China Birth Defect Prevention Day | Pay attention to medication safety during pregnancy to avoid adverse pregnancy outcomes

Ten months of pregnancy, one day of delivery. In the delivery room, a crisp cry of a baby sounded, and a new life was born with joy and expectation. The birth of life is so wonderful, but sometimes there are "regrets" - miscarriage, premature birth, low birth weight and significant birth defects are also ringing the alarm bell for prospective parents.

September 12 is Birth Defect Prevention Day. Having a healthy baby is the wish of every family, but birth defects are not an easy topic. There are many types of birth defects, and the causes are complex, and their tracing often starts from the beginning of life. Previously, in June this year, the world's top journal "Nature Communications" published a DEBC (maternal drug exposure birth cohort) study conducted by Chinese scholars for six years and involving a total of 112,986 pregnant women. The research results on the safety of medication for pregnant women may bring some benefits to all prospective parents.

Association between medications and adverse pregnancy outcomes

The safety of medication during pregnancy has always been one of the difficult problems in the medical field. The physical condition of pregnant women is closely related to fetal development. Maternal drug exposure may have a series of irreversible adverse effects on pregnancy outcomes, such as birth defects, miscarriage, stillbirth, etc.

Simply put, drug exposure refers to the process or state in which an individual is exposed to a drug, including inhalation, oral administration, injection, topical application, and skin absorption. That is, the concentration of a drug in the human body exceeds the normal or safe range. Drug exposure may have different effects on the body, and its risks depend on many factors, such as individual sensitivity to the drug, exposure dose and time. In daily life, a considerable number of pregnant women will use one or more drugs during pregnancy. In this process, the impact of drug exposure on pregnancy outcomes also follows.

DEBC study results show:

1. About 30.70% of pregnant women (34,690 cases) took one or more drugs in early pregnancy;

2. The most commonly used drugs in early pregnancy were dydrogesterone and progesterone, with exposure rates of 11.97% and 10.82%, respectively;

3. The exposure rate of progesterone was 10.82%, among which the exposure time of vaginal progesterone gel was the longest, reaching 58.9 days, but the exposure of progesterone did not increase the adverse pregnancy outcomes;

4. The risk of stillbirth, premature birth, low birth weight and birth defects in those exposed to dydrogesterone in early pregnancy is significantly higher than that in those not exposed. Studies have shown that dydrogesterone increases the risk of stillbirth by 27%, the risk of birth defects by 13%, the risk of premature birth by 8%, and the risk of low birth weight by 22%.

What is the difference between progesterone and dydrogesterone?

Through the DEBC research data, prospective parents may have a vague understanding of progesterone and dydrogesterone, two commonly used drugs during pregnancy. So what are progesterone and dydrogesterone? What are the differences between them?

Many expectant mothers may hear doctors say during prenatal checkups or medical consultations: "Your progesterone is a little low, you need to supplement it." Or when there is vaginal bloody discharge during pregnancy, doctors will also prescribe progesterone and ask you to go home and stay in bed to protect the fetus. The progesterone mentioned here is also called progesterone or luteinizing hormone, which is a type of progestogen. After the fertilized egg implants, it reduces the excitability of the pregnant uterus, has a certain calming effect on the uterus, and provides support and protection for the early growth and development of the fetus.

The secretion of progesterone fluctuates throughout the day. There are many reasons for low progesterone. Doctors will determine whether it is necessary to supplement progesterone to maintain pregnancy based on the specific situation. Progesterone and dydrogesterone are commonly used. Progesterone and dydrogesterone are both progestin drugs. They have similarities and differences in function and application.

Progesterone is a natural progestogen, also known as progesterone or luteinizing hormone. It is mainly secreted by the corpus luteum in the ovary. It protects the endometrium and supports the early growth and development of the fetus. It can also be used to treat diseases caused by progesterone deficiency, such as dysmenorrhea, female pregnancy, threatened abortion, menopause, etc. There are three routes of administration for progesterone, namely oral administration, intramuscular injection, and vaginal administration; while dydrogesterone is a synthetic progestogen without estrogen, androgen, anabolic and corticosteroid effects. It is mainly used in clinical practice to treat various diseases caused by insufficient endogenous progesterone, such as dysmenorrhea, endometriosis, secondary amenorrhea, irregular menstrual cycle, threatened abortion or habitual abortion caused by progesterone deficiency, infertility caused by corpus luteum deficiency, etc., mainly through oral administration.

Caution in using medication during pregnancy

For pregnant women, there is a complex relationship between drugs and adverse pregnancy outcomes. Improper use of drugs may interfere with the normal growth and development of the fetus, leading to congenital malformations or other complications. These effects may cause birth defects, mental retardation or other long-term health problems. Pregnant women should use drugs with caution during pregnancy and follow the doctor's advice to reduce potential risks to the fetus.

This DEBC study did not observe an increase in the incidence of adverse pregnancy outcomes related to maternal exposure to progesterone in early pregnancy. The exposure time of vaginal progesterone gel was the longest, reaching 58.9 days, but it did not increase the incidence of adverse reactions, which also showed the good safety of progesterone; the results also showed that the incidence of adverse pregnancy outcomes (such as stillbirth, premature birth, low birth weight and birth defects) in the dydrogesterone exposure group was higher than that in the unexposed group, that is, high exposure to dydrogesterone may increase the risk of adverse pregnancy outcomes, but the incidence of miscarriage/abortion in the dydrogesterone exposure group decreased. In general, pregnant women should use drugs with caution during pregnancy, taking into account both efficacy and safety, and follow the doctor's advice for rational use of drugs.

At the same time, we also remind all expectant mothers to insist on regular prenatal checkups to monitor the health of the fetus. Prenatal checkups can timely detect and deal with potential problems and reduce the risk of adverse pregnancy outcomes. Be careful to avoid using drugs at will during pregnancy, especially drugs that have potential risks to the fetus. If medication is necessary, it should be done under the guidance of a professional doctor, and the dosage and medication regimen should be adjusted according to the doctor's instructions. When using drugs, you should also pay attention to the occurrence of drug side effects. If adverse reactions occur, you should seek medical attention in time and inform the doctor of the type and dosage of the drug used so that the doctor can adjust the treatment plan in time.