产前护理的启动和暴露于原药物的治疗
Almut G Winterstein1,2,3, Yanning Wang1,4, Nicole E Smolinski1,2
1Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville.
JAMA network open
|February 1, 2024
概括
大多数产性药物暴露发生在怀孕早期,在产前护理开始之前. 这种时间,加上晚期的产前护理启动,限制了关于生殖选择和终止怀孕的讨论,特别是新的堕胎法律.
科学领域:
- 生殖健康 生殖健康
- 药理学 药理学是指药理学的学科.
- 公共卫生 公共卫生
背景情况:
- 法律对堕胎的限制凸显了产前护理启动的关键时机,以便在暴露于产药物的怀孕中讨论生殖选择.
- 了解原药物暴露的流行率和产前护理开始的时间对于明智的生殖决策至关重要.
研究的目的:
- 调查产前暴露于毒药物的流行率.
- 检查整个妊娠周的产前护理启动时间.
- 为了比较催产素药物暴露的时间与产前护理的开始和合法堕胎的截止时间.
主要方法:
- 这项描述性,以人口为基础的横截面研究利用了雇主赞助医疗保险的个人的国家健康遭遇数据.
- 一个经过验证的算法在2017年1月至2019年12月期间识别出具有活体或非活体结果的怀孕.
- 通过药房和医疗声明测量了137种产性药物的产前暴露;使用适应的儿童医疗保健质量指标评估了产前护理的启动.
主要成果:
- 在639,994个怀孕中,5.8%的活产和3.1%的非活产暴露于致性药物中.
- 在怀孕6周时,25.2%的原体暴露怀孕发生,其中84%的怀孕6周后开始产前护理或根本不开始.
- 怀孕15周时,有48.9%的孕妇暴露于原体,其中很大一部分在关键时期后开始产前护理,特别是那些没有活出结果的孕妇.
结论:
- 大多数毒性药物暴露发生在怀孕早期,在产前护理开始之前,这阻碍了风险效益评估.
- 产前护理的启动往往发生在合法堕胎截止后,限制了当担心产卵性影响出现时,终止怀孕的可能性.
- 这些发现强调了需要改进的策略,以确保及时进行生殖选择讨论,以确保孕妇暴露于产药物的必要性.
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