Monitoring outcomes of suicide attempts in pregnancy can better assess drug dangers.

Los Angeles, London, New Delhi, Singapore and Washington DC (17 September, 2008) u Monitoring the health of children born to women who attempted suicide while pregnant can shed light on which medicines and what doses are particularly dangerous to developing fetuses, according to researchers from Hungary who publish their findings in a series of reports in a special issue of Toxicology and Industrial Health, published this week by SAGE (see also SAGE Publications Uk).

Information about the harm particular drugs can do to unborn children u a measure known as tetrogenic potential u is generally extrapolated from experimental animal investigations before the drug is approved for sale, because ethical considerations prevent regulated tests of safe doses being conducted in women who are pregnant.

However, because it is difficult to translate the findings from animal models to a real human situation, regulators err on the side of caution, and frequently prohibit the use of potentially beneficial agents in pregnant women.

"Many drugs are subject to contraindications or special warnings because their effects have not been sufficiently studied during pregnancy or non-clinical studies revealed adverse teratogenic or fetotoxic effects," explain the authors. "Data from self-poisoned pregnant women provide an appropriate source of information for use in better estimating the potential human risks of exposure to drugs during pregnancy."

In desiging their study, the Hungarian researchers reasoned that if no congenital abnormalities occur in children born to women who ingest very large doses of a drug during critical developmental periods, then this information supports the notion that the ingested drug is not a human teratogen. What is more, they report, self-poisoned women present the opportunity to gather data on dose-response relationships, which are difficult to ascertain from animal models, because they are hospitalised and undergo extensive pharmacological tests. To test their hypothesis that self-poisoned pregnant women could give useful drug-safety data, the reserachers studied outcomes of all such admissions to the Department of Toxicological Internal Medicine, Koranyi Hospital, Budapest. During the study period of 1960-1993, 1044 pregnant women were admitted and 1021 of these attempted suicide with drugs (the other 23 pregnant women had accidental intoxication due to poisonous mushroom ingestion or carbon monoxide).

Among them, these ...