Cannabis is one of the most widely used illicit drugs during pregnancy and lactation. With the re... more Cannabis is one of the most widely used illicit drugs during pregnancy and lactation. With the recent legalization of cannabis in many countries, health professionals are increasingly exposed to pregnant and breastfeeding women who are consuming cannabis on a regular basis as a solution for depression, anxiety, nausea, and pain. Cannabis consumption during pregnancy can induce negative birth outcomes such as reduced birth weight and increased risk of prematurity and admission to the neonatal intensive care unit. Yet, limited information is available regarding the pharmacokinetics of cannabis in the fetus and newborn exposed during pregnancy and lactation. Indeed, the official recommendations regarding the use of cannabis during these two critical development periods lack robust pharmacokinetics data and make it difficult for health professionals to guide their patients. Many clinical studies are currently evaluating the effects of cannabis on the brain development and base their groups mostly on questionnaires. These studies should be associated with pharmacokinetics studies to assess correlations between the infant brain development and the exposure to cannabis during pregnancy and breastfeeding. Our project aims to review the available data on the pharmacokinetics of cannabinoids in adults, neonates, and animals. If the available literature is abundant in adult humans and animals, there is still a lack of published data on the exposure of pregnant and lactating women and neonates. However, some of the published information causes concerns on the exposure and the potential effects of cannabis on fetuses and neonates. The safety of cannabis use for non-medical purpose during pregnancy and breastfeeding needs to be further characterized with proper pharmacokinetic studies in humans feasible in regions where cannabis has been legalized. Given the available data, significant transfer occurs to the fetus and the breastfed newborn with a theoretical risk of accumulation of products known to be biologically active.
Titre de l'article-Single versus weekly courses of antenatal corticosteroids for women at risk of... more Titre de l'article-Single versus weekly courses of antenatal corticosteroids for women at risk of preterm labor. JAMA 2001;286:1581-7. Auteurs-Guinn DA, Atkinson MW, Sullivan L et collaborateurs. Commanditaires-« March of Dimes », fondation Berlex, association périnatale du Wisconsin, centre de recherche clinique périnatal du centre de santé de l'Université du Colorado. Cadre de l'étude-L'étude s'est déroulée dans 13 centres hospitaliers universitaires des États-Unis entre février 1996 et avril 2000. Chacune des institutions a fait approuver le protocole par son comité d'éthique. Devis-Randomisée, à double insu, contrôlée contre placebo. Objectif de l'étude-Évaluer l'efficacité d'une administration hebdomadaire de corticostéroïdes anténataux versus un seul régime dans le but de réduire la morbidité néonatale. Évaluer les morbidités maternelle et néonatale potentielles associées à des doses répétées de corticostéroïdes anténataux.
Journal of Obstetrics and Gynaecology Canada, 2022
OBJECTIVE This study aims to evaluate the impact of the implementation a mifepristone-misoprostol... more OBJECTIVE This study aims to evaluate the impact of the implementation a mifepristone-misoprostol protocol (MIFE/MISO) on the induction-to-expulsion interval in the context of second- and third-trimester pregnancy termination or intrauterine fetal death (IUFD) compared with misoprostol alone (MISO), and to share the experience of a Canadian tertiary hospital concerning the feasibility and safety of such a protocol. METHODS This is a single-centre retrospective pre-post cohort study carried out at the Centre Hospitalier Universitaire (CHU) Sainte-Justine between 2017 and 2019. Women in the MIFE/MISO group were instructed to take mifepristone 24-48 hours before induction. Induction in the MIFE/MISO group was performed with misoprostol dosages adjusted to gestational age and the presence of previous uterine scars, while, in the MISO group, all patients received 400 μg of misoprostol vaginally every 4 hours. RESULTS Ninety-four patients were included in the MIFE/MISO group and 103 patients, in the MISO group. Median time to expulsion was significantly lower in the MIFE/MISO group than the MISO group (13.5 and 19.5 h respectively; P < 0.001). The total dose of misoprostol administered was significantly lower in the MIFE/MISO group than the MISO group, and adverse effects were reported in 60% and 82% of patient records, respectively (P < 0.001). Complication rates were similar between the two groups. CONCLUSION The MIFE/MISO protocol is highly effective for second- and third-trimester induction for pregnancy termination or IUFD, without increasing complication rates and with fewer reported adverse effects. Its implementation is safe and feasible in a tertiary medical centre.
Resume Objectif : La Faculte de pharmacie de l’Universite de Montreal desire partager son experie... more Resume Objectif : La Faculte de pharmacie de l’Universite de Montreal desire partager son experience d’agrement du Programme de doctorat de premier cycle en pharmacie (Pharm.D.) par le Conseil canadien de l’agrement des programmes de pharmacie (CCAPP). Mise en contexte : La Faculte de pharmacie de l’Universite de Montreal a permis a son universite d’etre la premiere au Canada a lancer le Pharm.D. en septembre 2007 et parmi les premieres a le faire agreer en 2012. Apres dix ans d’existence, elle renouvele l’agrement en 2018 : la visite des evaluateurs externes s’est deroulee du 21 au 23 novembre 2017 et le rapport final du CCAPP a ete remis en juin 2018. Resultats : Le Programme repond majoritairement aux normes exigees : organisation et gouvernance de l’institution, ressources du Programme, services aux etudiants et programme universitaire. Le point central sur lequel elle doit concentrer ses efforts est la mise en œuvre d’un processus d’evaluation continue de la qualite. Les normes...
We wished to evaluate the efficacy, safety, and acceptability of cabergoline for lactation inhibi... more We wished to evaluate the efficacy, safety, and acceptability of cabergoline for lactation inhibition in women who live with HIV. In this multicenter prospective observational study, cabergoline was offered as a single oral dose of 1 mg within the first 48 h postpartum. Women were recruited if they delivered a live infant after 35 weeks of gestational age. Participants filled out a questionnaire regarding symptoms of lactation and cabergoline adverse effects on day 2 and day 14 postpartum. On day 14, they also completed a questionnaire about their satisfaction with cabergoline treatment. Prolactin serum level was measured on both visits. Among 68 participants, all but one received cabergoline. The overall effectiveness defined by partial or complete success at day 14 was 98.3% (confidence intervals: 89.5–99.9). At day 14, 67.4% of women who received cabergoline had prolactin serum levels &lt;25 mcg/L (threshold necessary for galactopoiesis). Mild nonspecific adverse effects were experienced by 24 (29.9%) women on day 2 and 24 (41.4%) on day 14, and lasted 48 h or less. Overall, 96% of women were satisfied with cabergoline’s ability to prevent postpartum lactation symptoms. In conclusion, cabergoline is an effective, well-accepted, and well-tolerated medication for lactation inhibition in WLWH.
Objectif. Reviser la documentation scientifique portant sur l’implication du pharmacien en gyneco... more Objectif. Reviser la documentation scientifique portant sur l’implication du pharmacien en gynecologie-obstetrique, evaluer les activites actuelles et proposer des ajustements pour optimiser la pratique pharmaceutique. Methodes. Etude descriptive comportant trois etapes : revue de la documentation scientifique portant sur l’implication du pharmacien en gynecologie-obstetrique, description des soins et services offerts, optimisation de la pratique pharmaceutique selon la revue documentaire et les suggestions des pharmaciennes œuvrant dans ce secteur. Resultats. Quinze articles ont ete retenus et indiquent que la presence du pharmacien diminue le taux d’erreurs medicamenteuses, augmente les connaissances des patients sur leurs medicaments et est evaluee positivement par les patients. Les resultats de la plupart de ces articles reposent sur des donnees probantes de qualite jugee insuffisante. La majorite des activites decrites sont deja realisees par les pharmaciennes de notre centre. Celles-ci incluent : conciliation medicamenteuse, optimisation de la pharmacotherapie, suivis pharmacocinetiques, conseils aux patientes, formation du personnel soignant et elaboration de protocoles de soins. Les ajustements proposes pour optimiser les activites pharmaceutiques incluent : optimisation des ressources documentaires, evaluation de la satisfaction des patientes, elargissement de l’automedication, etablissement d’une structure de prise en charge des patientes ambulatoires incluant les couples consultant au centre de procreation assistee et participation accrue a la recherche. Conclusion. Le sujet des soins pharmaceutiques en gynecologie-obstetrique est peu explore dans la documentation scientifique. Les pharmaciennes de notre centre realisent de nombreuses activites parmi celles decrites dans la documentation. Cet exercice a neanmoins permis d’identifier des elements a mettre en place afin d’optimiser leur pratique.
OBJECTIVES. Our goals were to (a) describe neonatal behavioral signs in a group of newborns expos... more OBJECTIVES. Our goals were to (a) describe neonatal behavioral signs in a group of newborns exposed in utero to selective serotonin reuptake inhibitors or venlafaxine at the time of delivery, (b) compare the rate of neonatal behavioral signs, prematurity, and admission to specialized neonatal care between a group of exposed and unexposed newborns, and (c) compare the effects in exposed preterm and term newborns. PATIENTS AND METHODS. This was a retrospective cohort study including mothers taking selective serotonin reuptake inhibitors or venlafaxine during the third trimester and mothers who were not taking any antidepressants, psychotropic agents, or benzodiazepines at the time of delivery of their newborns. Neonatal behavioral signs included central nervous, respiratory, and digestive systems, as well as hypoglycemia and the need for phototherapy. RESULTS. Seventy-six mothers taking antidepressants and 90 untreated mothers and their newborns were analyzed. Smoking, alcohol intake, and substance abuse were more frequent among treated mothers. In infants in the exposed group, signs involving the central nervous and the respiratory systems were often observed (63.2% and 40.8%, respectively). These signs appeared during the first day of life, with a median duration of 3 days for exposed newborns. The signs resolved in 75% of cases within 3 to 5 days for term and premature newborns, respectively. All exposed premature newborns presented behavioral manifestations compared with 69.1% of term exposed newborns. Median length of stay was almost 4 times longer for exposed premature newborns than for those who were unexposed (14.5 vs 3.7 days). CONCLUSIONS. Neonatal behavioral signs were frequently found in exposed newborns, but symptoms were transient and self-limited. Premature infants could be more susceptible to the effects of selective serotonin reuptake inhibitors and venlafaxine.
Introduction: Goserelin and tamoxifen are adjuvant endocrine therapy for women with hormone recep... more Introduction: Goserelin and tamoxifen are adjuvant endocrine therapy for women with hormone receptor positive (i.e., estrogen receptor-ER and progesterone receptor-PgR) breast cancer. Because of their adverse endocrine effects these drugs should not be used in women who are or may become pregnant [1,2]. A woman exposed to goserelin and tamoxifen inadvertently for the treatment of breast cancer during her pregnancy is reported here. Methods: A 34-years-old female presented with right breast mass in June 2016 and her diagnostic biopsy revealed invasive ductal carcinoma. After receiving 12 neoadjuvant chemotherapy sessions through August 2016-January 2017 and the mass was reduced, she underwent oncoplastic breast surgery in March 2017. The pathologic diagnosis of the resected tumor was hormone receptor positive (ER+, PgR +), invasive ductal carcinoma. She was evaluated not eligible for radiotherapy but goserelin and tamoxifen therapy was initiated postoperatively. After six months under the treatment with this regimen, the patient consulted to doctor about the mass and the movement sensation in her abdomen and she was detected to be pregnant according to performed ultrasonography as 30 weeks of gestation in October 2017. The patient realized to be inadvertently treated with goserelin and tamoxifen throughout 30 weeks of her pregnancy period. Previously the patient was experiencing irregular menstruation and she was told by the doctors that goserelin and tamoxifen might disturb menstruation regularity so she did not realize her pregnancy. After drugs discontinued immediately, she was consulted to our teratology information service (October 2017). Results: The fetus was observed as having no problem in detailed ultrasonography and other routine pregnancy tests in follow up to birth. She gave birth to a 3300 gram healthy male infant by cesarean section at 37 weeks of gestation (22 December 2017). The infant represented no signs of a teratogenic effect at delivery, breast fed for only one week (afterwards fed with formula) and had a normal growth and development up to 4 months of age (April 2018). Conclusions: Here we present a case who delivered for healthy infant after inadvertently exposing goserelin and tamoxifen during 30 weeks of her pregnancy period for hormone receptor positive invasive ductal carcinoma. The case will be under follow up for potential further developmental and/or cognitive pathologies.
Resume Notre travail visait a comparer le taux de macrosomie et la moyenne de poids de naissance ... more Resume Notre travail visait a comparer le taux de macrosomie et la moyenne de poids de naissance (en percentile) de nouveau-nes de meres diabetiques de type 1 (DT1) traitees par pompe a insuline sous-cutanee (PSC) ou par multi-injections quotidiennes d’insuline (MIQ). Il s’agit d’une etude retrospective, incluant les grossesses mono-fœtales de patientes DT1, dont l’issue de grossesse est survenue a plus de 16 semaines de grossesse, au CHU Sainte-Justine (Montreal, Quebec, Canada), entre le 1 er janvier 2000 et le 31 janvier 2009. Au total, 14 grossesses sous PSC et 94 sous MIQ ont ete evaluees. L’HbA 1c aux 1 er , 2 e et 3 e trimestres de grossesse n’etait pas significativement differente entre les groupes PSC et MIQ. Le percentile des poids de naissance (92±11 versus 77 ± 26) et le taux de macrosomie (71,4% versus 42,6%, respectivement) etaient significativement plus eleves dans le groupe PSC ( p
Pregnant women are at increased risk of severe complications associated with H1N1 pandemic influe... more Pregnant women are at increased risk of severe complications associated with H1N1 pandemic influenza. Fever and inflammatory syndrome associated with the infection may also be deleterious for the developing fetus. Therefore, early antiviral treatment is recommended. Oseltamivir and zanamivir are the two therapeutic options available indicated in the treatment of H1N1 influenza; however, limited data is published on their use during pregnancy and lactation. In this review, we will focus on the effects of H1N1 during pregnancy and on data safety of antivirals during pregnancy and lactation. Main health authorities recommendations for H1N1 influenza treatment of pregnant women will also be presented.
International Journal of Environmental Research and Public Health
The effect of the COVID-19 pandemic on maternal mental health has been described in Canada and Ch... more The effect of the COVID-19 pandemic on maternal mental health has been described in Canada and China but no study has compared the two countries using the same standardized and validated instruments. In this study, we aimed to evaluate and compare the impact of COVID-19 public health policies on maternal mental health between Canada and China, as we hypothesize that geographical factors and different COVID-19 policies are likely to influence maternal mental health. Pregnant persons >18 years old were recruited in Canada and China using a web-based strategy. All participants recruited between 26 June 2020 and 16 February 2021 were analyzed. Self-reported data included sociodemographic variables, COVID-19 experience and maternal mental health assessments (Edinburgh Perinatal Depression Scale (EPDS), Generalized Anxiety Disorders (GAD-7) scale, stress and satisfaction with life). Analyses were stratified by recruitment cohort, namely: Canada 1 (26 June 2020–10 October 2020), Canada ...
Neurogenic bladder is a frequent consequence of multiple sclerosis (MS). Eighty percent of all pa... more Neurogenic bladder is a frequent consequence of multiple sclerosis (MS). Eighty percent of all patients with MS experience urinary symptoms during the course of their disease.1 Symptoms of neurogenic bladder include urgency, frequency, dysuria, nocturia, enuresis, and incontinence. These symptoms are usually secondary to lesions in the spinal column. These lesions lead to detrusor hyperreflexia and urgency when there are small amounts of urine in the bladder. Nocturnal enuresis is one of the most distressing symptoms of MS, since it can lead to interrupted sleep, worsening of fatigue, skin breakdown, decubitus ulcers, and infections.2 Pharmacotherapeutic alternatives for nocturnal enuresis in patients with MS include tricyclic antidepressants and anticholinergics.3 However, due to the limited efficacy and potential toxicities of the above treatments, desmopressin acetate has been investigated. Desmopressin, a synthetic analog of the antidiuretic hormone, is indicated for the treatment of diabetes insipidus and nocturnal enuresis in adults and children without MS.4 The drug increases resorption of water in the collecting tubules of the kidneys, resulting in increased urine osmolality, decreased urine volume, decreased urinary flow, and decreased number of voidings.5 Since patients with MS may have detrusor hyperreflexia, reducing the volume of urine with desmopressin may be a potential benefit. We conducted a literature review to evaluate the efficacy and safety of desmopressin in the treatment of nocturnal enuresis in MS patients. CLINICAL TRIALS
Background Limited data is available on raltegravir (RAL) pharmacokinetics during pregnancy and t... more Background Limited data is available on raltegravir (RAL) pharmacokinetics during pregnancy and the value of therapeutic drug monitoring (TDM) in pregnancy is unknown. This study aims to describe RAL trough plasma concentrations (Ctrough) during pregnancy and review the impact of RAL TDM on outcomes. Methods Women from the prospective mother-infant HIV cohort of Mother and Children’s Infectious Diseases Center who received RAL during their pregnancy between 2011-2020 were included. TDM reports were reviewed and Ctrough values estimated when possible, using historical RAL half-lives. Results We included 76 pregnant women of which 47 underwent TDM. We observed a significant association between virological response and Ctrough ( p-value .034) with an increase of 0.1 mg/L corresponding to a 2.96 reduction in the risk of having a detectable viral load. The results indicated that in pregnant women a RAL Ctrough threshold of 0.04 mg/L has a higher specificity (75%) as compared to our curre...
Cannabis is one of the most widely used illicit drugs during pregnancy and lactation. With the re... more Cannabis is one of the most widely used illicit drugs during pregnancy and lactation. With the recent legalization of cannabis in many countries, health professionals are increasingly exposed to pregnant and breastfeeding women who are consuming cannabis on a regular basis as a solution for depression, anxiety, nausea, and pain. Cannabis consumption during pregnancy can induce negative birth outcomes such as reduced birth weight and increased risk of prematurity and admission to the neonatal intensive care unit. Yet, limited information is available regarding the pharmacokinetics of cannabis in the fetus and newborn exposed during pregnancy and lactation. Indeed, the official recommendations regarding the use of cannabis during these two critical development periods lack robust pharmacokinetics data and make it difficult for health professionals to guide their patients. Many clinical studies are currently evaluating the effects of cannabis on the brain development and base their groups mostly on questionnaires. These studies should be associated with pharmacokinetics studies to assess correlations between the infant brain development and the exposure to cannabis during pregnancy and breastfeeding. Our project aims to review the available data on the pharmacokinetics of cannabinoids in adults, neonates, and animals. If the available literature is abundant in adult humans and animals, there is still a lack of published data on the exposure of pregnant and lactating women and neonates. However, some of the published information causes concerns on the exposure and the potential effects of cannabis on fetuses and neonates. The safety of cannabis use for non-medical purpose during pregnancy and breastfeeding needs to be further characterized with proper pharmacokinetic studies in humans feasible in regions where cannabis has been legalized. Given the available data, significant transfer occurs to the fetus and the breastfed newborn with a theoretical risk of accumulation of products known to be biologically active.
Titre de l'article-Single versus weekly courses of antenatal corticosteroids for women at risk of... more Titre de l'article-Single versus weekly courses of antenatal corticosteroids for women at risk of preterm labor. JAMA 2001;286:1581-7. Auteurs-Guinn DA, Atkinson MW, Sullivan L et collaborateurs. Commanditaires-« March of Dimes », fondation Berlex, association périnatale du Wisconsin, centre de recherche clinique périnatal du centre de santé de l'Université du Colorado. Cadre de l'étude-L'étude s'est déroulée dans 13 centres hospitaliers universitaires des États-Unis entre février 1996 et avril 2000. Chacune des institutions a fait approuver le protocole par son comité d'éthique. Devis-Randomisée, à double insu, contrôlée contre placebo. Objectif de l'étude-Évaluer l'efficacité d'une administration hebdomadaire de corticostéroïdes anténataux versus un seul régime dans le but de réduire la morbidité néonatale. Évaluer les morbidités maternelle et néonatale potentielles associées à des doses répétées de corticostéroïdes anténataux.
Journal of Obstetrics and Gynaecology Canada, 2022
OBJECTIVE This study aims to evaluate the impact of the implementation a mifepristone-misoprostol... more OBJECTIVE This study aims to evaluate the impact of the implementation a mifepristone-misoprostol protocol (MIFE/MISO) on the induction-to-expulsion interval in the context of second- and third-trimester pregnancy termination or intrauterine fetal death (IUFD) compared with misoprostol alone (MISO), and to share the experience of a Canadian tertiary hospital concerning the feasibility and safety of such a protocol. METHODS This is a single-centre retrospective pre-post cohort study carried out at the Centre Hospitalier Universitaire (CHU) Sainte-Justine between 2017 and 2019. Women in the MIFE/MISO group were instructed to take mifepristone 24-48 hours before induction. Induction in the MIFE/MISO group was performed with misoprostol dosages adjusted to gestational age and the presence of previous uterine scars, while, in the MISO group, all patients received 400 μg of misoprostol vaginally every 4 hours. RESULTS Ninety-four patients were included in the MIFE/MISO group and 103 patients, in the MISO group. Median time to expulsion was significantly lower in the MIFE/MISO group than the MISO group (13.5 and 19.5 h respectively; P < 0.001). The total dose of misoprostol administered was significantly lower in the MIFE/MISO group than the MISO group, and adverse effects were reported in 60% and 82% of patient records, respectively (P < 0.001). Complication rates were similar between the two groups. CONCLUSION The MIFE/MISO protocol is highly effective for second- and third-trimester induction for pregnancy termination or IUFD, without increasing complication rates and with fewer reported adverse effects. Its implementation is safe and feasible in a tertiary medical centre.
Resume Objectif : La Faculte de pharmacie de l’Universite de Montreal desire partager son experie... more Resume Objectif : La Faculte de pharmacie de l’Universite de Montreal desire partager son experience d’agrement du Programme de doctorat de premier cycle en pharmacie (Pharm.D.) par le Conseil canadien de l’agrement des programmes de pharmacie (CCAPP). Mise en contexte : La Faculte de pharmacie de l’Universite de Montreal a permis a son universite d’etre la premiere au Canada a lancer le Pharm.D. en septembre 2007 et parmi les premieres a le faire agreer en 2012. Apres dix ans d’existence, elle renouvele l’agrement en 2018 : la visite des evaluateurs externes s’est deroulee du 21 au 23 novembre 2017 et le rapport final du CCAPP a ete remis en juin 2018. Resultats : Le Programme repond majoritairement aux normes exigees : organisation et gouvernance de l’institution, ressources du Programme, services aux etudiants et programme universitaire. Le point central sur lequel elle doit concentrer ses efforts est la mise en œuvre d’un processus d’evaluation continue de la qualite. Les normes...
We wished to evaluate the efficacy, safety, and acceptability of cabergoline for lactation inhibi... more We wished to evaluate the efficacy, safety, and acceptability of cabergoline for lactation inhibition in women who live with HIV. In this multicenter prospective observational study, cabergoline was offered as a single oral dose of 1 mg within the first 48 h postpartum. Women were recruited if they delivered a live infant after 35 weeks of gestational age. Participants filled out a questionnaire regarding symptoms of lactation and cabergoline adverse effects on day 2 and day 14 postpartum. On day 14, they also completed a questionnaire about their satisfaction with cabergoline treatment. Prolactin serum level was measured on both visits. Among 68 participants, all but one received cabergoline. The overall effectiveness defined by partial or complete success at day 14 was 98.3% (confidence intervals: 89.5–99.9). At day 14, 67.4% of women who received cabergoline had prolactin serum levels &lt;25 mcg/L (threshold necessary for galactopoiesis). Mild nonspecific adverse effects were experienced by 24 (29.9%) women on day 2 and 24 (41.4%) on day 14, and lasted 48 h or less. Overall, 96% of women were satisfied with cabergoline’s ability to prevent postpartum lactation symptoms. In conclusion, cabergoline is an effective, well-accepted, and well-tolerated medication for lactation inhibition in WLWH.
Objectif. Reviser la documentation scientifique portant sur l’implication du pharmacien en gyneco... more Objectif. Reviser la documentation scientifique portant sur l’implication du pharmacien en gynecologie-obstetrique, evaluer les activites actuelles et proposer des ajustements pour optimiser la pratique pharmaceutique. Methodes. Etude descriptive comportant trois etapes : revue de la documentation scientifique portant sur l’implication du pharmacien en gynecologie-obstetrique, description des soins et services offerts, optimisation de la pratique pharmaceutique selon la revue documentaire et les suggestions des pharmaciennes œuvrant dans ce secteur. Resultats. Quinze articles ont ete retenus et indiquent que la presence du pharmacien diminue le taux d’erreurs medicamenteuses, augmente les connaissances des patients sur leurs medicaments et est evaluee positivement par les patients. Les resultats de la plupart de ces articles reposent sur des donnees probantes de qualite jugee insuffisante. La majorite des activites decrites sont deja realisees par les pharmaciennes de notre centre. Celles-ci incluent : conciliation medicamenteuse, optimisation de la pharmacotherapie, suivis pharmacocinetiques, conseils aux patientes, formation du personnel soignant et elaboration de protocoles de soins. Les ajustements proposes pour optimiser les activites pharmaceutiques incluent : optimisation des ressources documentaires, evaluation de la satisfaction des patientes, elargissement de l’automedication, etablissement d’une structure de prise en charge des patientes ambulatoires incluant les couples consultant au centre de procreation assistee et participation accrue a la recherche. Conclusion. Le sujet des soins pharmaceutiques en gynecologie-obstetrique est peu explore dans la documentation scientifique. Les pharmaciennes de notre centre realisent de nombreuses activites parmi celles decrites dans la documentation. Cet exercice a neanmoins permis d’identifier des elements a mettre en place afin d’optimiser leur pratique.
OBJECTIVES. Our goals were to (a) describe neonatal behavioral signs in a group of newborns expos... more OBJECTIVES. Our goals were to (a) describe neonatal behavioral signs in a group of newborns exposed in utero to selective serotonin reuptake inhibitors or venlafaxine at the time of delivery, (b) compare the rate of neonatal behavioral signs, prematurity, and admission to specialized neonatal care between a group of exposed and unexposed newborns, and (c) compare the effects in exposed preterm and term newborns. PATIENTS AND METHODS. This was a retrospective cohort study including mothers taking selective serotonin reuptake inhibitors or venlafaxine during the third trimester and mothers who were not taking any antidepressants, psychotropic agents, or benzodiazepines at the time of delivery of their newborns. Neonatal behavioral signs included central nervous, respiratory, and digestive systems, as well as hypoglycemia and the need for phototherapy. RESULTS. Seventy-six mothers taking antidepressants and 90 untreated mothers and their newborns were analyzed. Smoking, alcohol intake, and substance abuse were more frequent among treated mothers. In infants in the exposed group, signs involving the central nervous and the respiratory systems were often observed (63.2% and 40.8%, respectively). These signs appeared during the first day of life, with a median duration of 3 days for exposed newborns. The signs resolved in 75% of cases within 3 to 5 days for term and premature newborns, respectively. All exposed premature newborns presented behavioral manifestations compared with 69.1% of term exposed newborns. Median length of stay was almost 4 times longer for exposed premature newborns than for those who were unexposed (14.5 vs 3.7 days). CONCLUSIONS. Neonatal behavioral signs were frequently found in exposed newborns, but symptoms were transient and self-limited. Premature infants could be more susceptible to the effects of selective serotonin reuptake inhibitors and venlafaxine.
Introduction: Goserelin and tamoxifen are adjuvant endocrine therapy for women with hormone recep... more Introduction: Goserelin and tamoxifen are adjuvant endocrine therapy for women with hormone receptor positive (i.e., estrogen receptor-ER and progesterone receptor-PgR) breast cancer. Because of their adverse endocrine effects these drugs should not be used in women who are or may become pregnant [1,2]. A woman exposed to goserelin and tamoxifen inadvertently for the treatment of breast cancer during her pregnancy is reported here. Methods: A 34-years-old female presented with right breast mass in June 2016 and her diagnostic biopsy revealed invasive ductal carcinoma. After receiving 12 neoadjuvant chemotherapy sessions through August 2016-January 2017 and the mass was reduced, she underwent oncoplastic breast surgery in March 2017. The pathologic diagnosis of the resected tumor was hormone receptor positive (ER+, PgR +), invasive ductal carcinoma. She was evaluated not eligible for radiotherapy but goserelin and tamoxifen therapy was initiated postoperatively. After six months under the treatment with this regimen, the patient consulted to doctor about the mass and the movement sensation in her abdomen and she was detected to be pregnant according to performed ultrasonography as 30 weeks of gestation in October 2017. The patient realized to be inadvertently treated with goserelin and tamoxifen throughout 30 weeks of her pregnancy period. Previously the patient was experiencing irregular menstruation and she was told by the doctors that goserelin and tamoxifen might disturb menstruation regularity so she did not realize her pregnancy. After drugs discontinued immediately, she was consulted to our teratology information service (October 2017). Results: The fetus was observed as having no problem in detailed ultrasonography and other routine pregnancy tests in follow up to birth. She gave birth to a 3300 gram healthy male infant by cesarean section at 37 weeks of gestation (22 December 2017). The infant represented no signs of a teratogenic effect at delivery, breast fed for only one week (afterwards fed with formula) and had a normal growth and development up to 4 months of age (April 2018). Conclusions: Here we present a case who delivered for healthy infant after inadvertently exposing goserelin and tamoxifen during 30 weeks of her pregnancy period for hormone receptor positive invasive ductal carcinoma. The case will be under follow up for potential further developmental and/or cognitive pathologies.
Resume Notre travail visait a comparer le taux de macrosomie et la moyenne de poids de naissance ... more Resume Notre travail visait a comparer le taux de macrosomie et la moyenne de poids de naissance (en percentile) de nouveau-nes de meres diabetiques de type 1 (DT1) traitees par pompe a insuline sous-cutanee (PSC) ou par multi-injections quotidiennes d’insuline (MIQ). Il s’agit d’une etude retrospective, incluant les grossesses mono-fœtales de patientes DT1, dont l’issue de grossesse est survenue a plus de 16 semaines de grossesse, au CHU Sainte-Justine (Montreal, Quebec, Canada), entre le 1 er janvier 2000 et le 31 janvier 2009. Au total, 14 grossesses sous PSC et 94 sous MIQ ont ete evaluees. L’HbA 1c aux 1 er , 2 e et 3 e trimestres de grossesse n’etait pas significativement differente entre les groupes PSC et MIQ. Le percentile des poids de naissance (92±11 versus 77 ± 26) et le taux de macrosomie (71,4% versus 42,6%, respectivement) etaient significativement plus eleves dans le groupe PSC ( p
Pregnant women are at increased risk of severe complications associated with H1N1 pandemic influe... more Pregnant women are at increased risk of severe complications associated with H1N1 pandemic influenza. Fever and inflammatory syndrome associated with the infection may also be deleterious for the developing fetus. Therefore, early antiviral treatment is recommended. Oseltamivir and zanamivir are the two therapeutic options available indicated in the treatment of H1N1 influenza; however, limited data is published on their use during pregnancy and lactation. In this review, we will focus on the effects of H1N1 during pregnancy and on data safety of antivirals during pregnancy and lactation. Main health authorities recommendations for H1N1 influenza treatment of pregnant women will also be presented.
International Journal of Environmental Research and Public Health
The effect of the COVID-19 pandemic on maternal mental health has been described in Canada and Ch... more The effect of the COVID-19 pandemic on maternal mental health has been described in Canada and China but no study has compared the two countries using the same standardized and validated instruments. In this study, we aimed to evaluate and compare the impact of COVID-19 public health policies on maternal mental health between Canada and China, as we hypothesize that geographical factors and different COVID-19 policies are likely to influence maternal mental health. Pregnant persons >18 years old were recruited in Canada and China using a web-based strategy. All participants recruited between 26 June 2020 and 16 February 2021 were analyzed. Self-reported data included sociodemographic variables, COVID-19 experience and maternal mental health assessments (Edinburgh Perinatal Depression Scale (EPDS), Generalized Anxiety Disorders (GAD-7) scale, stress and satisfaction with life). Analyses were stratified by recruitment cohort, namely: Canada 1 (26 June 2020–10 October 2020), Canada ...
Neurogenic bladder is a frequent consequence of multiple sclerosis (MS). Eighty percent of all pa... more Neurogenic bladder is a frequent consequence of multiple sclerosis (MS). Eighty percent of all patients with MS experience urinary symptoms during the course of their disease.1 Symptoms of neurogenic bladder include urgency, frequency, dysuria, nocturia, enuresis, and incontinence. These symptoms are usually secondary to lesions in the spinal column. These lesions lead to detrusor hyperreflexia and urgency when there are small amounts of urine in the bladder. Nocturnal enuresis is one of the most distressing symptoms of MS, since it can lead to interrupted sleep, worsening of fatigue, skin breakdown, decubitus ulcers, and infections.2 Pharmacotherapeutic alternatives for nocturnal enuresis in patients with MS include tricyclic antidepressants and anticholinergics.3 However, due to the limited efficacy and potential toxicities of the above treatments, desmopressin acetate has been investigated. Desmopressin, a synthetic analog of the antidiuretic hormone, is indicated for the treatment of diabetes insipidus and nocturnal enuresis in adults and children without MS.4 The drug increases resorption of water in the collecting tubules of the kidneys, resulting in increased urine osmolality, decreased urine volume, decreased urinary flow, and decreased number of voidings.5 Since patients with MS may have detrusor hyperreflexia, reducing the volume of urine with desmopressin may be a potential benefit. We conducted a literature review to evaluate the efficacy and safety of desmopressin in the treatment of nocturnal enuresis in MS patients. CLINICAL TRIALS
Background Limited data is available on raltegravir (RAL) pharmacokinetics during pregnancy and t... more Background Limited data is available on raltegravir (RAL) pharmacokinetics during pregnancy and the value of therapeutic drug monitoring (TDM) in pregnancy is unknown. This study aims to describe RAL trough plasma concentrations (Ctrough) during pregnancy and review the impact of RAL TDM on outcomes. Methods Women from the prospective mother-infant HIV cohort of Mother and Children’s Infectious Diseases Center who received RAL during their pregnancy between 2011-2020 were included. TDM reports were reviewed and Ctrough values estimated when possible, using historical RAL half-lives. Results We included 76 pregnant women of which 47 underwent TDM. We observed a significant association between virological response and Ctrough ( p-value .034) with an increase of 0.1 mg/L corresponding to a 2.96 reduction in the risk of having a detectable viral load. The results indicated that in pregnant women a RAL Ctrough threshold of 0.04 mg/L has a higher specificity (75%) as compared to our curre...
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Papers by Ema Ferreira