They Say: We Don’t Know How the Hell to Treat Pregnant Women
You already know this but a surprising number of medical professionals don’t: pregnant women aren’t just fat versions of average women (who, themselves, aren’t just mini versions of men). Which means you can’t necessarily medicate a pregnant women like you would any other woman, who you can’t just medicate like any ol’ guy.
That’s before you even consider the consequences of passively medicating a growing fetus.
This, it turns out, presents a problem that researchers are only now beginning to look into. Given shifts in the pregnant woman’s metabolism, among many other changes, it’s any doctor’s guess as to what and how much medication to prescribe to pregnant women who are battling cancer, depression, or the flu — not to mention WMD-type viruses.
Here’s an example of the problem the pregnant body presents: the American College of Obstretrics and Gynecology recommends giving patients amoxicillin during an anthrax scare. But how much? Who the hell knows!
From Time:
But an obstetrics researcher in Seattle recently concluded there’s no
way to give a pregnant woman enough of the antibiotic to be effective.
Kidney function is so revved up during pregnancy that even in high
doses, amoxicillin is excreted before it can work its magic. Think of
it as trying to fill a bathtub with the drain open, suggests Jason
Umans, an internist and maternal-fetal pharmacologist at Georgetown
University. “In emergencies, you always hear, ‘Treat the pregnant women
first!’” he says. “The joke should be ‘Yeah, how?’”
The good news a few dozen doctors, ethicists and government officials have launched a movement of clinical research they’re calling the Second Wave (the first was when officials realized women are mini-men in terms of medicine, or, anything else). They’re hoping to gather more data so that doctors no longer have to wing it with their expecting patients.
But what about the baby!!!!! Settle down, these, pioneer researchers say.
“Everyone thinks, Oh, my God, research on pregnant women! All kinds of
ethical flags go up,” says Ruth Faden, director of the Berman Institute
of Bioethics at Johns Hopkins University. “We don’t have to start with
high drama.” There’s enough “low-hanging fruit,” she says, “that we
could keep lots of medical researchers busy for a long time.”
In fact, two-thirds of women take up to five drugs during pregnancy and through labor. But only a dozen are FDA approved for pregnancy and those are all stuff for the labor and birth like induction meds and the epidural. The ones for high blood pressure or diabetes are any doctor’s educated guess.
What was your experience with meds during pregnancy? Did you and the doc just make it up as you went?
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Photo: Time.com
There actually is some good research around treatment for gestational diabetes. A Kaiser Permanente study found that women who had gestational diabetes but didn’t receive treatment delivered babies who were 82 percent more likely to become obese by a very young age. We write extensively about related issues at http://dentistryfordiabetics.com/blog, especially the links between elevated blood sugar and gum disease that can interfere with diabetes control and significantly increase risk of serious health events such as heart attack, stroke and blindness.
- Charles Martin, DDS
Founder, Dentistry For Diabetics
Kikiriki — OK. So you and other pregnant women had a treatment that worked and didn’t harm your fetus. The researchers want to know that. They also want to know how other pregnant women with, using your example, high-blood pressure have been treated and those outcomes.
The problem that I’m describing is that it hasn’t been studied or formalized … that pregnant women’s treatments have been tinkering here and there with but there’s never been a formal look at the data. Which is what they’re proposing to do, Jeanne. I agree, pregnant women aren’t likely to submit themselves to a trial of an unknown drug, but since they’re getting drugs, these researchers can analyze the data — no new drug trials necessary. That’s the “low-hanging fruit” they’re talking about.
I took synthroid for hypothyroidism. My high-risk Ob/GYN checked my levels twice every trimester. That was it. Didn’t need an increase or decrease in meds the entire pregnancy.
Kirikiri – do you have an actual problem with the article, or are you just here to insult the writer?
Madeline – I think the crux of the problem is: what woman in her right mind is going to submit to a medical trial while pregnant? They will never be able to pull together ENOUGH scientific evidence on the affect of medicines on the fetus/efficacy of treating pregnant women because they need such a broad range of women in treatment to come up with good, reliable data.
I suffer from depression, and I went off my pills during my pregnancy because I was afraid of what it would do to my daughter. One OB in my practice told me I didn’t have to, another, when I asked to go back on near the end of my pregnancy because I was so severely depressed and very worried about post-partum depression, told me that there were definite risks. She actually told me she couldn’t prescribe anti-depressants to me unless I was the one physically asking – because if she was the one suggesting I go on them, there was a liability to her.
I suppose this piece should address some of my anger at my (former) GP for essentially refusing to treat me for medical issues I’d been seeing him for years (a little issue like asthma…no big deal) and every other medical issue that came up during my pregnancy, but it doesn’t. Even better, now that I’m nursing, he still won’t treat me.
Anyone else have issues like this while pregnant and/or nursing?
And I’m sorry, but I have to ask: what sort of qualifications do they require of you Babble writers, to spout out the kind of misinformed (or uninformed) crap so many of you invariably write about? What do you do, read one article and then go off on it? Actually, I bet that’s what you do. No wonder you get cranky responses from some of your readers.
“The [drugs] for high blood pressure or diabetes are any doctor’s educated guess.”
Given that pregnant women have been treated for certain conditions such as high blood pressure for DECADES with drugs that have not shown side effects for the fetus or newborn, your statement seems ludicrous to me. If you have an underlying condition and are seen by any old OB, perhaps. But this is precisely what high-risk OBs are for! I have moderately high blood pressure and have taken Methyldopa for both of my pregnancies – it’s been around for many, many years and been used on many, many pregnant women without showing side effects. Far from “making it up,” my high-risk specialist understands my body’s needs and has had both his own medical experience and a wealth of information to treat me and my unborn children.
I can totally understand this. As a waiter for so many years, this article is right on!