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Staying engaged in women's health is fundamental to our society

Staying engaged in women's health is fundamental to our society
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Though the Affordable Care Act was not repealed, the new tax reform stands to profoundly affect health care and undermine it anyway. Never mind that many critical policies in the bill were created primarily by white men, which represent women’s concerns only through the lens of male experience; experts agree that sex and gender influence health, and have warned of the potential risks to women with diminished coverage of preventive and reproductive services, chronic disease care, and advancement of gender-specific research.

Pregnancy is, of course, a unique experience for women. As a professor of psychiatry and obstetrics and gynecology with more than three decades of experience treating pregnant women, I have been frustrated by how surprisingly few studies are available to guide their medical treatment on occasions when they become ill.

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One reason for so little available information is the focus on protection of the vulnerable woman and her fetus from potentially toxic exposures. Understandably, following the thalidomide tragedy over 50 years ago, the approach to pregnant women shifted to avoidance of all drug use in pregnancy. But this inclination to protect created a disadvantaged group for disease management and public health which continues to this day — pregnant women, who are referred to in the medical field as the last therapeutic orphans.

 

Certainly, we should protect pregnant women from unnecessary risks. As a newly graduated physician, I believed research was essentially treating patients like guinea pigs, yet soon I was confronted with an awful truth pregnant women get sick, and sick women get pregnant, and treatment advances will not be made without research.

The Centers for Disease Control and Prevention lists anemia, urinary tract and other infections, mental health conditions, hypertension, obesity, and diabetes as common disorders in pregnant women. Drug treatment is often required for these conditions, but little information on the effect of medications on reproductive outcomes is available.

I see the disadvantaged position of pregnant women daily. In recent consultation with a woman who had bipolar disorder, she tearfully said, “I don’t know whether I am more scared of getting depressed when I stop taking my medication or continuing the drug during pregnancy.” Recommending medication for a woman with the statement, “we have little information the use of this drug during pregnancy” is demoralizing for me as the prescriber, not to mention the plight of the unfortunate woman who has to make a critical choice about treatment.

But due to ethical, legal, and fetal safety concerns, pregnant women have been excluded from treatment investigations. They bear the burden, with their physicians and society, of a paucity of data to inform treatment decisions.

Through the Treating for Two initiative, the Centers for Disease Control and Prevention is promoting a conceptual shift from the view that medications in pregnancy must be avoided, to one that seeks to “improve the health of women and babies by working to identify the safest treatment options for the management of common conditions before and during pregnancy.”

Another hopeful sign is the recent establishment of the Task Force on Research Specific to Pregnant Women and Lactating Women (PRGLAC) to identify gaps in research on safe and effective therapies for pregnant and breastfeeding women. Studies are needed to develop new drugs to treat conditions that only occur in pregnancy, such as severe nausea and vomiting, pre-eclampsia and preterm birth. The PRGLAC recommendations will include ways to effectively communicate research findings and other information to health care professionals and the public.

To be sure, research participation also has risks, but it is more risky to continue with the current quality of treatment given to women when they happen to be pregnant. The responsible inclusion of pregnant women in research is a compelling public health concern because women deserve effective treatment during pregnancy and data on fetal safety is preferable to being in the dark. Lack of information creates reticence to treat potentially dangerous medical conditions and makes pregnant women a disadvantaged population which is not granted fair access to advances in treatment research.

Patients and health care professionals alike can receive free, expert consultation on any drug, disease or exposure is available from resources such as MotherToBaby, which receives funding from the U.S. Department of Health and Human Services. MotherToBaby also offers research participation to callers to collect data on exposures and pregnancy outcome to inform care for women and infants of the future.

While progress is slowly happening in this area, and some great resources are becoming available, it’s not enough. We must stay engaged in advocating for women’s health, which is fundamental to the critical role women have in our society.

While resources are helpful, funding research on the treatment for a variety of illnesses and conditions that befall pregnant women is crucial, and so is a shift in culture and care that recognizes the importance of serving the needs of all its population at every stage of their lives.

Katherine L. Wisner, MD, MS, is a perinatal psychiatrist and the Norman and Helen Asher Professor of Psychiatry and Obstetrics and Gynecology at Northwestern University, and a Public Voices Fellow.