Drugs in pregnancy and lactation , Drugs in pregnancy and lactation , کتابخانه دیجیتال جندی شاپور اهواز

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Drugs in Pregnancy and Lactation

The preterm parturition syndrome

WHO Regional Office for Europe.

We review herein the evidence that estrogen is protective against the development of cardiovascular disease in women To our knowledge, no studies in women have looked at endogenous estrogen levels as predictors of cardiovascular disease Studies of surrogate measures of endogenous estrogen such as parity, age at menarche, and age at menopause have provided inconsistent results Current use of oral contraceptives increases risk in older women who smoke cigarettes, but most studies of past use show no increased risk Most, but not all, studies of hormone replacement therapy in postmenopausal women show around a 50% reduction in risk of a coronary event in women using unopposed oral estrogen These important observations need to be confirmed in a double-blind, randomized clinical trial, since the protection is biologically plausible and the magnitude of the benefit would be quite large if selection factors can be excluded ( JAMA  1991;265:1861-1867)

https://jamanetwork.com/HttpHandlers/ArticlePdfHandler.ashx?journal=jama&articleId=385577&pdfFileName=jama_265_14_033.pdf

Estrogen and coronary heart disease in women.

von Willebrand disease (VWD) is a commonly encountered inherited bleeding disorder affecting both males and females, causing mucous membrane and skin bleeding symptoms, and bleeding with surgical or other haemostatic challenges. VWD may be disproportionately symptomatic in women of child-bearing age. It may also occur less frequently as an acquired disorder (acquired von Willebrand syndrome). VWD is caused by deficiency or dysfunction of von Willebrand factor (VWF), a plasma protein that mediates platelet haemostatic function and stabilizes blood coagulation factor VIII. The pathophysiology, classification, diagnosis and management of VWD are relatively complex, but understanding them is important for proper diagnosis and management of patients with VWD. These evidence-based guidelines for diagnosis and management of VWD from the National Heart, Lung, and Blood Institute (NHLBI) Expert Panel (USA) review relevant publications, summarize current understanding of VWD pathophysiology and classification, and present consensus diagnostic and management recommendations based on analysis of the literature and expert opinion. They also suggest an approach for clinical and laboratory evaluation of individuals with bleeding symptoms, history of bleeding or conditions associated with increased bleeding risk. This document summarizes needs for further research in VWF, VWD and bleeding disorders, including clinical research to obtain more objective information about bleeding symptoms, advancements in diagnostic and therapeutic tools, and enhancement in the education and training of clinicians and scientists in bleeding and thrombotic disorders. The NHLBI Web site (http://www.nhlbi.nih.gov/guidelines/vwd) has a more detailed document, a synopsis of these recommendations, and patient education information.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1365-2516.2007.01643.x

von Willebrand disease (VWD): evidence-based diagnosis and management guidelines, the National Heart, Lung, and Blood Institute (NHLBI) Expert Panel report (USA).

A prospective study was performed on the effect of smoking on pregnancy, using information from 6 363 pregnancies with known smoking habits. Of these, 2806 (44%) smoked during pregnancy, and 2731 (97%) of the 2 806 reported that they smoked during the whole pregnancy. The well-known effect on prematurity rate and mean birth weight was verified in this study. A 50% increase of prematurity rate was registered among smoking women compared with non-smoking women. The mean birth weight reduction was 170 g among live-born, non-malformed children. These effects were found to occur irrespective of other variables studied: maternal age, parity, and whether the pregnancy was wanted. The body length, head circumference, and shoulder circumference were found to be reduced in children born to smoking women. Placental weight was also reduced, but the ratio placental weight over body weight increased with smoking. No effect on the malformation rate was observed, but the series is too small to exclude a teratogenic effec...

A Prospective Study of Smoking and Pregnancy

Serum proteins of 30 women were estimated before, and 6 months after, regular intake of contraceptive pills (0.1 mg mestranol and 5 mg megestrol). A highly significant rise of increasing degree was observed for α2-macroglobulin, lipoproteins, transferrin, plasminogen, α1-antitrypsin, thyroxine-binding globulin (cortisol), and ceruloplasmin. The immunoglobulins were unchanged, but albumin, haptoglobins, and orosomucoid showed a highly significant decrease. The fall of orosomucoid and haptoglobins was greater than during pregnancy, while the rise of α1-antitrypsin, α2-macroglobulin, lipoproteins, and transferrin was less. It is concluded that the metabolic effects of contraceptive steroids has not been properly explored. This study implies that these metabolic effects are only in partial agreement with the alterations occurring during normal pregnancy.

Effect of administration of a combined estrogen-progestin contraceptive on the level of individual plasma proteins.

The present study describes the evolution over a 5-year period of an ultrasonic routine screening programme of a pregnant population with participation of approximately 90 % of the pregnant women. One obvious result obtained in the screening programme is the pronounced improvement of early detection of twins, the incidence now approaching 95 % with the mean gestational age for the detection being 20 (median 19) weeks. Early detection in combination with clinical measures was associated with a decrease in the incidence of twins born preterm (before week 37) from 33 % to 10 %. The perinatal mortality rate of twins fell from 6 to 0.6 % after the introduction of this programme.The power of an early measurement of the fetal biparietal diameter (BPD) to predict the date of confinement was high. Of 848 pregnant women with an early BPD measurement (96.5 % were measured before the 21st gestational week), 95 % were delivered spontaneously within 12 days according to the estimates from the BPD, only 1.5 % being deli...

Benefits of Ultrasonic Screening of a Pregnant Population

The results are presented of a prospective study on drug use during pregnancy involving antibiotics, analgesic drugs and iron and vitamin preparations. The study was conducted in Malmo between 1963 and 1965. No unfavourable effect of the use of antibiotics, mainly penicillin and sulphonamides, could be demonstrated. Among 15 women who had an infant with hypospadias, three had used penicillin during the first trimester, but this may well be coincidental. Analgesic drug use shows a variability which resembles that previously described for psychopharmaca. No effect on the malformation rate or infant survival could be found. A possible lengthening of the mean duration of pregnancy occurred after the use of analgesic drugs during the 2nd or 3rd trimesters. Women who are going to have a dead or malformed infant use iron and/or vitamin preparations less often during late pregnancy than women who prove to have a normal infant. When such drugs were used, the percentage of pregnancies ending in birth before the 38t...

A Prospective Study of Drugs and Pregnancy

In a prospective investigation biopsy specimens were obtained of 150 women with primary, untreated endometrial carcinoma for determination of the content of estrogen and progesterone receptors (E2 and PR). After a varying interval 13 who developed metastases despite routine surgical and radiation therapy received treatment with gestagens. The clinical effect of the hormone was studied for any correlation with the initial content of E2 and PR.Eight of the women (61–71 years) proved E2R positive (> 10 fmoles/mg cytosolprotein), 2 had no PR and the remaining 6 had PR in a concentration of 7–892 fmoles/mg cytosolprotein). 7 responded clinically to gestagen therapy (tumors poorly differentiated in 3 and moderately in 4).Five of the women (50–84 years) were E2R negative; they had no PR, they did not respond to gestagen therapy and died after 2–8 months (tumors poorly differentiated in 2 and moderately in 3).Determination of E2R and PR in endometrial carcinoma appears to be a clinically useful test for predictin...

Stig Kullander

Papers

A Prospective Study of Smoking and Pregnancy

Effect of administration of a combined estrogen-progestin contraceptive on the level of individual plasma proteins.

Benefits of Ultrasonic Screening of a Pregnant Population

A Prospective Study of Drugs and Pregnancy

Do estrogen and progesterone receptors (E2R and PR) in metastasizing endometrial cancers predict the response to gestagen therapy