Latest edition of Australian Prescriber out now

1 April 2014

The latest edition of Australian Prescriber is out now and looks at the following topical issues:

Classifying drugs in pregnancy

Marking 50 years since the Australian Drug Evaluation Committee was established to advise on the safety of new and current drugs in Australia, Dr Debra Kennedy provides a review of how the harms of drugs in pregnancy are classified. Dr Kennedy, certified clinical geneticist at the Human Genetics Society of Australasia and Director of MotherSafe at the Royal Hospital for Women, writes that most women will use at least one drug during their pregnancy, and that any risks associated with medicines exposure during pregnancy need to be expressed in comparison to the background risk of all pregnancies. She provides a summary of the Australian categories for prescribing medicines in pregnancy, but reminds health professionals of their limitations. Categories do come with some caveats, for example that they cannot provide clinical context to the risk, and don’t differentiate between use of medicines for more or less significant conditions. The categories also do not apply to breastfeeding.

Treatment of nausea and vomiting in pregnancy

Up to 90% of pregnant women are affected by nausea and vomiting, and while the cause is unclear, unrelenting nausea and vomiting can be debilitating. Tricia Taylor of MotherSafe at the Royal Hospital for Women, Sydney writes that research has shown that pre-emptive management early in pregnancy reduces the severity of symptoms and can have a profound effect on a pregnant woman’s health and quality of life. However studies have shown that many women don’t receive appropriate information about lifestyle changes or timely drug treatment. Ms Taylor describes when pharmacological therapies are indicated and provides a summary of current guidelines on drug treatments. She concludes that while dietary and lifestyle changes ought to be implemented first, the recommended drugs should not be withheld because of fear of harming the baby.

Non-invasive prenatal testing for Down syndrome

Professor Jon Hyett of the Royal Prince Alfred Hospital, Sydney reviews a recently developed test which can assist in screening pregnant women with an increased risk of Down syndrome and proposes how the test could fit into current practice. Professor Hyett says the test would be useful in the further assessment of women who are found to have a pregnancy with an intermediate risk of Down syndrome after routine antenatal screening. It may reduce the need for invasive testing in these women. The identification of cell-free fetal DNA in maternal plasma has enabled identification of genetic differences between mother and fetus, which means the fetal sex or rhesus D blood group and chromosomal abnormalities, including trisomies 21, 13, 18 and 45X, can be determined without amniocentesis. This testing won’t detect all genetic abnormalities found by amniocentesis such as cystic fibrosis and sickle cell, writes Professor Hyett.

Other articles in this edition of Australian Prescriber include

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Australian Prescriber is an independent peer-reviewed journal providing critical commentary on therapeutic topics for health professionals, particularly doctors in general practice. It is published every two months and distributed to health professionals free of charge, and is also available online at 

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