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Maternal antidepressant use during pregnancy does not appear to cause neurodevelopmental disorders in children
Patients and clinicians may be worried about the effect of drugs consumed during pregnancy on the fetus, some of which may not manifest until later in life. Antidepressant medications are commonly used and, in some studies, have been associated with neurodevelopmental disorders. This large cohort study collected data on over 3 million pregnancies and had a 14 year follow-up period. In crude unadjusted analyses, there appeared to be a doubling of rates of neurodevelopmental disorders; however, after adjustment for confounding factors, these increases disappeared. Antidepressant use itself does not appear to be a direct cause of neurodevelopmental disorders but may indicate patients at higher need of screening and support.
JAMA Intern Med https://doi.org/10.1001/jamainternmed.2022.4268
Linzagolix with or without hormonal add-back therapy reduces menstrual blood loss for those with uterine fibroids
Uterine fibroids are an important cause of heavy menstrual bleeding. The non-surgical treatment options are relatively limited. These paired phase 3 studies compared linzagolix (an oral gonadotrophin-releasing hormone receptor antagonist) at two different doses with and without hormonal add-back versus placebo (five equally weighted study arms). All active arms had a reduction in menstrual blood loss compared with placebo. The higher dose of linzagolix without hormonal add-back had a higher rate of menopause-type side effects (particularly hot flushing), but all other groups had a similar, lower rate. The formulations with hormone add-back represent a potentially valuable medical intervention for heavy menstrual bleeding with fibroids. The lower dose without hormone add-back may be of value to those who are not eligible or do not want hormone replacement.
Expectant management of retained products of conception as effective as medical management following medical abortion
Retained products of conception occur in approximately 4% of cases of early medical abortion. This randomised controlled trial at a single centre in Israel compared expectant management with 800 μg misoprostol for managing retained products of conception, defined as anteroposterior thickness 12–40 mm with positive Doppler flow. Participants received up to three ultrasound scans at fortnightly intervals. Those with persisting products of conception at the final visit were referred for evacuation. Approximately 60% of participants in both groups had resolution of products of conception by the final study visit. Repeat misoprostol doses did not appear to expedite resolution compared with expectant management. Misoprostol can have unpleasant side effects, so avoiding repeat treatment may be preferable to patients.
Serum progesterone levels in early pregnancy may be a useful adjunct for predicting viability
Around 30% of early pregnancies are complicated by pain or bleeding. Many of these continue but some spontaneously abort or are found to be ectopic. This systematic review and meta-analysis compared different thresholds of progestogen to predict the likelihood of either failing or continuing pregnancy. In symptomatic patients (ie, pregnant with pelvic pain and/or vaginal bleeding) progesterone levels <6.3 ng/mL give a more than 90% chance of a failing pregnancy. By contrast a progesterone level >20 ng/mL will give a more than 90% chance of a continuing pregnancy. This study does not appear to indicate levels that correlate with ectopic pregnancy, which would be of great utility to early pregnancy units and abortion services. Further research to identify these levels would be of value.
Telemedicine for medical abortion non-inferior to in-person consultations
Telemedicine delivery of early medical abortion care has become increasingly common in legal settings since the COVID-19 pandemic; however, the evidence base to support this practice has remained largely observational. This randomised controlled trial compared in-person consultation with ultrasound versus asynchronous online consultation with abdominal palpation by a clinician (to exclude gestation over 12 weeks). Complete abortion rates were high (over 95%) and did not differ significantly by group. Satisfaction rates and safety markers (rate of hospital admission and ectopic pregnancy) were likewise similar between groups. This study provides high quality evidence to support telemedicine management of medical abortion. Further research is needed to advance practice further to true self-management of medical abortion.
High levels of interest and acceptability of an over-the-counter progestogen-only pill in Germany, Italy, and Spain
In the last 18 months, the progestogen-only pill (desogestrel) has been approved as a pharmacy medicine in the UK, meaning that it can be sold over-the-counter following a consultation with a pharmacist. The UK was the first country to approve this in Western Europe and attitudes towards this in other European nations have not been previously reported. This study combines a quantitative survey of 3000 women in Spain, Italy, and Germany, and 300 pharmacists in these countries, with in-depth interviews with a selected group of women and clinicians. The surveys identified that a high proportion of respondents thought that having the progestogen-only pill available over-the-counter was a positive idea, with around a third stating that they would either switch to buying their method of contraception this way or buying a back-up supply of contraception. Pharmacists were equally positive with 80% rating themselves as ‘not worried’ about providing the method. With time, the progestogen-only pill (and other methods) will hopefully be available without prescription in pharmacies, removing barriers to access.
Euro Journ Contra and Reprod Health https://doi.org/10.1080/13625187.2022.2128643
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Footnotes
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests JJR-W has received an educational grant from Gedeon Richter.
Provenance and peer review Commissioned; internally peer reviewed.