My favorite science journal, PLOS, has a nice series of articles on women's health and more specifically maternal health. PLOS, which I love because they are public access, is a top tier journal. The gist of the articles is that after the scariness of DES and thalidomide, maternal medicine development has been at a relative standstill. As pregnant women still often have the need for medication, this has de facto resulted in the off-label use of medication. According to
Fisk and Atun, 75% of pregnant women are on at least one medication for which the safety has not been formally verified. This in no way means that all (or even any) of these drugs are actually dangerous--it moreso belies the fact that women are ignored by the drug companies. Only three new medications (atosiban, carboprost, and carbetocin) have come about in the last 20 years in the UK. This is in exception to abortifacients and reformulations. Moreover, two of them are only used post-delivery. The Big Medication Players in maternal health (magnesium sulfate, α-methyldopa, hydralazine, β-blockers, aspirin, and nifedipine) have all been around for decades.
Why is this so important? According to Fisk and Atun:
Worldwide, there are 536,000 maternal deaths annually, while nearly half the 13.5 million under-five child deaths occur as antepartum, intrapartum, or neonatal deaths.
In developing nations, the problems are even more pronounced because of their increased burden of disease. We do not know how to treat most tropical diseases in pregnant women, but that does not mean they are not getting sick and dying. I support careful testing of all people with no qualifications. Malaria, however, leads to a mortality rate of 50% in pregnant women in their 3rd trimester, according to
White et al, and we do not know how to treat it. There is no easy answer. Clinical trials are difficult as it is, let alone one in pregnant women or in a third world country.
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