Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Review › Research › peer-review
Polypharmacy in polymorbid pregnancies and the risk of congenital malformations - a systematic review. / Thunbo, Mette Østergaard; Vendelbo, Julie Hauer; Volqvartz, Tabia P. M. et al.
In: Basic & Clinical Pharmacology & Toxicology, Vol. 130, No. 3, 03.2022, p. 394-414.Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Review › Research › peer-review
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TY - JOUR
T1 - Polypharmacy in polymorbid pregnancies and the risk of congenital malformations - a systematic review
AU - Thunbo, Mette Østergaard
AU - Vendelbo, Julie Hauer
AU - Volqvartz, Tabia P. M.
AU - Witte, Daniel Rinse
AU - Larsen, Agnete
AU - Pedersen, Lars Henning
PY - 2022/3
Y1 - 2022/3
N2 - With an increased prevalence of concurrent morbidities during pregnancy, polypharmacy has become increasingly common in pregnant women. The risks associated with polypharmacy may exceed those of individual medication because of drug–drug interactions. This systematic review aims to evaluate the risk of congenital malformations in polymorbid pregnancies exposed to first-trimester polypharmacy. PubMed, Embase and Scopus were searched to identify original human studies with first- trimester polypharmacy due to polymorbidity as the exposure and congenital malformations as the outcome. After screening of 4034 identified records, seven studies fulfilled the inclusion criteria. Four of the seven studies reported an increased risk of congenital malformations compared with unexposed or monotherapy, odds ratios ranging from 1.1 to >10.0. Particularly, short-term anti-infective treatment combined with other drugs and P-glycoprotein substrates were associated with increased malformation risks. In conclusion, knowledge is limited on risks associated with first-trimester polypharmacy due to polymorbidity with the underlying evidence of low quantity and quality. Therefore, an increased focus on pharmacovigilance to enable safe drug use in early pregnancy is needed. Large-scale register-based studies and better knowledge of placental biology are needed to support the clinical management of polymorbid pregnancies that require polypharmacy.
AB - With an increased prevalence of concurrent morbidities during pregnancy, polypharmacy has become increasingly common in pregnant women. The risks associated with polypharmacy may exceed those of individual medication because of drug–drug interactions. This systematic review aims to evaluate the risk of congenital malformations in polymorbid pregnancies exposed to first-trimester polypharmacy. PubMed, Embase and Scopus were searched to identify original human studies with first- trimester polypharmacy due to polymorbidity as the exposure and congenital malformations as the outcome. After screening of 4034 identified records, seven studies fulfilled the inclusion criteria. Four of the seven studies reported an increased risk of congenital malformations compared with unexposed or monotherapy, odds ratios ranging from 1.1 to >10.0. Particularly, short-term anti-infective treatment combined with other drugs and P-glycoprotein substrates were associated with increased malformation risks. In conclusion, knowledge is limited on risks associated with first-trimester polypharmacy due to polymorbidity with the underlying evidence of low quantity and quality. Therefore, an increased focus on pharmacovigilance to enable safe drug use in early pregnancy is needed. Large-scale register-based studies and better knowledge of placental biology are needed to support the clinical management of polymorbid pregnancies that require polypharmacy.
KW - congenital malformation
KW - polymorbidity
KW - polypharmacy
KW - pregnancy
KW - systematic review
U2 - 10.1111/bcpt.13695
DO - 10.1111/bcpt.13695
M3 - Review
C2 - 34841667
VL - 130
SP - 394
EP - 414
JO - Basic & Clinical Pharmacology & Toxicology
JF - Basic & Clinical Pharmacology & Toxicology
SN - 1742-7835
IS - 3
ER -