Global Health Asia-Pacific May 2022 May 2022 - Page 45

Rebecca B . Lawn , a research fellow in epidemiology at the Harvard T . H . Chan School of Public Health and one of the study authors , said in a press release .
Such an approach could also be relevant in stroke prevention as high blood pressure is one of its major risk factors along with psycho-social stress , or the inability to cope with adverse experiences like domestic violence and sexual harassment , explained Dr von Euler , who ’ s an expert on stroke care .
She added that researching the social determinants of health could significantly contribute to improving rehabilitation for women who have had strokes , given that they can face disabling complications like paralysis , loss of muscle movements , and difficulty talking or swallowing due to the reduction or interruption of blood supply to the brain . Patients with such problems often need a lot of help from family members or caregivers to recover properly , but women usually get less support than men because they tend to have strokes at an older age when they ’ re either widows or have a husband who ’ s even older than they are because women tend to marry older men , she said , stressing that this affects how much help they can get at home .
“ We should look more at the living situations of women with stroke to tailor a good rehabilitation programme to their needs ,” she suggested .
The conundrum of research in pregnant women Significant improvements are also needed around the treatment of pregnant women in order to provide evidence-based therapies that are safe for both women and newborns .
This is because most medications today are approved by health authorities without any data supporting their efficacy and safety during pregnancy because of the potential risks of including pregnant women in clinical trials that could harm their foetuses .
Such risks are epitomised by the sedative Thalidomide , which in the 1960s was withdrawn from the market after reports that the drug , commonly taken by pregnant women to ease morning sickness , was responsible for severe foetal malformations like short , twisted , or missing limbs .
The tragic irony is that these legitimate fears have basically caused expecting and breastfeeding women to be shut out of medical research , potentially exposing them to those same risks that exclusion from research was supposed to avoid . Pregnant women , individuals over 65 , children , and people with intellectual or physical disabilities , “ are often implicitly or explicitly excluded from participating in clinical research studies ,” Dr Diana W . Bianchi , Director of the National Institute of Child Health and Human Development ( NICHD ), told Global Health Asia-Pacific back in 2019 . “ Yet , research findings have been applied to all people without scientific knowledge of how the findings affect the excluded populations .”
There ’ s little research on drugs safety during pregnancy
Indeed , pregnant women often have to take drugs to treat nausea , high blood pressure , or serious chronic diseases without knowing if their standard dosages apply to pregnancy , a condition that can change the way the body absorbs drugs , or how medications taken by pregnant and breastfeeding women affect foetuses and newborns .
“ The ethical problem of doing research on pregnant women is a real one ,” said Dr von Euler , adding that one approach for obtaining more evidence without increasing risks is to do comprehensive observational studies that look at the drugs that pregnant women are already taking and what effect they ’ re having on them and their babies .
“ We won ’ t get such solid answers because observational studies aren ’ t as good as randomised controlled trials , but at least we ’ ll get some answers ,” she acknowledged . Often hailed as the gold standard in medical research , randomised controlled trials involve the comparison of two patient groups treated with different approaches . Dividing patients by chance makes sure the groups are as similar as possible so that the different treatments are assessed fairly . “ I think sometimes we have to step away from randomised controlled trials because it ’ s not practically and ethically doable .”
One good model to power such observational studies is offered by Sweden where plenty of information about pregnant women and their babies , including medications taken during pregnancy and any subsequent abnormalities in babies , is collected during prenatal care , a free service that almost any pregnant woman in Sweden receives . n
Pregnant women often have to take drugs to treat nausea , high blood pressure , or serious chronic diseases without knowing if their standard dosages apply to pregnancy
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