Inclusion of pregnant and breastfeeding women in research – efforts and initiatives

Sílvia M. Illamola, Christina Bucci-Rechtweg, Maged M. Costantine, Ekaterini Tsilou, Catherine M. Sherwin, Anne Zajicek

Research output: Contribution to journalComment/debate

10 Scopus citations

Abstract

Pregnant and breastfeeding women have been rendered therapeutic orphans as they have been historically excluded from clinical trials. Labelling for most approved drugs does not provide information about safety and efficacy during pregnancy. This lack of data is mainly due to ethico-legal challenges that have remained entrenched in the post-diethylstilbestrol and thalidomide era, and that have led to pregnancy being viewed in the clinical trial setting primarily through a pharmacovigilance lens. Policy considerations that encourage and/or require the inclusion of pregnant or lactating women in clinical trials may address the current lack of available information. However, there are additional pragmatic strategies, such the employment of pharmacometric tools and the introduction of innovative clinical trial designs, which could improve knowledge about the safety and efficacy of medication use during pregnancy and lactation. This paper provides a broad overview of the pharmacoepidemiology of drugs used during pregnancy and lactation, and offers recommendations for regulators and researchers in academia and industry to increase the available pharmacokinetic and -dynamic understanding of medication use in pregnancy.

Original languageEnglish (US)
Pages (from-to)215-222
Number of pages8
JournalBritish Journal of Clinical Pharmacology
Volume84
Issue number2
DOIs
StatePublished - Feb 2018
Externally publishedYes

Keywords

  • breastfeeding
  • clinical pharmacology
  • drug utilization
  • obstetric
  • pregnancy

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