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Pregnancy-Associated Changes in Pharmacokinetics: A Systematic Review
Gali Pariente1, Tom Leibson1, Alexandra Carls1
1Division of Clinical Pharmacology and Toxicology, Hospital for Sick Children, Toronto, Ontario, Canada.
Plos Medicine
|November 2, 2016
Summary
Pregnancy significantly alters drug pharmacokinetics (PK), affecting absorption, distribution, metabolism, and excretion. While changes in drug elimination and exposure are common, their clinical impact on mothers and fetuses remains largely unknown.
Area of Science:
- Pharmacology
- Maternal-Fetal Medicine
- Drug Metabolism
Background:
- Pregnancy involves significant physiological changes affecting drug pharmacokinetics (PK).
- Understanding PK alterations is crucial for appropriate medication management during pregnancy.
- Existing evidence on pregnancy-associated PK changes needs systematic review.
Purpose of the Study:
- To systematically identify and review existing clinical evidence on pharmacokinetic changes during pregnancy.
- To synthesize findings on how drug absorption, distribution, metabolism, and excretion are altered in pregnant women.
Main Methods:
- Conducted systematic searches of major biomedical databases (MEDLINE, Embase, Cochrane, Web of Science) up to May 2016.
- Included clinical PK studies comparing pregnant women to nonpregnant individuals or population data.
- Analyzed 198 studies covering 121 different medications, focusing on drug classes like antiretrovirals, antiepileptics, antibiotics, antimalarials, and cardiovascular drugs.
Main Results:
- Pregnancy-associated changes in PK parameters were consistently observed across numerous studies.
- Enhanced drug elimination and decreased overall drug exposure were common findings.
- Clinical responses and outcomes related to these PK changes are largely undetermined.
Conclusions:
- A significant gap exists between knowledge of pregnancy-related PK changes and their clinical implications.
- Clinicians must be aware of altered drug pharmacokinetics in pregnant patients.
- Further research is needed to understand the clinical impact of these PK alterations on maternal and fetal health.
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