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Autoimmun Rev. 2016 Oct;15(10):955-63. doi: 10.1016/j.autrev.2016.07.014. Epub 2016 Aug 1.
Critical review of the current ...
BMC Pharmacol Toxicol. 2016 Jul 23;17(1):33. doi: 10.1186/s40360-016-0076-7.
Calls to a teratogen information service rega...
CONCLUSION:
This study found analgesics, cold medications, herbals, homeopathic, and dietary
medications were of the topic...
J Perianesth Nurs. 2016 Aug;31(4):317-29. doi: 10.1016/j.jopan.2014.09.006. Epub 2016 Apr 2.
Perianesthetic Considerations...
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(마더리스크라운드) Breastfeeding

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마더리스크라운드

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(마더리스크라운드) Breastfeeding

  1. 1. Autoimmun Rev. 2016 Oct;15(10):955-63. doi: 10.1016/j.autrev.2016.07.014. Epub 2016 Aug 1. Critical review of the current recommendations for the treatment of systemic inflammatory rheumatic diseases during pregnancy and lactation. Levy RA1 , de Jesús GR2 , de Jesús NR3 , Klumb EM4 . Author information  1 Department of Rheumatology, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil; Pós-graduação em Ciências Médicas (PGCM), Faculdade de Ciências, Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil. Electronic address: roger.a.levy@gmail.com.  2 Department of Obstetrics, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil; Department of Obstetrics, Instituto Fernandes Figueira, FIOCRUZ, Rio de Janeiro, Brazil; Pós-graduação em Ciências Médicas (PGCM), Faculdade de Ciências, Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil.  3 Department of Obstetrics, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil.  4 Department of Rheumatology, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil; Pós-graduação em Ciências Médicas (PGCM), Faculdade de Ciências, Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil. Abstract The crucial issue for a better pregnancy outcome in women with autoimmune rheumatic diseases is appropriate planning, with counseling of the ideal timing and treatment adaptation. Drugs used to treat rheumatic diseases may interfere with fertility or increase the risk of miscarriages and congenital abnormalities. MTX use post-conception is clearly linked to abortions as well as major birth defects, so it should be stopped 3months before conception. Leflunomide causes abnormalities in animals even in low doses. Although in humans, it does not seem to be as harmful as MTX, when pregnancy is detected in a patient on leflunomide, cholestyramine is given for washout. Sulfasalazine can be used safely and is an option for those patients who were on MTX or leflunomide. Azathioprine is generally the immunosuppressive of choice in many high-risk pregnancy centers because of the safety profile and its steroid-sparing property. Cyclosporine and tacrolimus can also be used as steroid-sparing agents, but experience is smaller. Although prednisone and prednisolone are inactivated in the placenta, we try to limit the dose to the minimal effective one, to prevent side effects. Antimalarials have been broadly studied and are safe during pregnancy and breastfeeding. Among biologic disease modifying anti-rheumatic agents (bDMARD), the anti-TNFs that have been used for longer are the ones with greater experience. The large monoclonal antibodies do not cross the placenta in the first trimester, and after conception, the decision to continue medication should be taken individually. The experience is larger in women with inflammatory bowel diseases, where anti-TNF is generally maintained at least until 30weeks to reduce fetal exposure. Live vaccines should not be administrated to the infant in the first 6months of life. Pregnancy data for rituximab, abatacept, anakinra, tocilizumab, ustekinumab, belimumab, and tofacitinib are limited and their use in pregnancy cannot currently be recommended.
  2. 2. BMC Pharmacol Toxicol. 2016 Jul 23;17(1):33. doi: 10.1186/s40360-016-0076-7. Calls to a teratogen information service regarding potential exposures in pregnancy and breastfeeding. Campbell SC1,2 , Kast TT3 , Kamyar M4 , Robertson J5 , Sherwin CM6,7 . Author information  1 Nelson Laboratories, Salt Lake City, UT, USA.  2 Department of Pharmacology and Toxicology, College of Pharmacy, University of Utah, Salt Lake City, UT, USA.  3 College of Pharmacy, University of Utah, Salt Lake City, UT, USA.  4 Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, School of Medicine, University of Utah, Salt Lake City, UT, USA.  5 Utah Department of Health, Pregnancy Risk Line, Salt Lake City, UT, 84108, USA.  6 Department of Pharmacology and Toxicology, College of Pharmacy, University of Utah, Salt Lake City, UT, USA. catherine.sherwin@hsc.utah.edu.  7 Division of Clinical Pharmacology, Department of Pediatrics, School of Medicine, University of Utah, Salt Lake City, UT, USA. catherine.sherwin@hsc.utah.edu. Abstract BACKGROUND: MotherToBaby Utah is a teratogen information service that provides support for pregnant and breastfeeding women and healthcare providers regarding risks of exposures to medications, infections, herbals, homeopathic and dietary medications, chemicals and other substances. Calls are anonymous and free of charge. This study was undertaken to examine the volume and classification of calls regarding exposures during pregnancy and breastfeeding. METHODS: Data were extracted from calls requesting information about medication use and other exposures to pregnant and breastfeeding women, between January 1 2009 and December 31 2012. Descriptive statistics were calculated. RESULTS: A total of 27,299 calls regarding 46,031 exposures were identified in this study population. The majority of calls were made by the exposed individual (82.1 %); 13.0 % were made by a healthcare provider and 4.9 % were made by a family member or acquaintance. The majority of calls concerned pregnancy (65.8 %) versus breastfeeding (34.2 %). Exposure during the current pregnancy was the subject of 88.6 % of calls. For calls where trimester information was available, the percentage of calls for first, second and third trimesters were 44.1, 32.5 and 23.4 %, respectively.
  3. 3. CONCLUSION: This study found analgesics, cold medications, herbals, homeopathic, and dietary medications were of the topic of concern for the majority of the calls regarding exposure during pregnancy and/or breastfeeding. Teratogen information services gather and provide important educational resources for both patients and healthcare providers. As the majority of calls concern nonprescription drugs and vaccines, these data provide insight into a lack of education on these subjects that should be addressed during prenatal care.
  4. 4. J Perianesth Nurs. 2016 Aug;31(4):317-29. doi: 10.1016/j.jopan.2014.09.006. Epub 2016 Apr 2. Perianesthetic Considerations for the Breastfeeding Mother. Smathers AB, Collins S, Hewer I. Abstract Breastfeeding has been shown to be beneficial in the development of infants, but sometimes, the breastfeeding mother may require anesthesia. It is important for perianesthesia caregivers to understand how the breastfed infant may be affected by the anesthetic medications received by the breastfeeding mother. This article reviews current literature on drug transfer into breast milk and specifically how anesthetic drugs may affect breastfed infants. The pharmacokinetics of drug transfer during lactation is described as well as considerations for perianesthesia providers when caring for breastfeeding patients. The results of this literature review provide evidence that there is little risk to the breastfed infant after the mother receives surgical anesthesia. However, the type of drug, the dosage, the timing of treatment, and the infant's age and health must be taken into consideration

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