Striving for balance in decisions on antenatal pharmacotherapy

Most individuals use medication during pregnancy. However, decision making on antenatal pharmacotherapy presents considerable ethical and scientific challenges. Amid a sociocultural paradigm prioritising the elimination of fetal risks, available evidence and guidance are limited, and current decisio...

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Bibliographic Details
Published in:The Lancet (British edition) 2024-11, Vol.404 (10464), p.1779-1782
Main Authors: Koldeweij, Charlotte, Jans, Verna AAM, Waitt, Catriona, Greupink, Rick, Auweele, Kim LHE Vanden, Franklin, Bryony D, Scheepers, Hubertina CJ, de Wildt, Saskia N
Format: Article
Language:English
Subjects:
Antidepressants
Antidepressive Agents - administration & dosage
Antidepressive Agents - therapeutic use
Clinical medicine
Decision making
Decision Making - ethics
Drug dosages
Drug therapy
Drug use
Ethics
Female
Fetuses
Health care access
Humans
Information services
Patients
Pregnancy
Pregnancy Complications - drug therapy
Prenatal Care - methods
Sertraline
Sertraline - administration & dosage
Sertraline - therapeutic use
Values
Womens health
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Summary:Most individuals use medication during pregnancy. However, decision making on antenatal pharmacotherapy presents considerable ethical and scientific challenges. Amid a sociocultural paradigm prioritising the elimination of fetal risks, available evidence and guidance are limited, and current decision making on antenatal drugs mostly proceeds in an ad-hoc and, often, biased manner. This approach might undermine the health of both mother and child. The need for a systematic approach towards antenatal drug decisions is becoming even more pressing with the growing knowledge of pregnancy-induced changes in drug disposition and effects. With this new complexity, pregnancy-specific doses might be necessary, potentially altering the balance between maternal and fetal benefits and risks. In this Viewpoint, we argue that ethical principles and a pregnant individual's values must be integrated alongside existing evidence when making decisions on antenatal drug use and dosing. We use the example of sertraline to outline practical strategies for achieving this goal. This approach is urgently needed to foster better-informed and balanced decisions on antenatal pharmacotherapy.
ISSN:0140-6736
1474-547X
1474-547X
DOI:10.1016/S0140-6736(24)02069-5