February 28, 2021

Medicine in pregnancy, that’s where Italian mothers go wrong


In pregnancy, mothers add to taking care of themselves by taking care of a life to come. An even more delicate responsibility when it comes to taking a drug. What helps the adult fight the disease, without side effects or with negligible repercussions, can instead be harmful to a body that is taking shape. To learn more about the use of medicines while pregnant, theItalian drug agency carried out a study, analyzing the information of 450 thousand mothers between 1 April 2016 and 31 March 2018 in eight regions (Lombardy, Emilia-Romagna, Veneto, Tuscany, Umbria, Lazio, Puglia and Sardinia). According to the survey, three-quarters of women received a prescription while pregnant, 51.5 percent took medicine in the first trimester after conception. In general, women are aware of the possible risks of drugs and follow the therapeutic indications says Anna Locatelli, head of the Maternal and Infant department of the Asst of Vimercate and professor of the Milano Bicocca University who participated in the work. There are aspects to be corrected.

Pay attention to the times

Drugs that can cause malformations today are few and rarely used, but they have not disappeared. I’m to avoid especially in the first quarter of gestation. In this period some medicines can create problems in the formation of organs, such as valproic acid used in case of epilepsy says Antonio Clavenna, pharmacologist of the Laboratory for Maternal and Child Health of the Mario Negri Institute in Milan, who took part in the study with Locatelli and other experts. Subsequently, the damages are of different types and concern the functioning of the organs. the case of Ace inhibitors against hypertension, which can cause kidney failure in the child. Among the first points of the survey there is one relating to all‘intake of folic acidto prevent defects of the neural tube, the embryonic neurological structure from which a large part of the nervous system of the unborn child originates. International recommendations recommend it to all those who are preparing to have a child or do not exclude the possibility, but in fact they are not fully respected in Italy. Other studies also confirm that folic acid supplementation is lower than the guidelines – continues Clavenna -. The ideal begin three months before pregnancy and continue for the first quarter. Starting early increases its effectiveness. Furthermore, folic acid has no health risks and is reimbursable by the National Health Service.


Inappropriate uses

On the contrary, regional data shows a not always appropriate use of progestogens, substances that have effects similar to those of progesterone, the female hormone secreted in the second phase of the menstrual cycle and in pregnancy. Italian custom to prescribe them in the first trimester of gestation, in order to reduce the chances of spontaneous abortion (despite the scarce scientific evidence) and subsequently to prevent premature birth. Clavenna explains in which cases it is good to take them: They are indicated only if the patient has a history of repeated abortions or births before the due date. Otherwise, the exposure is useless. Pure for the antibiotics the habit of prescribing them even when not needed is noticeable. A peak was detected between the 18th and 20th week of gestation – says the pharmacologist -, which is the period in which mothers undergo invasive tests such as CVS and amniocentesis. The hypothesis that they are suggested as prophylaxis, but there are no scientific indications in this regard. Abuse could have negative consequences. In addition to antibiotic resistance, with the development of bacteria increasingly difficult to fight, researchers are studying another effect. The data are not conclusive – Clavenna begins -, but we investigate possible risks due to excessive use. The little ones would suffer from asthma, allergies and obesity. Antibiotics are capable of altering the intestinal flora and could be at the root of these diseases.

Regional differences

The study highlights also significant differences between the Region and the Region in the prescriptions for future mothers, Locatelli points out. Sometimes there is a tendency to prescribe more drugs out of fear of the effects of the disease or to please patients and not just those who are pregnant, adds Clavenna. For all women who are pregnant or who do not rule out having a child, the main recommendation that emerges from the survey concerns the intake of folic acid. The second is the invitation for those suffering from a chronic disease to plan pregnancy in advance. Some diseases require a complex pharmacological approach – says Locatelli -, an overview of gynecologists and other specialists is needed to identify the best therapeutic path.

February 22, 2021 (change February 22, 2021 | 19:31)

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