Thread by @DocElovitz

#MFMmonday: THEREAPEUTICS in OBSTETRICS
Imperative reads: review & clinical opinion in July issue of @AJOG_thegray focused on developing drugs for pregnancy use. When reading, consider COVID vax & pregnant population

A mini tweetorial

The reviews introduce the history and the problem

from limitations in scientific discovery, to uninterested industry to regulatory constraints

These are not questionable obstacles; the issue is what have we done to change the narrative & importance

Stated: " for example, only 5% of women develop GDM, hardly justifying the cost and regulatory burden of drug approval"

🤔

For your consideration, the prevalence of benign prostatic hypertrophy in 4th decade is 8%

Preterm birth occurs in 1 out of 10 women.

Seems this is an under evaluation of women and maternal health.

I would offer that we (MFM) need to change this narrative. Pregnancy complications are NOT infrequent. They are critically important for short and long term health.

We have been telling the WRONG story.

This is clearly seen in the next review article presented

JULY 21 @AJOG_thegray page 23:
sciencedirect.com/science/articl…

take home from this review: "most of the medications lack appropriate labeling information for pregnant women and lactating women".

this infographic says it all.

This review describes needed efforts by @NICHD_NIH to create a new framework including IMPRINT initiative.

I would suggest two additional points needed for drug development

1) understanding the maternal immunome and maternal response (or not) to drug modulation

2) DART is insufficient. The focus on teratogenicity is needed. DART data should include

➡️does it CROSS the placenta?
➡️if it DOES NOT cross CAN it still alter function of placenta

The absence of teratogenicity does not preclude aits ability to contribute to pregnancy outcomes

As known, preeclampsia & preterm birth occur, mostly in the absence of fetal anomaly

The must read article.
sciencedirect.com/science/articl…

"Summary of Challenges to develop effective treatments for obstetrical syndromes"

IMO, it is an OBLIGATORY step to invest in UNDERSTANDING to being to advance drug discovery

🌟🌟"incomplete understanding of the pathophysiology"🌟🌟

How do we move forward?
1⃣ support @NICHD_NIH initiatives
2⃣ be transparent with what is known or not regarding existing therapeutics to
3⃣ Advocate for women and maternal health.

To improve the lives of moms & their children, we are obligated to speak to the inequities in the existing narrative

Obstetrical syndromes are NOT infrequent.

We need to invest so much more in many areas to mitigate the short & long term health impact on moms and babies