Analiza savetovanja trudnica o upotrebi antiinfektivnih i antiinflamatornih lekova tokom trudnoće

Abstract

Lekovi mogu delovati štetno u bilo kom razdoblju trudnoće, te se samo mali broj njih smatra potpuno bezbednim za upotrebu u toku trudnoće. Procena rizika i primena odgovarajuće terapije je vrlo važna. Cilj ovog rada je da ispita sve faktore povezane sa procenom visokog rizika od strane kliničkih farmakologa u trudnica kojima su propisani anti-infektivni lekovi i blagi analgetici. Sprovedena je studija-preseka u koju je uključeno 284 trudnica koje su dolazile po savet u Službu za kliničku farmakologiju Kliničkog centra Kragujevac , u periodu od 1997. do 2012. godine. Sve trudnice su koristile neke od anti-infektivnih lekova i blagih analgetika tokom prva tri meseca trudnoće. Podaci su prikupljeni iz medicinskih kartona pacijentkinja i putem telefonskih intervjua.. Klinički farmakolozi su procenili rizik od pojave kongenitalnih anomalija kao „visok“ kod trudnica koje su bile na terapiji tetraciklinima i derivatima propionske kiseline tokom perioda trudnoće. Poremećaji u razvoju prema podacima datim od majki, su bili povezani sa primenom cefalosporina u toku prva tri meseca trudnoće. Spontani i namerni pobačaji su bili češći kod trudnica koje su bile na terapiji tetraciklinima tokom trudnoće. Procena rizika od kongenitalnih anomalija data od strane klinički farmakologa je deo rutinske prakse i u najvećoj meri zavisi od dostupne, publikovane literature i znanja o beznednosti datog leka tokom trudnoće, naročito u prva tri meseca.

Considering that small number of drugs are completely safe for use during pregnancy, right choice and adequate risk assessment is extremely important. The aim of this study was to analyze factors associated with estimate of high teratogenic risk (as judged by clinical pharmacologist) in pregnant females who were prescribed anti-infective drugs or mild analgesics. A cross-sectional study included 284 pregnant women who came for an advice about teratogenic risk to clinical pharmacologist in Clinical Centre Kragujevac, Serbia during the period from 1997 to 2012. All of included pregnant women were prescribed mild analgesics and/or anti-infective drugs during the first 3 months of pregnancy. The data were collected from patient files and by phone interviews. Clinical pharmacologists estimated the risk of teratogenicity as “high” in pregnant females who were using tetracyclines or propionic acid derivatives. Disorders of development reported by mothers during phone interviews were associated with cephalosporin use during first 3 months of pregnancy, while miscarriages or abortions happened more often in women who used a tetracycline. Estimate of risk from congenital anomalies after use of drugs during pregnancy, which make clinical pharmacologists as part of their routine healthcare services, depends on amount of published data about previous experiences with specific drugs during the first 3 months of pregnancy.