25th미국기형학회 보고 - 한정열 센터장
-
Upload
mothersafe -
Category
Health & Medicine
-
view
676 -
download
0
Transcript of 25th미국기형학회 보고 - 한정열 센터장
25th International Conference Organization of Teratology
Information Specialists
Korean Motherisk Program JUNG YEOL HAN
In Baltimore 2012
Contents
25th OTIS Conference Visit of Motherisk Program
Vision of KMRP
25th OTIS Conference
Patient’s Perception of Teratogenic risks- Effects on Compliance
By G.Koren
Dental x-ray
VAS
EDPS > 13 : high risk of Termination of pregnancy Depression: 3-5% of pregnancy, suicide think : 32%
EDPS(Edinburgh postnatal depression scale)
TIS adapting to New Economic Realities and How it will Affect Research by Dee Quinn
History of TIS :
1979 : 1st TIS at UCSD
1985 : 1st meeting in Philadelphia
1990 : Formation of OTIS in Salt Lake City
1999 : Incorporation of OTIS in Montreal
2003 : Start of OTIS national Program
2011 : OTIS & ENTIS Collaboration
Economic evaluation & study : asthma, autoimmune ds Low dose MTX study 1992 : 38 in USA & Canada / 2000 - 2012 : 10 closed Source funding?
An Epidemiological Enterprise : From Fluoride to Folate by JD Ericson of CDC Vietnam war veterans: herbicides(Agent orange) & Spina bifida ( 1996 law ) Interview : multivitamin use – lower risk Periconception multivitamine study : S. bifida, VSD, ASD, CL+CL
An Epidemiological Enterprise : From Fluoride to Folate
Intervention Study in China : USFDA : require fortification of folic acid (25 states National birth defect prevention networks) Increased colorectal cancer : decrease by adjusting age Cognitive issues Methylation & epigenetics
The All or None Phenomenon :
How should we counsel ?
By Dr. Brent
Mouse vs Human
Preimplantation period (수정 후 2주 이내)
Usually not susceptible period to teratogen
Some highly susceptible period to teratogen
Surviving embryo : similar outcome
Mouse data 이용 상담 : no thanks by Brent.
예외:
Long half life
Teratogenic infectious agent
Maternal effect(large exposure)
Epigenetic effect
Mutagenic effect
By JM Friedman 6days : implantation begin
Very little data
Chronic exposure
Few accumulative exposure situation
Czeizel : Hofpp study
24-42days of LMP : Exposure vs Non-exposure
Live birth 92% -
BW 3,222 3,268
Anomaly 3.3% -
IVF/ICSI
Angelman SD/ Beckwith-Wiedemann syndrome -- inconsistent , absolute risk <1% 동물 :
Most agents : no effect
Some agents : increased malformation
Zygotic induced anomaly
hydrops 22%
Bent limbs 24%
Abdominal wall defect 17%
---- multifactorial birth defects
strikingly absence of other common anormaly ( NTD, CHD…)
hydrops may be pathogenic , but mechanism is unknown
Post-zygotic period : zygote와 다름 , Death more common
Answer by JD Friedman: We don’t know Counseling : never say : “All or none” But, risk is very low
The potential benefit of a Multi-micronutrient Supplementation in Pregnant women who consume Alcohol by Christina D. Chambers
: Choline (precursor molecule for the neurotransmitter acetylcholine)
Alcohol : CNS의 acetylcholine inhibitor
RCT : Alcoholic pregnant women 300(control)/150(choline)
f/u : 6mo, 12mo
FASD : decreased in choline group
Next step “ 5세 (preschool neurobehavioral test)
Strategies of Reducing the impact of Known teratogen
Thyroid Hormone to Reduce Impact of Gestational Alcohol use in the rat by EE Redei 가설 : Thyroid function abnormal--- like FASD Maternal T4 administration – FASD 경감 Dio3 gene : epigenetic effect
Antiepileptic drugs : Cellular, Physiological, and behavioral evidence of developmental Neurotoxicity by KN Gale
Phenobarbital, phenytoin, lamotrigine --- neurobehavioral abnormal - brain growth에 영향(neuronal cell death induction) , But FA 완화
Future direction : “Antidote” Epilepsy + AED + Antidote : reduce of risk of Adverse pregnancy outcome === AED use 증가( more compliance)
Thomas Sheperd Lecture
“ The future of Research : The View of NICHD “ by AE Guttmacher (NICHD director)
NICHD : 50 yrs celebration ( 1962 : President Kennedy sign)
The mission :
every person is born healthy
women suffer no harmful effects from reproductive processes
all children have the chance to achieve their full potential for
healthy and productive lives, free from disease or disability,
health, productivity, independence, and well-being of all people
through optimal rehabilitation
NICHD study :
Reproduction
Developmental biology
Pregnancy : biomarker
Early origin of health and disease, growth, development
: association is not equal to mechanism
placenta , multigenerational effect
Conduct of science
trans -disciplinary science
omics( genome, epigenome)
training
OTIS 25th Anniversary Session
By G. Koren : OTIS early challenges & future opportunities Abuse of drugs and alcohol Folic acid Occupational exposure Infection Pharmacogenomics methyl mercury Drugs & breastfeeding Biomarker : hair/meconium
By Tina : OTIS & NOFAS: partners in preventing birth defect By M Kisor : Parents & OTIS – One mother’s experience with OTIS By L Morrison : Birth defects prevention, risk reduction, and Awareness Act By G. Koren : A model of industry-Academia collaboration for drugs in pregnancy
Pregnancy registry workshop
What should pregnancy registries use for a comparison group(s)?
Pregnancy registries and REMS: opportunities for collaboration risk
(Risk Evaluation and Mitigation Strategy : to enhance labeling)
Conducting Global pregnancy registries- Challenges and opportunities
How can pregnancy registries Work with/Complement other sources of
Clinical and observational information? How does a registry fit in an
overall plan to obtain information?
Interpreting Data from pregnancy registries: Who, When, How?
Advantage :
Aim of pregnancy registry : major birth defect, Birth defect trend
Used to generate hypothesis
Limitations :
Exposure의 classification - lack
Outcome(birth defect , developmental disability)의
universal determination - lack
Representation : voluntary
Loss to f/u : limit interpretation
Pregnancy registry
Congenital malformation studies in Chernobyl Impacted
Regions of Ukraine: Lessons learned
by W. Werterlecki
Thyroid cancer NTD increase
Birth weight decrease
2012 Teratogen Update : ART by JL Simpson (March of Dimes)
IVF alone (<1993) vs ICSI (>1993 대략 50%) IVF alone : 1979-1993 : 2.9% ICSI : De novo chromosomal abnormality - 1.66% ( 0.45% in general) Hypospadias : RR 3.0( 1.09-6.50) Beckwith-Wiedemann syndrome (BWS) : epigenetic perturbation( MTHFR, IGF2) Reasons : Underlying reasons for ART old age genetic disorder balanced translocation Limitation : no true comparison group
Education Lunchbox Session
1. Diagnostic radiation
2. Influenza vaccine
3. Binge drinking
---
Motherisk Calls for 2011
Lines : Motherisk general help line : 31,201 calls
Alcohol and substance abuse line : 1,317 calls
NVP help line : 2,035 calls
82% : women & their partners , 18% : health care provider
34,553 calls : 63% regarding pregnancy , 37% regarding breastfeeding
Motherisk general help line : mc question : psychotropics(19-25%)
417 : clinical fellow on call
149 : in clinic ( 45% psychotropic)
A review of calls to MotherSafe regarding exposures
during lactation: 2000-2010 by Kennedy D.(Ausralia)
79% call : consumers but, midwives & early childhood nurses Consumer call : increase Repeat caller : 35% in 2000 and 55% in 2010 Commonest concern exposure : antihistamines, cold, flu preparations and antibiotics Before contacting (79%) : 38% family doctor, 35% internet, 9% medical specialist, 9% pharmacist F/U of breastfeeding practice ( 100 women) : positive with no women stopping breastfeeding in order to take medication
- Abstracts -
E-teratogens: a case-report and a glance at the availability of Isotretinoin on the Web : “buy isotretinoin” on Google Safety of levetriacetam in pregnancy : 2.2%(20/897) Are change in Steroid hormones associated with smoke exposure responsible for pregnancy outcome? SA in cortisol high/ estrogen& progesterone level lower, but not related cigarette smoke Unplanned pregnancies and contraceptive utilization among women calling the California TIS regarding exposure to category D or X medication : 99% no contraceptive methods Pregnancy outcome and factors associated with voluntary termination of pregnancy in Korean women inadvertently exposed to Isotretinoin : 25% ToP, by 1st contact physician Adj OR : 2.06 Pregnancy outcome after Licorice exposure in pregnancy : Stillbirth 2.3% vs 0.3%
Free Thyroid Hormone levels, Second-Hand Smoke, and pregnancy
outcome: SA 48 vs successful pregnancy outcome
Cotinine levels : no difference
FT4 : slightly higher/ FT3 : lower
---- may contribute to adverse pregnancy outcome including SA
Is lithium only a cardiovascular teratogen? A prospective comparative
multicenter observational study : in 219 lithium exposure vs 812 control
major anomaly : 8.6% in 1st exposure (2.6%)
CV anomaly : 3.9%(0.6%)
non-CV anomaly : 6.6%(2.0%)
Preterm delivery : 15.2%(6.2%)
Japan Drug Information Institute of pregnancy 2012
Visit of Motherisk Program
Motherisk Program 2012
Motherisk Program 2012
Motherisk Program 2012
Motherisk Program 2012
Motherisk Program 2012
Gidi’s office door 2012
OTIS Conference Visit of Motherisk Program
Vision of Korean MRP
Insight
Networks
Concentration
In Toronto 2012