[{"command":"openDialog","selector":"#drupal-modal","settings":null,"data":"\u003Cdiv id=\u0022republish_modal_form\u0022\u003E\u003Cform class=\u0022modal-form-example-modal-form ecl-form\u0022 data-drupal-selector=\u0022modal-form-example-modal-form\u0022 action=\u0022\/en\/article\/modal\/6888\u0022 method=\u0022post\u0022 id=\u0022modal-form-example-modal-form\u0022 accept-charset=\u0022UTF-8\u0022\u003E\u003Cp\u003EHorizon articles can be republished for free under the Creative Commons Attribution 4.0 International (CC BY 4.0) licence.\u003C\/p\u003E\n \u003Cp\u003EYou must give appropriate credit. We ask you to do this by:\u003Cbr \/\u003E\n 1) Using the original journalist\u0027s byline\u003Cbr \/\u003E\n 2) Linking back to our original story\u003Cbr \/\u003E\n 3) Using the following text in the footer: This article was originally published in \u003Ca href=\u0027#\u0027\u003EHorizon, the EU Research and Innovation magazine\u003C\/a\u003E\u003C\/p\u003E\n \u003Cp\u003ESee our full republication guidelines \u003Ca href=\u0027\/horizon-magazine\/republish-our-stories\u0027\u003Ehere\u003C\/a\u003E\u003C\/p\u003E\n \u003Cp\u003EHTML for this article, including the attribution and page view counter, is below:\u003C\/p\u003E\u003Cdiv class=\u0022js-form-item form-item js-form-type-textarea form-item-body-content js-form-item-body-content ecl-form-group ecl-form-group--text-area form-no-label ecl-u-mv-m\u0022\u003E\n \n\u003Cdiv\u003E\n \u003Ctextarea data-drupal-selector=\u0022edit-body-content\u0022 aria-describedby=\u0022edit-body-content--description\u0022 id=\u0022edit-body-content\u0022 name=\u0022body_content\u0022 rows=\u00225\u0022 cols=\u002260\u0022 class=\u0022form-textarea ecl-text-area\u0022\u003E\u003Ch2\u003EFinding drugs that are safe to take while pregnant\u003C\/h2\u003E\u003Cp\u003EPregnant women are excluded from trials of new medications for ethical reasons, which has led to growing uncertainty around the effects of drugs on the foetus. The thalidomide scandal of the 1950s and 1960s, when \u003Ca href=\u0022https:\/\/www.bbc.com\/news\/magazine-15536544\u0022 target=\u0022_blank\u0022 rel=\u0022noopener noreferrer\u0022\u003Edoctors prescribed\u003C\/a\u003E the sedative to pregnant women to quell their morning sickness, has also highlighted the dangers of taking medications during pregnancy: thousands of women miscarried after taking thalidomide and tens of thousands of children were born with birth defects.\u003C\/p\u003E\u003Cp\u003E\u003Ca href=\u0022https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/28880394\u0022 target=\u0022_blank\u0022 rel=\u0022noopener noreferrer\u0022\u003EStudies\u003C\/a\u003E now indicate that pregnant women tend to steer clear of medicines as much as possible.\u003C\/p\u003E\u003Cp\u003E\u2018We see women suffering with pain or conditions that should be treated,\u2019 said Professor Hedvig Nordeng from the school of pharmacy at the University of Oslo, Norway. \u2018Non-adherence to needed treatment is a major problem during pregnancy.\u2019\u003C\/p\u003E\u003Cp\u003EBut some women may be taking drugs in the early weeks of pregnancy before they realise they are expecting, while others can have serious conditions that mean they cannot avoid medication. For them, the lack of information about the impact this might have on their child can be a source of great anxiety.\u003C\/p\u003E\u003Cp\u003EIn an attempt to tackle this uncertainty, researchers like Prof. Nordeng are turning to databases of medical information and long-term studies\u0026nbsp;to probe how treatments taken by mothers might affect their children\u2019s development over time.\u003C\/p\u003E\u003Cp\u003E\u003Cstrong\u003ECord blood\u003C\/strong\u003E\u003C\/p\u003E\u003Cp\u003EIn 1999, the Norwegian Institute of Public Health invited families to participate in a long-term study that collected details about pregnant women, fathers, and the children who were born later. It now includes data on more than 100,000 individuals and provides a wealth of information for scientists wanting to analyse the effects of pharmaceuticals over time.\u003C\/p\u003E\u003Cp\u003E\u003Cblockquote class=\u0022tw-text-center tw-text-blue tw-font-bold tw-text-2xl lg:tw-w-1\/2 tw-border-2 tw-border-blue tw-p-12 tw-my-8 lg:tw-m-12 lg:tw--ml-16 tw-float-left\u0022\u003E\n \u003Cspan class=\u0022tw-text-5xl tw-rotate-180\u0022\u003E\u201c\u003C\/span\u003E\n \u003Cp class=\u0022tw-font-serif tw-italic\u0022\u003E\u0026#039;We see women suffering with pain or conditions that should be treated.\u0026#039;\u003C\/p\u003E\n \u003Cfooter\u003E\n \u003Ccite class=\u0022tw-not-italic tw-font-normal tw-text-sm tw-text-black\u0022\u003EProfessor Hedvig Nordeng, University of Oslo, Norway\u003C\/cite\u003E\n \u003C\/footer\u003E\n\u003C\/blockquote\u003E\n\u003C\/p\u003E\u003Cp\u003EProf. Nordeng is using this database as part of a project called\u0026nbsp;\u003Ca href=\u0022https:\/\/www.mn.uio.no\/farmasi\/english\/research\/projects\/drug-in-pregnancy\/index.html\u0022 target=\u0022_blank\u0022 rel=\u0022noopener noreferrer\u0022\u003EDrugsInPregnancy\u003C\/a\u003E\u0026nbsp;to examine the effect of drugs on an infant\u2019s neurological development, focusing on drugs like antidepressants, migraine agents and painkillers. She is combining medical data with surveys that tap into the parents\u2019 observations, such as when their child starts walking, or whether a 3-year-old can catch a ball.\u003C\/p\u003E\u003Cp\u003ECrucially, the Norwegian Institute of Public Health also stored biological material such as umbilical cord blood from those taking part, providing information that could shed new light on the underlying mechanisms of how drugs affect genes, or what is known as pharmacoepigenetics.\u003C\/p\u003E\u003Cp\u003E\u2018It may actually alter the way that we understand underlying biological pathways of drug neurotoxicity, and consequently what we teach in pharmacology,\u2019 said Prof. Nordeng.\u003C\/p\u003E\u003Cp\u003EShe has found that most standard treatments are safe for pregnant women, with some exceptions. More than half of pregnant women are known to take paracetamol, and the majority risk nothing in doing so. Prolonged use of paracetamol, however, was associated with increased risk of ADHD and behavioural problems for the child, according to Prof. Nordeng\u2019s findings.\u003C\/p\u003E\u003Cp\u003E\u003Cstrong\u003EInternalising behaviour\u003C\/strong\u003E\u003C\/p\u003E\u003Cp\u003EAnother area of concern is a widely-used type of antidepressants known as selective serotonin reuptake inhibitors, or SSRIs. Their use in pregnancy correlates with higher risks of what is called internalising behaviour in young children \u2014 symptoms of depression or shyness in interacting with others.\u003C\/p\u003E\u003Cp\u003EBut Prof. Nordeng points out that studies using observational data can only show associations and not causation. A mother with depression, for example, might be more likely to have a child with similar symptoms than a woman without depression, due to genetic or familial predispositions, but it does not mean the drugs she took during pregnancy are necessarily the cause.\u003C\/p\u003E\u003Cp\u003ETo allow for this, Prof. Nordeng adjusts for confounding factors as much as possible when comparing the children of depressed mothers who took medication with those of mothers with depression who did not. Even so, this cannot account for other unmeasured factors, such as non-pharmacological treatment.\u003C\/p\u003E\u003Cp\u003E\u2018We really try in every way to say that these are signals, these are observational studies,\u2019 said Prof. Nordeng. \u2018We\u0027re very conscious about not scaring women and the public. In many cases, the risk of the untreated maternal disorder is much greater to the unborn child than the drug exposure. You must always weigh the risk of the underlying illness.\u2019\u003C\/p\u003E\u003Cp\u003EIn many cases, however, the risk posed by an illness during pregnancy versus that of a treatment is still not clearly understood. It is something researchers at the University of Ulster, in Northern Ireland, have been trying to untangle.\u003C\/p\u003E\u003Cp\u003EThey host a database called \u003Ca href=\u0022http:\/\/www.euromedicat.eu\/\u0022 target=\u0022_blank\u0022 rel=\u0022noopener noreferrer\u0022\u003EEUROmediCAT\u003C\/a\u003E, which contains details on pregnant women from 22 registries across 15 European countries and aims to provide evidence on the safety of medications for chronic disease taken by the mother in the first trimester of pregnancy.\u003C\/p\u003E\u003Cp\u003EDr Maria Loane, a reader at the University of Ulster\u2019s school of nursing and manager of EUROmediCAT\u2019s Central Database, said their research has shown that some commonly used anti-epileptic drugs are associated with specific abnormalities when taken during pregnancy.\u003C\/p\u003E\u003Cp\u003ETheir research has confirmed that valproic acid, a drug combatting epilepsy, brings an increased risk of spina bifida, a birth defect in which a baby\u0027s spinal cord doesn\u0027t develop properly. Women who rely heavily on this drug are now strongly advised against becoming pregnant.\u003C\/p\u003E\u003Cp\u003E\u003Cstrong\u003EDecades\u003C\/strong\u003E\u003C\/p\u003E\u003Cp\u003EIt took decades for warnings about valproic acid\u2019s effect on unborn babies to trickle out to the medical community after problems were \u003Ca href=\u0022https:\/\/www.cdc.gov\/mmwr\/preview\/mmwrhtml\/00000129.htm\u0022 target=\u0022_blank\u0022 rel=\u0022noopener noreferrer\u0022\u003Efirst identified in the early 1980s\u003C\/a\u003E. Studies from many countries, along with data on animal experiments, were needed to change medical advice and it took years for the important information to reach doctors and patients.\u0026nbsp;\u003C\/p\u003E\u003Cp\u003EBut Dr Loane and her colleagues have also shown that another anti-epileptic drug, Lamotrigine, does not appear to be associated with cleft palates in babies if it is taken during the first three months of pregnancy. This appears to contradict earlier research in the US.\u003C\/p\u003E\u003Cp\u003E\u2018We did a five-year follow-up study, and we never found an increased risk of orofacial cleft relative to other malformations,\u2019 Dr Loane explained. \u0026nbsp;Compared with valproic acid, she says there\u2019s a lower risk of congenital anomalies associated with Lamotrigine.\u003C\/p\u003E\u003Cp\u003E\u2018But more research is needed.\u2019\u003C\/p\u003E\u003Cp\u003EWith this sort of data-orientated approach, together with new statistical methods and technological innovations, it will be easier to identify any risks associated with medications and get information to patients much more quickly, according to Prof. Nordeng.\u003C\/p\u003E\u003Cp\u003EIt can currently take decades for new advice about drugs for pregnant women to be issued \u2013 as was the case with valproic acid \u2013 but she believes that could be reduced to just two to three years.\u003C\/p\u003E\u003Cp\u003E\u2018These are very, very important findings from a public health perspective,\u2019 said Prof. Nordeng.\u003C\/p\u003E\u003Cp\u003E\u003Cem\u003EThe research in this article was funded by the EU. 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