Spotlight Commentary: Medicines use during pregnancy and harmful effects on offspring
Notice bibliographique
Résumé
Medicines use during the pregnancy can have a potentially negative impact on offspring because most medicines taken during pregnancy cross the placenta and reach the foetus. Safety concerns about the common medicines such as antibiotics, antidepressants, and paracetamol have been raised in postmarketing studies. A nested case-control study with 77 429 pregnancies which included 7039 spontaneous abortions and 70 390 controls in the Quebec Pregnancy Cohort was published recently in the British Journal of Clinical Pharmacology.1 They reported that trimethoprim-sulfamethoxazole (TMP-SMX) exposure during pregnancy was associated with an increased risk of spontaneous abortion (adjusted odds ratio 2.94, 95% confidence interval (CI) 1.89–4.57, 25 exposed cases). This strong association was unlikely to be biased by unmeasured confounding factors. A study conducted in France found that about a quarter of pregnant women took antidepressants2 and this highlights the potential safety concern about the offspring of these pregnant women. However, decisions regarding the use of antidepressants during pregnancy are complex and requires balancing the risks and benefits of the medications on both mother and child. The association between antidepressants in pregnancy and risk of attention-deficit/hyperactivity disorder in children has been reported in the literature.3 Zhao and colleagues conducted a systematic review and meta-analysis of cohort studies on the association between maternal fluoxetine use during the first trimester of pregnancy and congenital malformations in infants.4 Fluoxetine use was associated with increased risks of major malformations (relative risk (RR) 1.18, 95% CI, 1.08–1.29), cardiovascular malformations (1.36, 95% CI, 1.17–1.59), septal defects (1.38, 95% CI, 1.19–1.61), and non-septal defects (1.39, 95% CI, 1.12–1.73) with low heterogeneity in infants. No significant observations of other system-specific malformations were found from this review articles. Paracetamol is a commonly used medicine to treat pain and reduce a high temperature. A 25 case series review article5 reported that a causal relationship between maternal paracetamol intake and fetal ductus arteriosus constriction or closure is likely according to the World Health Organization Uppsala Monitoring Centre (WHO-UPC) causality tool (one case was classified as unlikely, nine as possible, 11 as probable and four as certain). The authors concluded that the findings suggest that pharmacovigilance studies on paracetamol safety during pregnancy are warranted to quantify the risk of such event and put the current findings into clinical perspective. The public should recognize the potential risk to offspring when pregnant women take any medicines should be highlighted to the general population. Due to the nature of observational studies, the results should be interpreted cautiously, especially any weak associations. More well designed studies are required to investigate the medicine safety issues in pregnant women. There are no competing interests to declare.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,009 | 0,073 |
| Méta-épidémiologie (sens strict) | 0,002 | 0,001 |
| Méta-épidémiologie (sens large) | 0,005 | 0,003 |
| Bibliométrie | 0,002 | 0,003 |
| Études des sciences et des technologies | 0,003 | 0,004 |
| Communication savante | 0,004 | 0,005 |
| Science ouverte | 0,010 | 0,002 |
| Intégrité de la recherche | 0,049 | 0,027 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,039 | 0,015 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».