pregnancy.

OBJECTIVE. The objectives of this article are to discuss the current evidence-based recommendations regarding radiation dose concerns, the use of iodinated and gadolinium-based contrast agents, and the comparative advantages of multimodality imaging (ultrasound, CT, and MRI) during pregnancy and lactation. We also discuss the use of imaging to evaluate pregnant trauma patients. CONCLUSION. Maternal and fetal radiation exposure and dose are affected by gestational age, anatomic site, modality, and technique. The use of iodinated and gadolinium-based contrast agents during pregnancy and lactation has not been well studied in human subjects. Imaging should be used to evaluate pregnant trauma patients only when the benefits outweigh the risks.

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Imaging of Pregnant and Lactating Patients: Part 1, Evidence-Based Review and Recommendations

OBJECTIVE. The objective of our study was to determine family physicians' and obstetricians' perceptions of the risk of major fetal malformations associated with exposure to radiation from radiography and CT during early pregnancy.MATERIALS AND METHODS. Structured questionnaires were sent to 400 family physicians and 100 obstetricians selected randomly across Ontario, Canada. The physicians were informed about the 1–3% baseline risk for major malformations and were asked about their perceptions of the risk to the fetus associated with an abdominal radiograph and an abdominal CT scan during early pregnancy and whether they would recommend a therapeutic abortion after such exposure.RESULTS. Fifty-five percent (218/400) of the family physicians and 69% (69/100) of the obstetricians responded to our questionnaire. Forty-four percent of family physicians estimated the risk associated with an abdominal radiograph to be 5% or greater, and 61% estimated the risk associated with an abdominal CT scan to be 5% or gr...

Physicians' Perceptions of Teratogenic Risk Associated with Radiography and CT During Early Pregnancy

We quantified the perception of teratogenic risk in women attending the Motherisk program for counseling about diagnostic radiation in pregnancy (n = 50) and compared it with a control group of women exposed to nonteratogenic drugs and chemicals (n = 48). Before receiving known information about the specific exposure, women exposed to radiation assigned themselves a significantly higher teratogenic risk compared with the control group (25.5 +/- 4.3% versus 15.7 +/- 3.0% for major malformations, P less than 0.01). The post-consultation perception of teratogenic risk did not differ between the two groups. Special consideration and attention should be given when counseling pregnant women exposed to low-dose ionizing radiation, as their misperception of teratogenic risk may lead them to unnecessary termination of their pregnancy.

N. Horlatsch

Papers

Exposure to ionizing radiation during pregnancy: Perception of teratogenic risk and outcome

Exposure to Ionizing Radiation During Pregnancy: Perception of Teratogenic Risk and Outcome