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Mascherpa M, Fichera A, Orabona R, Recupero D, Borroni B, Odicino FE, Prefumo F. Inherited episodic ataxia type 2 in pregnancy: A case report. Int J Gynaecol Obstet 2024; 165:387-389. [PMID: 38059694 DOI: 10.1002/ijgo.15292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 11/15/2023] [Accepted: 11/28/2023] [Indexed: 12/08/2023]
Abstract
SynopsisAn optimal materno‐neonatal outcome was obtained in a pregnancy with inherited episodic ataxia through a multidisciplinary team handling timing and mode of delivery.
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Affiliation(s)
- Margaret Mascherpa
- Department of Obstetrics and Gynecology, ASST-Spedali Civili, Brescia, Italy
| | - Anna Fichera
- Department of Obstetrics and Gynecology, ASST-Spedali Civili, Brescia, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Rossana Orabona
- Department of Obstetrics and Gynecology, ASST-Spedali Civili, Brescia, Italy
| | - Daniela Recupero
- Department of Anesthesiology 1, Spedali Civili of Brescia, University of Brescia, Brescia, Italy
| | - Barbara Borroni
- Centre for Neurodegenerative Disorders, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Franco Edoardo Odicino
- Department of Obstetrics and Gynecology, ASST-Spedali Civili, Brescia, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Federico Prefumo
- Obstetrics and Gynecology Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy
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Demarinis G, Tatti F, Taloni A, Giugliano AV, Panthagani J, Myerscough J, Peiretti E, Giannaccare G. Treatments for Ocular Diseases in Pregnancy and Breastfeeding: A Narrative Review. Pharmaceuticals (Basel) 2023; 16:1433. [PMID: 37895903 PMCID: PMC10610321 DOI: 10.3390/ph16101433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 09/30/2023] [Accepted: 10/02/2023] [Indexed: 10/29/2023] Open
Abstract
Pregnancy is a medical condition in which the physiological changes in the maternal body and the potential impact on the developing fetus require a cautious approach in terms of drug administration. Individual treatment, a thorough assessment of the extent of the disease, and a broad knowledge of the therapeutic options and different routes of administration of ophthalmic drugs are essential to ensure the best possible results while minimizing risks. Although there are currently several routes of administration of drugs for the treatment of eye diseases, even with topical administration, there is a certain amount of systemic absorption that must be taken into account. Despite continuous developments and advances in ophthalmic drugs, no updated data are available on their safety profile in these contexts. The purpose of this review is both to summarize the current information on the safety of ophthalmic treatments during pregnancy and lactation and to provide a practical guide to the ophthalmologist for the treatment of eye diseases while minimizing harm to the developing fetus and addressing maternal health needs.
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Affiliation(s)
- Giuseppe Demarinis
- Department of Surgical Sciences, Eye Clinic, University of Cagliari, Via Ospedale 48, 09124 Cagliari, Italy; (G.D.); (F.T.); (E.P.)
| | - Filippo Tatti
- Department of Surgical Sciences, Eye Clinic, University of Cagliari, Via Ospedale 48, 09124 Cagliari, Italy; (G.D.); (F.T.); (E.P.)
| | - Andrea Taloni
- Department of Ophthalmology, University ‘Magna Græcia’ of Catanzaro, Viale Europa, 88100 Catanzaro, Italy;
| | | | - Jesse Panthagani
- Department of Ophthalmology, Southend University Hospital, Southend-on-Sea SS0 0RY, UK; (J.P.); (J.M.)
| | - James Myerscough
- Department of Ophthalmology, Southend University Hospital, Southend-on-Sea SS0 0RY, UK; (J.P.); (J.M.)
| | - Enrico Peiretti
- Department of Surgical Sciences, Eye Clinic, University of Cagliari, Via Ospedale 48, 09124 Cagliari, Italy; (G.D.); (F.T.); (E.P.)
| | - Giuseppe Giannaccare
- Department of Surgical Sciences, Eye Clinic, University of Cagliari, Via Ospedale 48, 09124 Cagliari, Italy; (G.D.); (F.T.); (E.P.)
- Department of Ophthalmology, University ‘Magna Græcia’ of Catanzaro, Viale Europa, 88100 Catanzaro, Italy;
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Belkin A, Chen T, DeOliveria AR, Johnson SM, Ramulu PY, Buys YM. A Practical Guide to the Pregnant and Breastfeeding Patient with Glaucoma. Ophthalmol Glaucoma 2021; 3:79-89. [PMID: 32672600 DOI: 10.1016/j.ogla.2019.12.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 12/04/2019] [Accepted: 12/10/2019] [Indexed: 01/28/2023]
Affiliation(s)
- Avner Belkin
- Department of Ophthalmology and Vision Sciences, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Teresa Chen
- Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | | | | | - Pradeep Y Ramulu
- Johns Hopkins Wilmer Eye Institute, Baltimore, Maryland; Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Yvonne M Buys
- Department of Ophthalmology and Vision Sciences, Toronto Western Hospital, Toronto, Ontario, Canada.
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Razeghinejad MR, Nowroozzadeh MH. Anti‐glaucoma medication exposure in pregnancy: an observational study and literature review. Clin Exp Optom 2021; 93:458-65. [DOI: 10.1111/j.1444-0938.2010.00526.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- M Reza Razeghinejad
- Department of Ophthalmology, Shiraz University of Medical Sciences, Shiraz, Iran
E‐mail:
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Ketz J, Saxena V, Arregui S, Jackson A, Schwartz GJ, Yagisawa T, Fairchild RL, Hains DS, Schwaderer AL. Developmental loss, but not pharmacological suppression, of renal carbonic anhydrase 2 results in pyelonephritis susceptibility. Am J Physiol Renal Physiol 2020; 318:F1441-F1453. [PMID: 32390512 DOI: 10.1152/ajprenal.00583.2019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Carbonic anhydrase II knockout (Car2-/-) mice have depleted numbers of renal intercalated cells, which are increasingly recognized to be innate immune effectors. We compared pyelonephritis susceptibility following reciprocal renal transplantations between Car2-/- and wild-type mice. We examined the effect of pharmacological CA suppression using acetazolamide in an experimental murine model of urinary tract infection. Car2-/- versus wild-type mice were compared for differences in renal innate immunity. In our transplant scheme, mice lacking CA-II in the kidney had increased pyelonephritis risk. Mice treated with acetazolamide had lower kidney bacterial burdens at 6 h postinfection, which appeared to be due to tubular flow from diuresis because comparable results were obtained when furosemide was substituted for acetazolamide. Isolated Car2-/- kidney cells enriched for intercalated cells demonstrated altered intercalated cell innate immune gene expression, notably increased calgizzarin and insulin receptor expression. Intercalated cell number and function along with renal tubular flow are determinants of pyelonephritis risk.
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Affiliation(s)
- John Ketz
- Center for Clinical and Translational Medicine, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - Vijay Saxena
- Division of Pediatric Nephrology, Department of Pediatrics, Indiana University, Indianapolis, Indiana
| | - Samuel Arregui
- Division of Pediatric Nephrology, Department of Pediatrics, Indiana University, Indianapolis, Indiana
| | - Ashley Jackson
- Center for Clinical and Translational Medicine, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - George J Schwartz
- Division of Nephrology, Department of Pediatrics, University of Rochester Medical Center, Rochester, New York
| | - Takafumi Yagisawa
- Department of Inflammation and Immunity, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Robert L Fairchild
- Department of Inflammation and Immunity, Cleveland Clinic Foundation, Cleveland, Ohio
| | - David S Hains
- Division of Pediatric Nephrology, Department of Pediatrics, Indiana University, Indianapolis, Indiana
| | - Andrew L Schwaderer
- Division of Pediatric Nephrology, Department of Pediatrics, Indiana University, Indianapolis, Indiana
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Ibrahim A, Hussain N. Brief report: Metabolic acidosis in newborn infants following maternal use of acetazolamide during pregnancy. J Neonatal Perinatal Med 2020; 13:419-425. [PMID: 31771084 DOI: 10.3233/npm-190333] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The information regarding fetal effects of acetazolamide use during pregnancy and lactation is sparse. We report the clinical and pharmacodynamic characteristics of maternal acetazolamide use and the timing of its effects on acid-base balance in three cases who presented with metabolic acidosis in the newborn period. We found that the infants' clinical status soon after birth was inconsistently correlated with maternal drug dose and concentrations of medication in maternal serum. However, there was low transfer of the drug in breast milk and its use did not affect clinical symptomatology. We also present a review of literature on this subject to help consolidate our current knowledge on this topic.
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Affiliation(s)
- A Ibrahim
- Department of Volunteer Services, Connecticut Children's Medical Center and University of Connecticut School of Medicine, Farmington, CT, USA
| | - N Hussain
- Department of Pediatrics, Division of Neonatology, Connecticut Children's Medical Center and University of Connecticut School of Medicine, Farmington, CT, USA
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Sethi HS, Naik M, Gupta VS. Management of glaucoma in pregnancy: risks or choices, a dilemma? Int J Ophthalmol 2016; 9:1684-1690. [PMID: 27990376 PMCID: PMC5145101 DOI: 10.18240/ijo.2016.11.24] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 05/26/2016] [Indexed: 11/23/2022] Open
Abstract
The treatment of glaucoma in and around pregnancy offers the unique challenge of balancing the risk of vision loss to the mother as against the potential harm to the fetus or newborn. Most anti-glaucoma drugs (i.e. beta-blockers, prostaglandin analogues, carbonic anhydrase inhibitors topical and systemic, cholinergics, anticholinesterases, and apraclonidine) are considered category C agents and ophthalmologists are usually limited to treating patients with the category B drugs of brimonidine and dipivefrin. Brimonidine is generally the preferred first-line drug in the first, second and early third trimester. Late in the third trimester, brimonidine should be discontinued because it can induce central nervous system depression in newborns wherein topical carbonic anhydrase inhibitors may be the optimal choice. Glaucoma surgery can be performed with caution in second and third trimester if the patients have a strong indication for the procedure. However, anesthetics, sedative agents, and antimetabolites still have potential risk for the fetus. Argon laser trabeculoplasty (ALT) or selective laser trabeculoplasty (SLT) is an alternative treatment that can be performed in all trimesters. Carbonic anhydrase inhibitors and β-blockers are certified by the American Academy of Pediatrics for use during nursing. However, low doses of these medications should be considered when used in the breast feeding period. Optimum treatment for glaucoma in pregnancy must not be withheld so as to prevent any further deterioration in progressive vision loss and quality of life.
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Affiliation(s)
- Harinder Singh Sethi
- Department of Ophthalmology, V.M.M.C & Safdarjung Hospital, Newdelhi 110029, India
| | - Mayuresh Naik
- Department of Ophthalmology, V.M.M.C & Safdarjung Hospital, Newdelhi 110029, India
| | - Vishnu Swarup Gupta
- Department of Ophthalmology, V.M.M.C & Safdarjung Hospital, Newdelhi 110029, India
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Borgelt LM, Hart FM, Bainbridge JL. Epilepsy during pregnancy: focus on management strategies. Int J Womens Health 2016; 8:505-517. [PMID: 27703396 PMCID: PMC5036546 DOI: 10.2147/ijwh.s98973] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
In the US, more than one million women with epilepsy are of childbearing age and have over 20,000 babies each year. Patients with epilepsy who become pregnant are at risk of complications, including changes in seizure frequency, maternal morbidity and mortality, and congenital anomalies due to antiepileptic drug exposure. Appropriate management of epilepsy during pregnancy may involve frequent monitoring of antiepileptic drug serum concentrations, potential preconception switching of antiepileptic medications, making dose adjustments, minimizing peak drug concentration with more frequent dosing, and avoiding potentially teratogenic medications. Ideally, preconception planning will be done to minimize risks to both the mother and fetus during pregnancy. It is important to recognize benefits and risks of current and emerging therapies, especially with revised pregnancy labeling in prescription drug product information. This review will outline risks for epilepsy during pregnancy, review various recommendations from leading organizations, and provide an evidence-based approach for managing patients with epilepsy before, during, and after pregnancy.
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Affiliation(s)
| | - Felecia M Hart
- Departments of Clinical Pharmacy and Neurology, University of Colorado Anschutz Medical Campus, Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA
| | - Jacquelyn L Bainbridge
- Departments of Clinical Pharmacy and Neurology, University of Colorado Anschutz Medical Campus, Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA
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Al-Saleem AI, Al-Jobair AM. Possible association between acetazolamide administration during pregnancy and multiple congenital malformations. DRUG DESIGN DEVELOPMENT AND THERAPY 2016; 10:1471-6. [PMID: 27143854 PMCID: PMC4841426 DOI: 10.2147/dddt.s99561] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Congenital malformations might occur because of environmental or genetic factors, and sometimes occur because of unknown causes. Acetazolamide is a carbonic anhydrase inhibitor that is used to treat idiopathic intracranial hypertension, glaucoma, and epilepsy. The use of acetazolamide has not been recommended for pregnant women because of reported teratogenic risks. Congenital malformations, such as ectrodactyly, syndactyly, cleft lip/palate, and retarded incisor teeth development, have been reported in experimental animals. However, tooth agenesis due to the use of acetazolamide has not been reported yet. Oligodontia is a severe type of tooth agenesis involving six or more congenitally missing teeth. The causes of oligodontia are attributed to environmental factors, such as irradiation, drugs, trauma, tumors, infection, genetic factors, or a combination. There is no credible evidence of undesirable effects of acetazolamide use in human pregnancy. However, we report a case of a 12-year-old Saudi boy who was exposed to maternal acetazolamide (1,000 mg/day) for treatment of idiopathic intracranial hypertension before pregnancy, during the first trimester, and throughout the pregnancy. This treatment might have resulted in some congenital malformations, such as ectrodactyly, syndactyly, and oligodontia.
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Affiliation(s)
- Afnan I Al-Saleem
- Dental Department, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Asma M Al-Jobair
- Department of Pediatric Dentistry and Orthodontics, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
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Townsel C, Keller R, Johnson K, Hussain N, Campbell WA. Seronegative Maternal Ocular Myasthenia Gravis and Delayed Transient Neonatal Myasthenia Gravis. AJP Rep 2016; 6:e133-6. [PMID: 26989568 PMCID: PMC4794443 DOI: 10.1055/s-0036-1579624] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Background Myasthenia gravis (MG) is an autoimmune disorder with fluctuating muscle weakness, divided into generalized and localized (ocular) forms. Maternal antibodies to acetylcholine receptors cross the placenta and may cause transient neonatal myasthenia gravis (TNMG). We present a case of seronegative maternal ocular MG and delayed TNMG. Case A 29-year-old G3P1011 underwent cesarean birth of a male infant who developed oxygen desaturation requiring supplemental oxygen on day of life (DOL) 3. Based on the clinical course and after exclusion of other diagnoses, the infant was diagnosed with TNMG. Infant's condition improved spontaneously and he was weaned off supplemental oxygen and discharged home on DOL 12. Conclusion Infants born to mothers with seronegative localized (ocular) MG are also susceptible to TNMG which may be late in onset.
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Affiliation(s)
- Courtney Townsel
- Division of Maternal Fetal Medicine, University of Connecticut School of Medicine, Farmington, Connecticut
| | - Rebecca Keller
- Division of Maternal Fetal Medicine, University of Connecticut School of Medicine, Farmington, Connecticut
| | - Kendall Johnson
- Division of Neonatology, Connecticut Children's Medical Center, Farmington, Connecticut
| | - Naveed Hussain
- Division of Neonatology, Connecticut Children's Medical Center, Farmington, Connecticut
| | - Winston A Campbell
- Division of Maternal Fetal Medicine, University of Connecticut School of Medicine, Farmington, Connecticut
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Abstract
INTRODUCTION Carbonic anhydrase (CA) inhibitors have an impressive safety record despite the multiple functions that CA isozymes serve because they are not fully inhibited with most dosing. While reducing the targeted CA-dependent process sufficiently for disease control, residual activity and uncatalyzed rates in combination with compensations are adequate to avoid lethal consequences. Some drugs have in vitro selectivity differences against the 13 active isozymes, but none are convincingly selective in vivo or clinically. Efforts to synthesize selective inhibitors should result in safer drugs with fewer side effects. AREAS COVERED This review will focus on approved drugs with CA-inhibiting activity, whether used directly for this purpose or others. Side effects are discussed in relation to various organ systems and the disease being treated. Causes of side effects are considered, and strategies for symptom reduction are given. EXPERT OPINION Common side effects of paresthesias, dyspepsia, lassitude and fatigue in 30 - 40% of patients are generally tolerable or abate, but if not can be partially relieved by bicarbonate supplementation. The most important safety concerns are severe acidosis, respiratory failure and encephalopathy in patients with renal, pulmonary and hepatic disease where caution is critical, as is also the case in persons with sulfa drug allergies.
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Affiliation(s)
- Erik R Swenson
- University of Washington - Medical Service, VA Puget Sound Health Care System , 1660 S Columbian Way, S-111-PLUM, Seattle, WA 98108 , USA
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Falardeau J, Lobb BM, Golden S, Maxfield SD, Tanne E. The Use of Acetazolamide During Pregnancy in Intracranial Hypertension Patients. J Neuroophthalmol 2013; 33:9-12. [DOI: 10.1097/wno.0b013e3182594001] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Jean D, Moore LG. Travel to high altitude during pregnancy: frequently asked questions and recommendations for clinicians. High Alt Med Biol 2012; 13:73-81. [PMID: 22724609 DOI: 10.1089/ham.2012.1021] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
The effects of altitude on pregnancy have been extensively studied in high altitude residents, but there is a lack of knowledge concerning the pregnant altitude visitor. Exposure to hypoxia results in physiologic responses which act to preserve maternal and fetal oxygenation. However, these reactions are limited and maternal/fetal complications may be observed, especially in association with exercise. Certain pre-existing conditions or risk factors of hypertension/preeclampsia and/or fetal growth restriction are contra-indications for traveling to high altitude, especially after 20 weeks. The acclimatization process has to be respected to avoid acute mountain sickness without taking drugs, and at least a few days of acclimatization are required before exercising.
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Affiliation(s)
- Dominique Jean
- Centre Pluridisciplinaire de Diagnostic Prénatal, Centre Hospitalier Universitaire de Grenoble, France.
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Razeghinejad MR, Sawchyn AK, Katz LJ. Fixed combinations of dorzolamide-timolol and brimonidine-timolol in the management of glaucoma. Expert Opin Pharmacother 2010; 11:959-68. [PMID: 20307220 DOI: 10.1517/14656561003667540] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
IMPORTANCE OF THE FIELD The emergence of fixed-combination drugs for the treatment of glaucoma has, to some extent, changed the medical management of glaucoma. The potential benefits of these drugs include a reduction in the total number of drops and preservatives instilled per day and improved patient comfort factors, which may contribute to better compliance. Combination medications may also improve therapeutic efficacy and play an important role in controlling medication cost. However, the fixed dosing may be a disadvantage in some cases. AREA COVERED IN THIS REVIEW This review describes the composition, pharmacokinetics, mode of action, efficacy, side effects, and safety profile of fixed-combination dorzolamide-timolol and fixed-combination brimonidine-timolol. WHAT THE READER WILL GAIN Understanding of the pros, cons, and safety profile of two FDA approved fixed-combination antiglaucoma medication. TAKE HOME MESSAGE Fixed-combination medications may be a reasonable adjunct to prostaglandins if a large drop in the intraocular pressure (IOP) is desired and adding only one medication is unlikely to reach the target IOP range. Both mentioned drugs are effective in reducing the IOP and further clinical studies will help identify differences in efficacy between the two. The clinician must make an individualized assessment of the medication's risk-benefit profile for each patient.
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Beallor C. STATEMENT ON PREGNANCY AND TRAVEL: Committee to Advise on Tropical Medicine and Travel. CANADA COMMUNICABLE DISEASE REPORT = RELEVE DES MALADIES TRANSMISSIBLES AU CANADA 2010; 36:1-44. [PMID: 31682651 PMCID: PMC6802433 DOI: 10.14745/ccdr.v36i00a02] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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Carroll ID, Williams DC. Pre-travel vaccination and medical prophylaxis in the pregnant traveler. Travel Med Infect Dis 2008; 6:259-75. [PMID: 18760249 DOI: 10.1016/j.tmaid.2008.04.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2008] [Accepted: 04/15/2008] [Indexed: 11/29/2022]
Abstract
BACKGROUND Practitioners are often fearful of giving vaccinations and prophylactic medications to pregnant travelers. And yet pregnancy is often a time of heightened danger from travel-related infections and illnesses. METHOD Literature search and communication with researchers. RESULTS With a few exceptions, there is little systematic research regarding the use of prophylactic medications and vaccines during pregnancy. Case reports and small studies do, however, indicate an increased risk in pregnancy from many of the preventable illnesses, and there is some data to support the use of preventive measures. CONCLUSIONS The authors present some non-medical interventions that may be used to limit exposure to a number of disease processes. They then review the available information regarding the safety and efficacy of routine and travel-related vaccines as well as prophylactic medications for malaria, diarrhea, motion sickness and altitude sickness. When there are no obstetrical or medical contraindications, travel-related illness can usually be safely prevented during pregnancy in much the same ways as in the non-pregnant state.
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Affiliation(s)
- I Dale Carroll
- The Pregnant Traveler, 18691 Pinecrest Lane, Spring Lake, MI 49456 USA.
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Lee AG, Pless M, Falardeau J, Capozzoli T, Wall M, Kardon RH. The use of acetazolamide in idiopathic intracranial hypertension during pregnancy. Am J Ophthalmol 2005; 139:855-9. [PMID: 15860291 DOI: 10.1016/j.ajo.2004.12.091] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2004] [Indexed: 11/18/2022]
Abstract
PURPOSE To describe the pregnancy outcomes after the use of acetazolamide in pregnant patients with idiopathic intracranial hypertension (IIH). DESIGN Observational case series. METHODS setting: Two tertiary care academic neuro-ophthalmology units. patient population: Patients with IIH treated with acetazolamide. observation procedure: Documentation of pregnancy outcome. main outcome measures: Normal pregnancy, fetal loss, or congenital malformation. RESULTS Twelve patients were treated with acetazolamide for IIH during pregnancy, and there were no adverse pregnancy outcomes. A critical review of the English language literature on the subject failed to demonstrate any convincing evidence for any adverse effect on pregnancy for acetazolamide. CONCLUSIONS Acetazolamide at high doses may produce birth defects in animals, but there is little clinical or experimental evidence to support any adverse effect of the drug on pregnancy outcomes in humans. If the clinical situation warrants the use of acetazolamide in IIH, then the drug probably can be offered after appropriate informed consent.
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Affiliation(s)
- Andrew G Lee
- Department of Ophthalmology, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, PFP, Iowa City, IA 52242, USA.
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Carroll ID, Van Gompel A. The pregnant wilderness traveler. Travel Med Infect Dis 2005; 3:225-38. [PMID: 17292041 DOI: 10.1016/j.tmaid.2004.11.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2004] [Accepted: 11/02/2004] [Indexed: 10/25/2022]
Abstract
BACKGROUND Travel during pregnancy, especially, when it involves potentially hazardous activities in remote areas, often raises serious concerns regarding the health and safety risks involved. METHOD The authors have researched the available medical literature to identify these risks and present the current recommendations for their prevention and treatment. RESULTS Topics addressed include some political and social issues, insurance, basic comfort measures, complications of pregnancy, infectious diseases, environmental exposures, and trauma. Preventive measures include pre-travel evaluation and teaching, possible modifications of the itinerary, vaccinations and medications. Also briefly discussed are the handling of obstetrical emergencies in the field and medical evacuation of the pregnant patient. CONCLUSIONS The authors conclude that many trips of this nature can be made relatively safe for the pregnant traveler, but she may need to accept some precautions and modifications of the itinerary that might not otherwise be necessary.
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Affiliation(s)
- I Dale Carroll
- The Pregnant Traveler, 4475 Wilson Ave., SW, Suite 8, Grandville, MI 49418, USA
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Qasqas SA, McPherson C, Frishman WH, Elkayam U. Cardiovascular Pharmacotherapeutic Considerations During Pregnancy and Lactation. Cardiol Rev 2004; 12:240-61. [PMID: 15316305 DOI: 10.1097/01.crd.0000102421.89332.43] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Table 2 summarizes the recommendations regarding the use of cardiovascular drugs during pregnancy and lactation.
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Affiliation(s)
- Shadi A Qasqas
- Departments of Medicine, Washington University School of Medicine/Barnes-Jewish Hospital, St. Louis, Missouri, USA
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Binder DK, Horton JC, Lawton MT, McDermott MW. Idiopathic intracranial hypertension. Neurosurgery 2004; 54:538-51; discussion 551-2. [PMID: 15028127 DOI: 10.1227/01.neu.0000109042.87246.3c] [Citation(s) in RCA: 179] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2003] [Accepted: 09/15/2003] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE The history, diagnosis, and therapy of idiopathic intracranial hypertension (IIH) (pseudotumor cerebri) are reviewed. Theories of pathogenesis are considered, the clinical presentation is described, and potential diagnostic and therapeutic challenges are explored. METHODS An extensive literature review of IIH and related conditions (secondary pseudotumor syndromes) was performed. The history of and rationale for the diagnosis and medical and surgical approaches to treatment are reviewed. Available outcome studies are presented. RESULTS Diagnosis of IIH requires that the modified Dandy criteria be satisfied. Multiple potential contributing causes of intracranial hypertension must be identified or excluded. The clinical presentation most often includes headaches and papilledema, but many other findings have been described. The most important goal of therapy is to prevent or arrest progressive visual loss. Medical therapies include alleviation of associated systemic diseases, discontinuation of contributing medications, provision of carbonic anhydrase inhibitors, and weight loss. Surgical therapies include lumboperitoneal shunting, ventriculoperitoneal shunting, and optic nerve sheath fenestration. On the basis of the advantages and disadvantages of these treatment modalities, a suggested treatment paradigm is presented. CONCLUSION Idiopathic intracranial hypertension is the term to be adopted instead of pseudotumor cerebri. IIH remains an enigmatic diagnosis of exclusion. However, prompt diagnosis and thorough evaluation and treatment are crucial for preventing visual loss and improving associated symptoms.
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Affiliation(s)
- Devin K Binder
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California 94143-0112, USA
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Abstract
A 30-year-old pregnant woman with glaucoma is presented. The management of her case is used as a basis for a discussion of the use of glaucoma medications, including newer formulations, during pregnancy and lactation.
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Affiliation(s)
- S M Johnson
- Department of Ophthalmology, University of North Carolina Hospitals, Chapel Hill, NC, USA
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23
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Abstract
OBJECTIVE To summarize the pharmacology, pharmacokinetics, efficacy, and safety of acetazolamide and to evaluate its therapeutic role in patients with epilepsy. DATA SOURCES A computerized search of the MEDLINE (OVID) database (1966-1994) was used to identify publications regarding acetazolamide. The MEDLINE search was supplemented by information from textbooks. STUDY SELECTION Included were English-language review articles, clinical trials, cohort studies, and case reports. Topics investigated included basic pharmacology, therapeutics, toxicology, adverse reactions, dosage, administration, and pharmacokinetics of acetazolamide. DATA SYNTHESIS Acetazolamide, a carbonic anhydrase inhibitor, has been approved for the treatment of epilepsy since 1953. Acetazolamide is primarily used in combination therapy with other antiepileptic medications in both children and adults although it may be used as monotherapy. Drug concentration monitoring has not been found to be routinely beneficial. Adverse effects include kidney stones, metabolic acidosis, lethargy, appetite suppression, paresthesias, and rare blood dyscrasias. Partial tolerance may develop to the antiepileptic activity. CONCLUSIONS Acetazolamide is a beneficial adjunctive agent in the pharmacotherapy of epilepsy and should be considered in refractory epilepsy. Although it may be useful in partial, myoclonic, absence, and primary generalized tonic-clonic seizures uncontrolled by other marketed agents, acetazolamide has been inadequately studied by current standards and its use has been limited.
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Affiliation(s)
- W G Reiss
- Department of Pharmacy Practice Science, School of Pharmacy, University of Maryland, Baltimore, USA
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