Pregnancy and medication: a lack of knowledge

As a precaution, pregnant women are almost always excluded from studies that test drugs before they are marketed. Therefore, there is little data on the effect of pharmaceuticals taken during pregnancy. A void that Montreal researchers are working to fill.

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Little is known about the effects that taking medications can have on pregnant women and their babies.

• Gaëlle Lussiaà-Berdou (View profile)Gaëlle Lussiaà-Berdou

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“I would have liked it to be a more definitive answer, because there, it was very gray”: this is how Marie -Philippe Busque summarizes the decision she had to make when starting a family.

The thirty-year-old from Boucherville, in Montérégie, was diagnosed with attention deficit disorder (ADD) during her higher education studies. The medication she took to treat her ADD, methylphenidate, made her life a lot easier. But when she wanted to have children, she realized that little information was available about the potential effects of her treatment on the fetus.

The data was really insufficient, she regrets. There were studies that said it was okay [to continue taking it during pregnancy], but there were minimal risks of heart defects. I preferred not to take a chance.

When in doubt, she chose to stop her treatment during her pregnancy and during breastfeeding her baby. But his decision was not without consequences.

Everything is more difficult, everything is more tiring. In addition to the lack of sleep, because I have a young baby, I have this additional fatigue caused by the fact that I am not taking my medication. So, I'm even more tired and it's certain that that puts me a little more at risk and fragile in terms of mental health, she notes, while her little Louis seems in great shape, from the top of his eight months.

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Marie-Philippe Busque preferred to stop her medication during her pregnancy, and she suffered the consequences.

Professor at the Faculty of Pharmacy at the University of Montreal and researcher at the CHU Sainte-Justine Research Center, Anick Bérard is well aware of these difficult decisions, based on insufficient data. For nearly 20 years, the epidemiologist has specialized in studying the effects of medications taken during pregnancy and breastfeeding.

Before a drug is approved by Health Canada, the manufacturer must conduct clinical trials. However, in these trials, pregnant women are systematically excluded.

A quote from Anick Bérard, professor at the Faculty of Pharmacy at the University of Montreal and researcher at CHU Sainte-Justine

We want to protect them and their babies. That being said, by doing this, we are not protecting anyone, believes Ms. Bérard. On the one hand, she argues, women take medications while they are pregnant, intentionally or not – before they know they are pregnant, for example. On the other hand, forgoing treatments out of caution can deprive them of their beneficial effects.

Pregnancy is not an illness, but being pregnant does not prevent you from being sick. In Quebec, 75% of pregnant women will take medication at some point during their pregnancy, underlines Ms. Bérard.

However, we know that during pregnancy, we can metabolize the drug differently, eliminate it differently, respond differently, points out Dr. Ema Ferreira, pharmacist at CHU Sainte-Justine, who collaborates on the work of Anick Bérard. /p>

In her practice, Ms. Ferreira treats pregnant women hospitalized for various reasons, for example infections, but also some who are planning a pregnancy while taking complex medications.

It's always a balance because the mother's health is important. The baby's health too, that's for sure. And we have to find something between the two, where the mother will be as well as possible, because in a well-treated mother, the pregnancy will go better, she summarizes.

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An example used by researchers: epilepsy. Almost all antiepileptic drugs can cause mutations in the fetus, underlines Anick Bérard.

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Professor at the Faculty of Pharmacy at the University of Montreal and researcher at CHU Sainte-Justine, epidemiologist Anick Bérard is closely interested in the effects of taking medications during pregnancy and breastfeeding.

< p class="StyledBodyHtmlParagraph-sc-48221190-4 hnvfyV">However, she indicates, the data we have so far demonstrate that epilepsy must absolutely be treated during pregnancy because the seizures are more harmful than the medication. […] The option is not to treat or not to treat. Although there are pregnant women with epilepsy who do not take any medication. We see it. But the option should be: which drug to use, which drug is the least worse?

In order to improve the knowledge on which to base these delicate decisions , Anick Bérard and her team carry out so-called observational studies.

In large databases, such as that of the Régie de l'assurance santé du Québec or hospital records, researchers trace pregnant women who have been exposed to various pharmaceutical products to identify their still unknown effects.

For example, these are women who take medication to treat asthma, depression or even epilepsy, and then, all of a sudden, at five or six weeks of gestational age, they realize that #x27;they are pregnant, illustrates Ms. Bérard. This is called inadvertent exposure. They didn't want to take the medicine during pregnancy, but they took it.

The results of this work highlight increased risks of malformations or pregnancy complications associated with certain medications, such as antidepressants or antifungals, while in other cases, for certain antibiotics, for example, the data are, at least on the contrary, rather reassuring.

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Pharmacist at CHU Sainte-Justine, Dr. Ema Ferreira collaborates in the work of Anick Bérard.

In addition to informing caregivers and their patients, these data feeds the Pregnancy and breastfeeding guide, of which Ema Ferreira is preparing the third edition. Co-written with her pharmacist colleagues Caroline Morin and Brigitte Martin, this 1000-page “bible” is THE reference of the IMAGe Center of CHU Sainte-Justine.

Brigitte Martin is the manager of this telephone service which has been answering questions from health professionals about the treatments to be offered to their pregnant or breastfeeding patients for over 25 years .

We receive around 5,000 requests per year, specifies Ms. Martin, who notes that over time, questions from caregivers have become more specific, undoubtedly because information on medications and pregnancy, although lacking, has exploded over the past 15 years. years. Before, our job was to seek out information that was difficult to find, now it's more about taking this information and making a coherent synthesis of it.

However, if information accumulates for certain drugs, new therapeutic approaches constantly raise new questions for caregivers, she observes, citing in particular treatments against ADD or those against obesity.

< p class="StyledBodyHtmlParagraph-sc-48221190-4 hnvfyV">All the more reason to continue to demand more studies in pregnant women, particularly from pharmaceutical companies. It's the mantra of people in the field: protect pregnant women BY research, not OF research, says Brigitte Martin.

On this subject, Anick Bérard is optimistic. Pharmaceutical companies see that their drugs are used in pregnant women. So, more and more, they want to participate in research […] It's going to take time, but I think it's changing.

A report by Gaëlle Lussiaà-Berdou and Hélène Morin on this subject will be presented on the show Découverte Sunday at 6 h 30 on HERE TV.

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