Pregnancy pharmacogenetics and individual drug treatment
Some areas of medicine use pharmacogenetics to assist clinicians in implementing individualized pharmacotherapy. The field of pharmacogenetics during pregnancy is still in its infancy. There are many areas in obstetric therapy where data is emerging that offers glimpses into the future.
These include opioid pain management and antihypertensive treatment, antidepressant medication, preterm labor and tocolytics, antenatal Corticosteroids, and drugs for nausea or vomiting during pregnancy. To fully understand if pharmacogenetics can help in individualizing pharmacotherapy during pregnancy, more data is needed. This review aims to highlight research gaps and summarize the current data.
Pharmacogenetics and Therapeutics Research in Maternal and Child Health. (PREGMED).
The right drug at the right dosage, given at the correct time, and for the right patient. When prescribing drugs to patients, this is the ideal healthcare professionals strive for. This is especially important for medication and conditions with a high chance of adverse effects or drugs that have narrow therapeutic windows. Pregnancy is another condition that can be attractive to the above mantra. The clinician faces particular challenges in pregnancy therapeutics due to the development of the fetus, as well as the changes in the mother. To achieve the individualization of pharmacotherapy during pregnancy, information and tools are necessary to ensure that the care is optimal.
Many pregnant women need to take therapeutic drugs. More than 95% of pregnant women use a prescription drug or supplement in their pregnancy [1,2]. This includes more than 65% who take a prescription drug that is not prenatal vitamins or iron. Women with serious medical conditions can become pregnant and need to continue drug therapy. Pregnant women may also have conditions that require medication. Providers are dependent upon the dosing instructions in package inserts. These dosing plans are usually derived from studies on healthy males. To avoid any accidental early fetal exposure, the 1974 US National Research Act prohibited the inclusion of pregnant women in many trials. In 1993, however, the NIH in the US changed the paradigm and mandated that women be included in trials unless they were prohibited by law. This guidance also included guidelines for pregnant women.
Due to the long exclusion of pregnant women from clinical drug trials, there is not much data on drug concentrations in pregnancies for many therapeutics. However, this trend is changing. There have been 264 clinical trials for drugs used in pregnancy that were registered within the past two years. One hundred and eighty-six percent of these registered trials were found to have reported pharmacokinetic data on pregnant women. This is significant as recent reports have shown that pregnant women have lower drug concentrations than their nonpregnant counterparts for many drugs, including antihypertensive, antiretroviral and antibiotic drugs [5-9]. This is due in large part to the many physiological changes that occur during pregnancy, which are documented elsewhere. This gap in pharmacokinetic data and pharmacodynamic data is being filled by several international groups, such as the US NIH-funded Obstetric-Fetal Pharmacology Research Units Network. This review will discuss current pharmacogenetics in therapeutics, current research in obstetric pharmacogenetics, and what is required to ensure the future success of pharmacogenetics in pregnancy.