Journal of midwifery & women's health
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J Midwifery Womens Health · May 2017
ReviewMigraines in Women: Current Evidence for Management of Episodic and Chronic Migraines.
Migraine headache is a disabling brain disorder that affects millions of women in the United States. Many migraine sufferers are undertreated. ⋯ This clinical update reviews the pathophysiology and diagnosis of migraine headaches in women, discusses the efficacy of abortive and chronic pharmacologic treatment, and examines strategies to prevent progression from episodic migraine to chronic migraine. A discussion of treatment during pregnancy and lactation is included.
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Marijuana is the most commonly used illicit drug in pregnancy, and the prevalence of use during pregnancy is increasing in the United States. Although much of the existing research investigating marijuana use in pregnancy is limited by study design and confounding factors, a growing accumulation of data suggests adverse outcomes. ⋯ Moderate concentrations of marijuana have also been identified in breast milk. Due to these findings, multiple professional societies have issued clear statements against marijuana use during pregnancy and lactation.
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J Midwifery Womens Health · May 2017
ReviewFundamentals of Clinical Pharmacology With Application for Pregnant Women.
Medication use is common in pregnancy, yet for most medications the optimal formulation and dosage have not been described specifically for pregnant women. Often, adverse effects are only discovered anecdotally or after extensive off-label use occurs. Since pharmacologic research that includes pregnant women is sparse and animal studies are often not applicable to the human fetus, providers must use knowledge of drug behavior and normal physiologic changes of pregnancy to personalize treatment for pregnant women. ⋯ The normal physiologic changes of pregnancy are presented as a framework to understand alterations in drug behavior. A clinical vignette that addresses 4 pregnancy scenarios involving medications-preterm birth, vaccination, herpes simplex virus infection, and codeine toxicity-is provided to illustrate application of core clinical pharmacologic concepts. Discussion of relevant literature illustrates the challenges of offering individualized pharmacologic therapy in pregnancy.
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J Midwifery Womens Health · May 2017
ReviewTobacco Harms, Nicotine Pharmacology, and Pharmacologic Tobacco Cessation Interventions for Women.
Firsthand and secondhand tobacco use is linked to a multitude of harmful illnesses, adverse perinatal outcomes, and death. Cessation attempts among women may be hampered by their unique biologic response to nicotine. Current research has revealed epigenetic changes from intrauterine nicotine exposure that have intergenerational consequences. ⋯ Pharmacokinetics, effectiveness, regimens, and safety profiles for nonpregnant, pregnant, and lactating women are reviewed. Alternative tobacco cessation options and potential new pharmacologic tobacco cessation agents are discussed. Initiating brief interventions, using the 5A's and 5R's model is described.
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J Midwifery Womens Health · May 2017
Initiating Intrapartum Nitrous Oxide in an Academic Hospital: Considerations and Challenges.
A 50%-50% mixture of nitrous oxide and oxygen has long been used for managing pain during labor in many countries, but only recently has this intrapartum analgesic technique become popular in the United States. Nitrous oxide is considered minimal sedation and a safe pain management alternative. Many facilities are now interested in providing laboring women this analgesic option. ⋯ Nurses at the University of New Mexico Hospital now directly oversee the administration of nitrous oxide to women in labor in accordance to an established guideline. Despite limited available research, the guideline also allows offering nitrous oxide as a pain management technique for women with opioid dependence. Key components of the guideline and specifics related to education, cost, and safety are reviewed.