Dissemination and informed discussion of research on medications in pregnancy is challenging, complex and sometimes controversial, but all the more important for these very reasons. In this blog Brian Cleary discusses a newly formed Medicines in Pregnancy Twitter Journal Club (#MedsPregJC), a collaborative initiative which aims to support safe and effective use of medicines in pregnancy.
Brian Cleary is Chief Pharmacist in the Rotunda Hospital in Dublin and Honorary Clinical Associate Professor in the School of Pharmacy, Royal College of Surgeons in Ireland. He is a member of the European Network of Teratology Information Services and a researcher who examines the safety and efficacy of medication use in pregnancy.
The Medicines in Pregnancy Twitter Journal Club is an international collaborative community of clinicians and researchers with a shared interest in medication use in pregnancy. For me, the Journal Club has its roots in my experience of working in the Maternity Services for nearly 20 years and the desire to improve the safe and effective use of medicines in pregnancy.
I had the good fortune of working with Prof. Patricia Crowley, a formidable advocate for women and evidence-based medicine who did pioneering work to progress the use of antenatal steroids to reduce the risk of respiratory distress and death in neonates following preterm birth. As outlined in a fascinating report of a Wellcome History of Medicine Seminar (http://www.histmodbiomed.org/witsem/vol25.html), Prof Crowley was profoundly affected by seeing the first baby that she attended the birth of as a medical student die from respiratory distress despite being born at 36 weeks’ gestation. She described “a culture of nihilism towards most medical interventions with the exception of those ordained by institutional policy” in the hospital that she trained in. This reluctance extended to antenatal steroids which were emerging as a promising means of promoting fetal lung maturation and reducing the risk of neonatal death in clinical trials. Crowley actively engaged in ongoing reviews of studies in this area culminating in the publication of one of the initial Cochrane Collaboration meta-analyses (pooling of results from all available studies). This work ultimately changed practice globally and led to significant reductions in death from respiratory distress syndrome.
Working as a clinical pharmacist in a Dublin maternity hospital in the early 2000s, I could still see signs of a culture of nihilism when it came to the use of medicines in pregnancy. Women were sometimes deprived of treatment, with long term medications being stopped abruptly in early pregnancy, or reluctance to use medications for conditions such as severe nausea and vomiting of pregnancy. There was an excessive focus theoretical risks of the medication exposure without adequate consideration of the potential impact of the untreated maternal condition. It was obvious that there was a need for information on the safe and effective use of medicines in pregnancy and advocacy to ensure that women received optimal treatment.
In pursuing this, I joined the European Network of Teratology Information Services, a collaborative group who coordinate research on medicines in pregnancy and the provision of information with the aim of preventing birth defects and developmental disorders. Following discussions among multidisciplinary specialist colleagues including Prof. Per Damkier, Clinical Pharmacologist at the Department of Clinical Research, University of Southern Denmark; Dr. Jennifer Donnelly, Consultant Obstetrician/Maternal Fetal Medicine Specialist, Rotunda/Mater Hospitals, Dublin and Fergal O’Shaughnessy, Senior Pharmacist, Rotunda Hospital Dublin it became evident that there was an unmet need for an online forum for discussion of emerging papers in the field in order to critically appraise study quality and discuss implications for practice and future research. We felt that there was an opportunity to build a community with an interest in the topic of medicines in pregnancy and to create a space for discussion of important publications and potentially to support future collaborations.
As various studies on medication use in pregnancy were discussed on Twitter, including WRISK’s tweets, the need to establish the Medicines in Pregnancy Journal Club became obvious.
As various studies on medication use in pregnancy were discussed on Twitter, including WRISK’s tweets, the need to establish the Medicines in Pregnancy Journal Club became obvious. It was evident that there was a need for critical appraisal of studies and an informed discussion on the implications for practice and future research, considering the methodological limitations of observational research in this context. This also presented significant opportunities for shared learning and building international links between clinicians, researchers and women with an interest in this topic. It is also a potential vehicle to advocate for responsible risk communication on medicines in pregnancy, with the aim of ensuring that studies are accurately reported in mainstream media.
Journal clubs began in the 19th century as a vehicle for discussion of current medical literature and education of health professionals. The formation of our Twitter journal club was guided by the excellent work of Nephrology Journal Club (@NephJC) and their Twitter journal club primer available at: http://www.nephjc.com/jc-primer
The first paper addressed risk of maternal diabetes among women exposed to SSRI antidepressants during pregnancy. This paper had been highlighted on Twitter by colleagues in the WRISK project. After selecting a paper, we publicise the time and date of the Journal Club and upload a summary in advance to our website https://rotunda.ie/medspregnancyjc/ . We also direct potential participants to the #NephJC primer, which contains all the required background information for people unfamiliar with Twitter and Twitter journal clubs. All of the discussion of this paper is accessible by searching for #MedsPregJC on Twitter. We also plan to archive sessions in the future.
From our initial establishment in November 2019, we have rapidly gained a diverse group of over 200 followers including interested members of the public, researchers, obstetricians, maternal-fetal medicine specialists, obstetric physicians, midwives, pharmacists, general practitioners, intensivists, anaesthesiologists, psychologists and clinicians from a broad variety of specialities who treat women during pregnancy including haematology, rheumatology, nephrology, neurology, clinical pharmacology, cardiology, perinatal psychiatry and endocrinology.
Our aim for the Medicines in Pregnancy Twitter Journal Club is to create an open space for discussion of important issues in this context among health care professionals and researchers within the field. Ultimately we hope to build a wider community to support and promote the safe and effective use of medicines in pregnancy and improve decision support to benefit pregnant women.
Our aim for the Medicines in Pregnancy Twitter Journal Club is to create an open space for discussion of important issues in this context among health care professionals and researchers within the field. Ultimately we hope to build a wider community to support and promote the safe and effective use of medicines in pregnancy and improve decision support to benefit pregnant women. We see significant opportunities to learn from each other and potential to link in with established organisations such as ENTIS (and the equivalent US organisation OTIS) or projects such as the newly established ConcePTION project, funded by the EU Innovative Medicines Initiative (https://www.imi-conception.eu/). Twitter offers an environment that fosters open discussion, creating a new communication channel within and outside the #MedsInPregnancy community. We do not want the journal club to be an adversarial endeavour where authors feel that their studies are being attacked. Instead, we feel it can become a space that will foster discussion, sharing and collaboration, supporting and encouraging researchers and improving the quality of work in this context. Individuals working in this specialised field can feel isolated. We aim to empower this community to disseminate and discuss important findings. The openness of this forum may also allow us to learn how to involve women in the discussion and ensure that information needs are met.
The second Medicines in Pregnancy Journal Club will take place on Wednesday 26th February at 9pm GMT. Please join us as we discuss a recently published paper on pregnancy outcomes following diphtheria, tetanus and pertussis (Tdap) vaccination in pregnancy (https://pubmed.ncbi.nlm.nih.gov/31952872-safety-of-tetanus-diphtheria-and-acellular-pertussis-vaccination-among-pregnant-active-duty-us-military-women/?from_term=diphtheria+military+pregnancy&from_pos=2)
If you are interested in the area of medicines in pregnancy, the ongoing IMI ConcePTION project is looking at the information needs of women and health professionals. Please take the time to contribute to this survey: https://www.imi-conception.eu/respond/