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Dissertations / Theses on the topic 'In Utero Drug Exposures'

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Published: 25 May 2024

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1

Fitton, Catherine Alexandra. "Identifying adverse outcomes in neonates and children following in utero exposure to medication." Thesis, University of Aberdeen, 2019. http://digitool.abdn.ac.uk:80/webclient/DeliveryManager?pid=240861.

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Introduction: Many medications have an unproven safety profile for use during pregnancy, leading to issues when chronic diseases, such as hypertension and depression, present during pregnancy. The focus of this research programme is to determine whether in utero exposure to antihypertensive and antidepressant medication is associated with increased risk of adverse events at birth, and up to 27 months of age in the child. Methods: Two systematic reviews were performed to identify current published literature and knowledge gaps. Following this, using Scottish healthcare data, a cohort of 268,711 children born 2010-2014 were identified. Following cleaning of the data, multiple imputation was used to account for missing values. Poisson, linear and multinomial regressions were performed to identify the relationship between in utero medication exposure and child outcomes. Results: In utero antihypertensive exposure was associated with preterm birth, low birth weight, small for gestational age, but not developmental issues. However, untreated hypertension was associated with low birth weight, preterm birth, and small for gestational age. In utero antidepressant exposure was associated with preterm birth, low birth weight, small for gestational age, preeclampsia, having a special needs indicator at 10 days and 6-8 weeks post-birth, developmental issues at 27 months Conclusions: This research programme identified several adverse outcomes following in utero exposure to antihypertensive and antidepressant medication.

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2

Shallcross, Rebekah. "Child development following in utero exposure : a comparison of novel and established antiepileptic drug treatment." Thesis, University of Liverpool, 2012. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.569778.

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Research regarding child outcome following in utero exposure to antiepileptic drugs, has documented increased risks for later developmental delay, cognitive impairment and associated language difficulties. Research regarding malformation data has utilised pregnancy and epilepsy registers in order to document the relative risks associated with individual antiepileptic drug exposure, yet pregnancy and epilepsy registers have not been widely utilised in the investigation of child cognitive development. The current research aims to document the developmental abilities of children born to women with epilepsy exposed to the novel antiepileptic drug Levetiracetam (n=110) and the established antiepileptic drug Sodium Valproate (n=86), utilising the U.K.Epilepsy and Pregnancy Register. A control group of children born to women without epilepsy, not taking medication during pregnancy, previously assessed by the Liverpool and Manchester Neurodevelopment Group-was also utilised for comparison (n=232). Children were assessed at either 0-24 months of age or 36-54 months of age. Tests of child development and language abilities, as well as parental report questionnaires pertaining to neurodevelopmental disorders, were administered. Children exposed in utero to Levetiracetam were not found to differ from control children on any measures administered. Linear regression analysis revealed Sodium Valproate exposure to be predictive of poorer overall developmental abilities for children between 0-24 months of age. Further, for children 36-54 months of age, linear regression analysis revealed Sodium Valproate exposure to be predictive of poorer gross locomotor skills, comprehension oflanguage abilities and expressive language abilities. No significant differences were found between any of the groups in regards to parental report pertaining to features of neurodevelopmental disorder. Pregnancy guidelines and preconception counselling information for women with epilepsy should take into account the findings of the current thesis, when deciding upon anti epileptic drug treatment, so that informed decisions can be made by women with epilepsy in conjunction with their healthcare professionals. The current research was sponsored by UCR

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3

Staley, Elizabeth. "Persistent Developmental Delays in Children Born with Neonatal Abstinence Syndrome and In Utero Drug Exposure." University of Dayton / OhioLINK, 2021. http://rave.ohiolink.edu/etdc/view?acc_num=dayton1622630310967578.

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4

Barr, Sarah Elizabeth. "Understanding Caregiver Perceptions of Attachment with Drug Exposed Foster Children." ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/7364.

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Lacking a healthy attachment to a caregiver and having in-utero methamphetamine exposure have been linked to a variety of cognitive delays, developmental delays, and mental health issues throughout a person's lifespan. It is unknown if there is a relationship between in-utero methamphetamine exposure and the ability to build a healthy attachment to a caregiver. The purpose of this generic qualitative study was to improve understanding of the perceptions of caregivers about attachment efforts for foster children under the age of 3, who have had in-utero methamphetamine exposure. This study was guided by attachment theory. Purposeful sampling was used to select 7 participants who had provided care to foster children with in-utero methamphetamine exposure within the last year. Data were collected through the use of semistructured interviews, which were conducted in-person, audiotaped, and then transcribed. Data was analyzed through text searches of themes, axial coding, and repetitive words. Trustworthiness was obtained through member checking and generating a rich description of the participants' experiences. The findings revealed that many of the participants feel that these children do not respond to their efforts to build a healthy attachment to them. They also felt that the foster children did not process stimuli, such as touch, in the same way as other children; that the foster children found such interactions to be aversive. The findings of this study have the potential to impact social change by assisting therapists, caseworkers, and foster parents better understand the needs of foster children and to create a foundation for interventions to better serve foster children with in-utero methamphetamine exposure.

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5

Smith, Andrew Lawrence. "Pregnancy and Multiple Sclerosis: Risk of Unplanned Pregnancy, Drug Exposure In Utero, Relapse while Attempting Conception, and Post-Partum Relapse by Anesthesia Choice." Case Western Reserve University School of Graduate Studies / OhioLINK, 2017. http://rave.ohiolink.edu/etdc/view?acc_num=case1498749393114796.

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6

Cooney, Maureen Anne Siega-Riz Anna Maria. "In utero environmental exposures and reproductive endpoints." Chapel Hill, N.C. : University of North Carolina at Chapel Hill, 2008. http://dc.lib.unc.edu/u?/etd,2433.

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Thesis (Ph. D.)--University of North Carolina at Chapel Hill, 2009.
Title from electronic title page (viewed Sep. 3, 2009). "... in partial fulfillment of the requirements for the degree of Doctor of Philosophy in the Department of Epidemiology." Discipline: Epidemiology; Department/School: Public Health.

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7

Hübinette, Anna. "Exposures in utero and chronic disease : an alternative methodological approach /." Stockholm : Karolinska Univ. Press, 2002.

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8

Cummings, C. A. "A study of the effect of in utero exposure to antiepileptic drugs on later childhood development and behaviour." Thesis, Queen's University Belfast, 2008. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.446121.

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9

Bailey, Beth A., David Wood, and Darshan Shah. "The Role of in Utero Exposure to Drugs Beyond Opioids in the Development and Severity of Neonatal Opioid Withdrawal Syndrome (NOWS)." Digital Commons @ East Tennessee State University, 2020. https://dc.etsu.edu/etsu-works/7673.

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10

Wide, Katarina. "Children exposed to antiepileptic drugs in utero : clinical and epidemiological aspects on growth, development and occurrence of malformations /." Stockholm, 2000. http://diss.kib.ki.se/2000/91-628-4320-6/.

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11

Shoemaker, Griffin, Gloria Kwak, Gayatri Bala Jaishankar, and Karen E. Schetzina. "Prenatal Drug and Related Exposures in Infant Patients at Northeast Tennessee Pediatric Primary Care Clinic." Digital Commons @ East Tennessee State University, 2019. https://dc.etsu.edu/etsu-works/5032.

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12

Shoemaker, Griffin, Gloria Kwak, Gayatri B. MD Jaishankar, and Karen E. MD MPH Schetzina. "Prenatal Drug and Related Exposures in Infant Patients of a Northeast Tennessee Pediatric Primary Care Clinic." Digital Commons @ East Tennessee State University, 2018. https://dc.etsu.edu/asrf/2018/schedule/18.

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Introduction: The prevalence of opioid abuse has increased throughout Northeast Tennessee. Subsequently, more infants are born drug-exposed or with Neonatal Abstinence Syndrome (NAS). According to the Tennessee Department of Health, hospitalizations for deliveries with maternal substance abuse tripled in Tennessee between 1999 and 2011. During this period, the inpatient hospitalization rate for NAS increased 11-fold. In 2017, there were 163 NAS cases reported in Northeast Tennessee. Depending on intrauterine and environmental exposures, there may be differences in health, growth, behavior, and development in infants. Our goal was to assess and explore those differences to help update education and care recommendations for pediatric primary care clinics. Methods: This cross-sectional study was set in a Northeast Tennessee pediatric clinic. 120 patients seen for a newborn visit between June 30, 2013 and July 1, 2014 were randomly selected. An additional sample of all infants with suspected drug exposure was identified for this period based on diagnosis codes. In total, 99 infants had no drug exposure and 62 were drug-exposed. An 83-item chart abstraction template was developed. Data was analyzed by SPSS. The chi-squared test and Mann-Whitney U test were used, with a critical value of p<0.05 to determine significance. The Bonferroni correction was applied to account for multiple comparisons. The research protocol was reviewed and approved by the Institutional Review Board of East Tennessee State University. Results: Of the 120 charts initially selected, 3.33% of infants were exposed to buprenorphine, 1.67% to methadone, 0.83% to marijuana, 0.83% to cocaine, and 1.67% to tobacco, 8.33% to benzodiazepine, and 1.67% to barbiturates during gestation. In total, 18.33% of infants had any drug exposure, 10.00% to any opiate, and 3.33% had a documented diagnosis of NAS in their chart. Prenatal drug exposure was significantly associated with multiple demographic factors as well as pediatric respiratory, behavioral, gastrointestinal, infectious disease, and cardiac conditions. Conclusions: Prenatal drug exposure was significantly associated with multiple pediatric complications. This illustrates the significance of addressing the increased incidence of prenatal drug exposure in Northeast Tennessee. Future multivariate analyses will attempt to control for potential confounders. This analysis is retrospective and exploratory, and any associations should be confirmed with a prospective study. A weakness of this study includes potential under-diagnosis of drug exposure and NAS due to lack of documentation in the EHR. Additional research will include further comparison of maternal and infant complications in drug-exposed and non-exposed infants. This will allow for a better understanding of the risks associated with maternal drug exposure. Findings from these research projects will be used to inform clinical initiatives for NAS in Northeast Tennessee.

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13

Goodrich, Geoffrey G. "Detoxification gene polymorphisms, patient demographics, environmental exposures and potential relationships with childhood asthma cross-sectional case study /." abstract and full text PDF (free order & download UNR users only), 2008. http://0-gateway.proquest.com.innopac.library.unr.edu/openurl?url_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:dissertation&res_dat=xri:pqdiss&rft_dat=xri:pqdiss:3326205.

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14

Turner, Susan Langston. "Teratogenic effects on the neuroepithelium of the CD-1 mouse embryo exposed in utero to the anticonvulsant drug sodium valproate /." The Ohio State University, 1988. http://rave.ohiolink.edu/etdc/view?acc_num=osu1487598303837757.

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15

Magnusson, Linda L. "Parental exposures and occurrence of adverse pregnancy outcomes and childhood atopic diseases /." Stockholm, 2006. http://diss.kib.ki.se/2006/91-7140-673-5/.

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16

Hanna, Bishoy. "DEVELOPMENT AND VALIDATION OF A SEMI-PHYSIOLOGICAL PHARMACOKINETIC (PBPK) MODEL TO PREDICT SYSTEMIC AND PULMONARY EXPOSURES AFTER INTRAVENOUS, ORAL ADMINISTRATION AND PULMONARY INHALATION OF SELECTED DRUGS, BUDESONIDE, TOBRAMYCIN AND CIPROFLOXACIN, IN HUMANS." VCU Scholars Compass, 2018. https://scholarscompass.vcu.edu/etd/5470.

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Using a semi-PBPK modeling/quantitative meta-analysis approach, this project investigated what factors affect pulmonary and systemic exposures of Budesonide (BUD), Tobramycin (TOB), and Ciprofloxacin (CIP) after inhalation: Three structurally different pulmonary disposition models were developed for each drug, including pulmonary absorption (all three), excretion (TOB and CIP) and sequestration (TOB) in a peripheral and central lung compartment. Systemic disposition parameters were estimated using available human mean plasma (cp(t)) and sputum (cs(t)) concentration profiles after IV administration, and GI absorption parameters were estimated from these profiles after oral administration. Pulmonary disposition parameters were estimated from cp(t) and cs(t) profiles after inhalation using various devices along with their published pulmonary deposition characteristics. Appropriate covariate models accounted for effects of Cystic Fibrosis on the systemic disposition/GI absorption for TOB and CIP. Monte Carlo Simulations (MCS) were used to optimize parameters and validate the final models and parameter spaces against published data. Despite limited available data, especially cs(t) for BUD and CIP (after IV administration), the point estimates for the final model parameters were mechanistically plausible for all three drugs and consistent with their known differences in physicochemical and ADME properties. Model predictions adequately described the observed cp(t) and cs(t) profiles as well as exposure metrics across studies. As the most lipophilic drug, BUD showed the fastest pulmonary absorption rates and highest Fpul (83%). TOB, a very hydrophilic drug, exhibited (intracellular) pulmonary sequestration, resulting in slow pulmonary absorption and excretion and low Fpul (10%). CIP - as zwitterion - showed relatively slow pulmonary absorption and excretion, leading to low Fpul (8%); pulmonary excretion accounted for 27% of CIP overall elimination. Results of a formal parameter sensitivity analysis demonstrated that, for all three drugs, after inhalation, (1) their systemic exposures (cp(t)) depend primarily on CLtot along with Fpul/sequestration combined with Foral; (2) increasing pulmonary exposures (cs(t)) can be accomplished by slowing down pulmonary absorption rates (kca) and/or slowing down mucociliary clearance from the lungs into the GI tract (kcm) – affirming the overall hypothesis guiding the project.

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17

Moller, Monique. "Detection of Prenatal Opiate Exposures in Alternative Matrices." Thesis, 2010. http://hdl.handle.net/1807/25865.

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Identification of maternal opioid abuse in pregnancy is often difficult to ascertain in the absence of reliable self report. For this reason, physicians and child protection workers often turn to maternal and neonatal hair analysis for the detection of in utero opioid exposures. Since neonatal opiate hair analysis continues to prove difficult due to the scarcity of the hair sample and low drug concentrations, I developed a sensitive method utilizing headspace solid-phase microextraction (HS-SPME) coupled with gas chromatography-mass spectrometry (GC-MS) for the detection of three principal opiates (morphine, codeine, and 6-monoacetylmorphine) in human hair. Moreover, I characterized an at-risk neonatal population for in utero opiate exposures as well as for other drugs of abuse and alcohol. Equipped with a sensitive and specific method for the detection of opiate exposures and understanding the addiction profiles of pregnant women may lead to better clinical and social management and may benefit an at-risk population.

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18

Carey, Nathalie. "The Long-term Neurocognitive Development of Children Exposed to Above Manufacturer Recommended Doses of Diclectin In Utero." Thesis, 2012. http://hdl.handle.net/1807/33349.

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Nausea and vomiting of pregnancy (NVP) affects up to 90% of pregnancies. Diclectin (doxylamine/pyridoxine) is the only anti-emetic approved in Canada for NVP, at a maximum dose of 4 tablets/day. However, some women receive higher doses, up to 12 tablets/day. In this study we compared the neurocognitive development of children from four mother-child groups: (1) NVP and >4 tablets Diclectin, (2) NVP and ≤ 4 tablets Diclectin, (3) NVP and no treatment and (4) no NVP. Children received a full age-appropriate psychological assessment. All groups scored in the normal range for IQ and cognition tests. The Diclectin-exposed groups scored significantly higher on a small number of subtests, but none of the differences could be considered clinically significant. No dose-dependent effects were observed. Above manufacturer recommended doses of Diclectin do not appear to harm neurodevelopment and should be considered safe for the treatment of NVP.

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