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Педиатрическая фармакология

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Фармакологическая безопасность при беременности: систематический обзор применения потенциально тератогенных лекарственных средств

https://doi.org/10.15690/pf.v14i2.1727

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Аннотация

Цель исследования: оценить распространенность использования потенциально тератогенных лекарственных средств (ЛС) женщинами на протяжении всей беременности и в периконцептуальном периоде. Методы. Поиск проводился в электронной базе данных Medline (PubMed) с использованием ключевых слов «pharmacoepidemiology», «pregnancy», «drug use», «safety», «pregnancy risk category», «fetal risk», «teratogen». В систематический обзор включали результаты исследований, опубликованных на английском языке в период с января 2006 по декабрь 2015 г. Результаты. Проанализированы результаты 28 исследований. Показано, что в США и Канаде доля беременных, принимавших противопоказанные препараты (категория X по классификации FDA), варьировала от 2,4 до 5,3% (1,1–5,0% в I триместре), а с доказанным риском (категория D) — от 5,8 до 39,6% (2,7–6,0). В европейских странах доля беременных, принимавших препараты категории X, варьировала в пределах 1,0–4,9% (0,3–3,2), препараты категории D — 2,0–5,9% (1,6–3,7), в развивающихся странах — в пределах 0,2–2,1 и 1,9–11,4% соответственно. Доля женщин, принимавших потенциально тератогенный препарат в I триместре, была выше по сравнению с величиной показателя во II и III триместрах. С наступлением беременности по сравнению с периодом до зачатия использование противопоказанных ЛС быстро уменьшается. Однако редукция в применении препаратов с доказанным риском менее выражена, возможно, из-за большей их востребованности для лечения хронических состояний. На основании полученных сведений сформирован рекомендательный перечень потенциально тератогенных ЛС. Заключение. Опубликованные данные подтверждают различия в методах исследования, затрудняющие сравнение оценки использования ЛС во время беременности. Фундаментальной проблемой остается недостаточность или отсутствие доступной информации о фетальной безопасности ЛС, часто используемых при беременности. 

Об авторах

О. В. Решетько
Саратовский государственный медицинский университет им. В.И. Разумовского
Россия
доктор медицинских наук, заведующая кафедрой фармакологии


К. А. Луцевич
Саратовский государственный медицинский университет им. В.И. Разумовского
Россия


И. И. Санина
Саратовский государственный медицинский университет им. В.И. Разумовского
Россия


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Для цитирования:


Решетько О.В., Луцевич К.А., Санина И.И. Фармакологическая безопасность при беременности: систематический обзор применения потенциально тератогенных лекарственных средств. Педиатрическая фармакология. 2017;14(2):127-141. https://doi.org/10.15690/pf.v14i2.1727

For citation:


Reshetko O.V., Lutsevich K.A., Sanina I.I. Pharmacological Safety in Pregnancy: A Systematic Review On the Use of Potentially Teratogenic Drugs. Pediatric pharmacology. 2017;14(2):127-141. (In Russ.) https://doi.org/10.15690/pf.v14i2.1727

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