Uncomplicated Pregnancies and Ultrasounds for Fetal Growth Restriction: A Pilot Randomized Clinical Trial

This study was a randomized control trial to see if we should continue to give women ultrasonographic exams in their third trimester if their pregnancies are deemed uncomplicated.  These ultrasounds can be expensive, and this study was designed to see if they are beneficial at that point in the pregnancy.  Specifically, they wanted to see if having a third trimester ultrasound in an uncomplicated pregnancy would have any effect on detection of “small for gestational age” (SGA) when the birth weight of the baby less than 10% for the baby’s gestational age.

From a study done in 2012, approximately 10% of babies were born with SGA, and these pregnancies did not improve with the routine prenatal care  (bed rest, nutritional care, supplements).  These pregnancies did improve when abnormal growth is discovered before birth so that it may be evaluated and techniques to improve growth could be implemented.  The thinking is that these ultrasonographic exams can provide this information as to prevent the prevalence of SGA.

Of the women who were approached and gave consent, the detection of SGA was much higher (67%) when women had an ultrasonographic exam than the control (9%).  The evidence is overwhelming that receiving an ultrasound–even in the third trimester of an uncomplicated pregnancy–can still be beneficial and worth the time and money.  It was noted in the study that this may not be reflective of the entire population, as it had a small sample size.  The women they studied were very easy to find and only came from three sites.

 

Hammad IA, Chauhan SP, Mlynarczyk M, et al. Uncomplicated pregnancies and ultrasounds for fetal growth restriction: a pilot randomized clinical trial. AJP Rep. 2016; 6(1):83-90.

Effects of Prenatal Acetaminophen Exposure and Risk of Attention Deficit/Hyperactivity Disorder in Children

Acetaminophen has always been one of the most commonly used medications during pregnancy. It is reported that 65%-70% of women use acetaminophen at least once during their pregnancy due to the safety associated with it. In 2015, the FDA stated that there is a possible risk of ADHD developing in children who were exposed to acetaminophen prenatally.

After reviewing several previous studies, it was found that no certain relationship can be identified between prenatal exposure to acetaminophen and the development of ADHD. This is partly caused by the fact that diagnosing methods of ADHD have also changed. There are new medications now that are extended release to treat ADHD. These factors affect the number of children being reported to have ADHD, typically increasing it. It is not clear if there is actually an increase in the number of children with ADHD or if it is just being correctly diagnosed now.

The article explains that pharmacists should continue to recommend the lowest effective dose of acetaminophen. They should also make an effort to educate other health care providers and the expecting mothers of the importance of using acetaminophen properly. Other than these suggestions, what else could pharmacists due to prevent any additional side effects of common medications to pregnant women?

Hoover RM, Hayes AG, Erramouspe J. Association Between Prenatal Acetaminophen Exposure and Future Risk of Attention Deficit/Hyperactivity Disorder in Children. Ann Pharmacother. 2015: 49(12); 1357-1361. http://aop.sagepub.com/content/49/12/1357.full.pdf

Pharmacist Role in Counseling on Preconception Health

As accessible health care providers, pharmacists have a unique opportunity to improve preconception health in women which can lead to overall improved pregnancy outcomes. If women are thinking about conceiving a baby, it is important that they are counseled on prenatal supplementation and vaccinations. The information that a pharmacist can provide can help the woman make informed decisions about their lifestyle.

Screening for immunizations for measles, mumps, rubella, varicella, human papillomavirus, hepatitis A, and hepatitis B should all be recommended for women thinking about conceiving since they may have harmful effects on the developing fetus after conception. Not all vaccinations are off limits however. Inactivated influenza virus and tetanus, diphtheria, and pertussis vaccinations are recommended) even if the woman is pregnant (regardless of trimester) and should not pose a risk to the fetus. Moreover, contraction of influenza may cause problems for the baby. Influenza contraction in the first trimester gives rise to higher incidence of schizophrenia in the child. Contraction of the virus in the second and third trimesters poses more risk for the mother as breathing is impaired and the fetus is applying pressure on the mother’s diaphragm and lungs.

Counseling the woman on supplementation of folic acid may also lead to improved pregnancy outcomes as this B vitamin has been shown to improve optimal birth outcomes and neural tube development. Deficiency of this vitamin may result in spina bifida, a condition in which the spine does not close properly which can result in paralysis or mental retardation. It can also result in anencephaly or the case in which the brain does not form altogether. Since these events occur in the developing fetus within the first 28 days, it is important that the woman supplements this ahead of time.

Pharmacists have a role in helping educate people about medication day to day. However this role may be all the more important when discussing good preconception habits with women. This is a situation that there is a good chance that they have not been in before and since the development of the fetus is so fragile, it is important to make sure that they are getting all of the information correct in order to improve the likelihood of optimal birth outcomes.

Reference

El-Ibiary S, Raney E, Moos M. The pharmacist’s role in preconception health. J Am Pharm Assoc. 2014; 54(5): 288-303

J Am Pharm Assoc. 2014; 54(5): 288-303