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Koren G.,Motherisk Program | Nordeng H.M.E.,University of Oslo | Nordeng H.M.E.,Norwegian Institute of Public Health
Seminars in Fetal and Neonatal Medicine

Selective serotonin reuptake inhibitors (SSRIs) are widely used by pregnant women due to the high rates of depression among reproductive-age women. Several studies based on administrative databases reported an increased risk of cardiac malformations among infants of pregnant users. This has caused anxiety and fears among expecting women and their physicians, often leading to discontinuation of much-needed therapies. Recent decisive evidence documented a similar higher risk of cardiac malformations among depressed women not taking SSRIs during pregnancy. The most likely reason is ascertainment bias, with depressed women, treated or untreated, undergoing significantly more diagnostic tests in their children. These data strongly support the view that SSRIs do not increase the risk of cardiovascular malformations. © 2012. Source

Koren G.,Motherisk Program
Canadian Family Physician

Question: A patient in my practice who takes buprenorphine for chronic pain would like to conceive. Is it safe for her to continue taking her medication? Answer: The literature regarding periconceptional opioid use is conflicted as to whether opioids pose an elevated risk of birth defects. Confounding factors such as socioeconomic status, stress, and alcohol consumption might play a role. The first trimester of pregnancy is the critical period of development for many organ systems in the embryo. A chemical or environmental insult is more likely to produce major congenital malformations such as neural tube defects or mental retardation if it occurs within this window. Medical practitioners should judiciously consider a risk-benefit analysis before making their decisions. © 2015, College of Family Physicians of Canada. All rights reserved. Source

Nordeng H.,University of Oslo | Koren G.,University of Toronto | Einarson A.,Motherisk Program
Annals of Pharmacotherapy

BACKGROUND: Beliefs about medication may impact a woman's decision to take a needed medication during pregnancy. While many women will be faced with decisions regarding medication use during pregnancy, there is a paucity of research on this topic in the literature. OBJECTIVE: To study pregnant women's beliefs about medication and factors that determine those beliefs. METHODS: A questionnaire was posted at the University of Oslo's Web site for Internet surveys for 5 weeks from mid-September 2008 through October 2008. Seven general statements from the "Beliefs about Medicines" questionnaire and 9 pregnancy-specific statements were used to assess pregnant women's attitudes toward medication use during pregnancy. Other information, such as sociodemographic background and personal medication use during pregnancy, was also collected. RESULTS: A total of 866 pregnant women completed the questionnaire. Most women had a positive attitude toward medication in general, but believed pregnant women should be more restrictive regarding use than nonpregnant women. There was a significant association between women's education, occupation, and attitudes, with less educated women believing that medications in general were harmful and herbal remedies were safe, while women with a higher education were more reluctant to use any medication in pregnancy. Women with health-related occupations were more knowledgeable about the possible risks of untreated illness during pregnancy. There was also an association between pregnant women's attitudes and their use of prescribed penicillins and herbal remedies. CONCLUSIONS: Most pregnant women believe that medicines in general are helpful and safe to use. However, they are much more restrictive and unsure about use during pregnancy. Health-care professionals should be aware of such attitudes when advising a woman to take a needed medication during pregnancy. Source

Nordeng H.,University of Oslo | Nordeng H.,Norwegian Institute of Public Health | Ystrom E.,Norwegian Institute of Public Health | Einarson A.,Motherisk Program
European Journal of Clinical Pharmacology

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. © 2009 Springer-Verlag. Source

Chandranipapongse W.,Hospital for Sick Children | Koren G.,Motherisk Program
Canadian Family Physician

Question A healthy woman of reproductive age complained that when she saw me before pregnancy I did not advise her that she could check her varicella immunity and get vaccinated. She contracted chickenpox and endured unnecessary anxiety. This led me to think that it would be useful to have a summary of all the preconception counseling advice we should give to our patients to ensure the best pregnancy outcomes possible. Could Motherisk provide such a summary? Answer Although favourable pregnancy outcomes cannot be guaranteed, when a pregnancy is planned, many risk factors can be reduced and modified to enhance pregnancy outcomes. In the summary provided we will discuss optimization of diet, weight, and exercise; discontinuation of smoking and drinking; controlling chronic medical conditions; starting supplementation with multivitamins and folic acid; and ensuring proper immunization. Source

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