妊娠期用药咨询门诊的焦点问题与思考  

Focal problems and considerations for drug consultation clinics about pregnancy

作　　者：叶淑雅 郑彩虹[1] YE Shu-ya;ZHENG Cai-hong(Department of Pharmacy,Women’s Hospital,School of Medicine,Zhejiang University,Zhejiang Hangzhou 310006,China)

机构地区：[1]浙江大学医学院附属妇产科医院,浙江杭州310006

出　　处：《中国医院药学杂志》2021年第11期1171-1176,共6页Chinese Journal of Hospital Pharmacy

摘　　要：目的:交流药学门诊中遇到的关于妊娠期用药咨询的常见问题。方法:通过查阅说明书、《妊娠期和哺乳期用药》、PubMed、维普、国内外临床指南、UpToDate、优生智库、clinicaltrials等各类书籍、中英文期刊、指南、软件、网站及其他各个途径的文献中有关妊娠用药的内容,就妊娠期及哺乳期用药咨询门诊中遇到的一些重要问题进行分析和探讨。结果:门诊咨询中,在未知妊娠状况下的用药最为常见,因此借助于非药学知识估算孕龄、判断"全或无"效应的时间窗非常重要;尽管一种真正的致畸物质通常会产生一种或一系列特殊类型的缺陷,但大多数致畸点的缺陷模式很难框定;正如会造成严重畸形的药物并非一定致畸一样,即使是安全等级较高的药物,也可能存在胎儿畸形风险。其他需要关注的是:所咨询药物以外的隐藏信息;用药外疾病本身对胎儿的风险;药物的浓度、剂量、叠加成分、未知成分和信息变更。结论:药学门诊中,关于妊娠期用药风险评估有许多共性问题,其中最大的障碍是人类资料匮乏,迫切需要越来越多的前瞻性、观察性的研究,开展妊娠暴露药物登记,以期更好地评估并给出建议。OBJECTIVE To exchange some common questions about drug consultation during pregnancy at pharmacist-managed clinics.METHODS Some focal problems were analyzed based upon medication consultations during pregnancy and lactation through reviewing the relevant literature such as"drugs in pregnancy and lactation",PubMed,Vip,instructions,clinical guidelines,UpToDate,Think Tank about Eugenics,clinicaltrials and corresponding books,journals in Chinese and English,guidelines,software,websites and others.RESULTS In outpatient consultations,drugs always were taken under unknown pregnancy status.Thus it is important to estimate gestational weeks and judge whether or not medication time within the"all or no"stage.Although a real teratogenic substance usually produces one or one serial kind of specific defects,defect pattern of most teratogenic points is difficult to decipher.Just as drugs producing severe deformities frequently are not teratogenic each gestational week for everyone,those with high safety levels may somewhat carry certain malformation risks.Other concerns are evident.Hidden information is not mentioned by consultants;the risk to fetus may be induced by disease but not drug.Concentration,dose,superimposed or unknown ingredients and information changes may lead to different consequences.CONCLUSION At pharmacist-managed clinics,there are too many common questions of risk assessment of medication during pregnancy.The biggest obstacle in providing a good proposal lies in an acute lack of human data.Therefore more prospective or observational studies are urgently required for drug pregnancy registry to offer valid recommendations.

关 键 词：妊娠期 药学门诊 致畸 妊娠用药暴露 

分 类 号：R969.3[医药卫生—药理学]