Biomedical subjects

Donald Mattison

Publications and source records attributed to Donald Mattison.

5 recordsLinked to original sources

PubMed2006

Gaps in knowledge in treating pregnant women.

Because studies are often undertaken without knowledge of the pharmacokinetics of a drug, efficacy is difficult to assess in pregnant women. To address this lack, basic and clinical research within the National Institute of Child Health and Human Development is focusing on expanding knowledge of pharmacology during pregnancy. Although medication use, including prescription, over-the-counter, and herbal products, is common during pregnancy, physicians may not be aware of the nonprescription products their patients are taking or the interactions these products may have with prescribed medications. A number of studies have found sex differences in oxidative metabolism and transport, as well as pharmacologic and toxicologic differences in hepatic metabolism, that are ultimately reflected in pharmacokinetics. Sex differences exist in distribution volumes, transport proteins, and drug clearance. Beyond these sex differences, pregnancy itself affects the absorption, distribution, metabolism, and elimination of a drug. Women experience more adverse drug reactions (ADRs) than do men, and these reactions tend to be more severe. QT prolongation (torsades de pointes) and hepatic toxicity are two of the most severe ADRs, frequently causing withdrawal of a drug from the market. Women may also metabolize drugs more quickly than do men, and drugs metabolized by cytochrome P3A4 are cleared more rapidly during pregnancy. A substantial increase in the clearance of drugs eliminated by renal mechanisms also has been noted. A significant number of women are clinically depressed during pregnancy and postpartum, and eliminating treatment for depression during pregnancy may have negative consequences for both mother and fetus. Among women with depression who are treated with selective serotonin reuptake inhibitors, the dose needed to maintain efficacy increases across the course of pregnancy. Drug disposition and response not only can differ between men and women, but also between pregnant and nonpregnant women. Research is needed to understand how pregnancy alters the pharmacokinetics and pharmacodynamics of drugs; then, efficacy trials can be initiated. Alternative strategies also need to be developed to characterize safety information.

Female↗

PubMed2003

Risk assessment.

Explore the source record for details and available documents.

Abnormalities, Drug-Induced↗

PubMed2002

Contribution of birth defects to infant mortality in the United States.

BACKGROUND: While overall infant mortality rates (IMR) have declined over the past several decades, birth defects have remained the leading cause of infant death in the United States. To illustrate how this leading cause of infant mortality impacts subgroups within the US population a descriptive analysis of the contribution of birth defects to infant mortality at the national and state level was conducted. METHODS: Descriptive analyses of birth defects-specific IMRs and proportionate infant mortality due to birth defects were conducted for the US using 1999 mortality data from the National Center for Health Statistics. In 1999, the change to ICD-10 impacted how cause-specific mortality rates were coded. Aggregated 1995-1998 state- birth defects infant death statistics were used for state comparisons. RESULTS: In 1999, birth defects accounted for nearly 1 in 5 infant deaths in the US. Variation in birth defects-specific IMRs were observed by maternal race with black infants having the highest rates when compared with other race groups. However, among black infants prematurity/low birthweight was the leading cause of death, followed by birth defects. There is substantial variation in state-specific birth defects IMRs and the state-specific proportion of infant deaths due to birth defects. CONCLUSIONS: Birth defects remain the leading cause of infant death in the United States, despite the changes that resulted in 1999 from an update in the coding of cause of death from ICD-9 to ICD-10. While birth defects-specific IMRs provide an overall picture of fatal birth defects and a gauge of the impact of life-threatening anomalies, they represent only a fraction of the impact of birth defects, missing those who survive past infancy and those birth defects related losses in the antepartum period. Expansion and support of effective birth defects monitoring systems in each state that include the full spectrum of perinatal outcomes must be a priority. However, paralleling these efforts, analyses of this leading cause of infant mortality provide critical insight into perinatal health and should continue, with appropriate adjustments for the 1999 classification changes.

Black or African American↗

PubMed2002

Neural tube defect-specific infant mortality in the United States.

BACKGROUND: Significant resources have been devoted to decreasing the rate of neural tube defects (NTDs) in the United States. Both surveillance data and birth records have strengths and limitations for evaluating the outcomes of this resource allocation. Cause-specific infant mortality data can be used as one measure to support evaluation efforts. METHODS: Using period linked birth/infant death data from the National Center for Health Statistics (NCHS), a retrospective analysis was performed to assess the NTD-specific IMR at the national, state, and regional level. NTD-specific IMRs for the United States were calculated from 1996 to 1998; stratified rates by race/ethnicity, maternal age, age at death, and gestational age and birthweight by type of NTD for the total US population were based on three-year aggregates (1996-98); state and regional rates were based on four-year aggregates (1995-98). RESULTS: Annual US NTD-specific IMRs significantly decreased between 1996 and 1998. Black infants were significantly less likely to die from an NTD when compared to white infants, largely attributed to the high rate of NTD-specific deaths among white Hispanic infants. Infants born to women less than 20 years were more likely than infants born to women in other age groups to die from an NTD. Seventy-six percent of all NTD-specific deaths occurred in the first 23 hours of life. Seventy-four percent of NTD-specific infant deaths were low birthweight and 58 percent were preterm. The Midwest had the highest rate of NTD-specific infant deaths among US regions. CONCLUSION: Enhanced prevention efforts are needed to address the disparities in infant deaths due to NTDs between Hispanics and other populations, as well as women under 20 years. Decreases in NTD-specific IMRs may have been impacted by fortification of enriched grain products with folic acid since these efforts were optional beginning in 1996. While there are limitations in cause-specific IMRs, NTD-specific IMRs can be used as one measure to assess the impact of public health interventions aimed at reducing NTDs, respectful of the relatively small numbers.

Cause of Death↗

PubMed2002

Chemical contaminants in breast milk and their impacts on children's health: an overview.

Human milk is the best source of nutrition for infants. Breast milk contains the optimal balance of fats, carbohydrates, and proteins for developing babies, and it provides a range of benefits for growth, immunity, and development. Unfortunately, breast milk is not pristine. Contamination of human milk is widespread and is the consequence of decades of inadequately controlled pollution of the environment by toxic chemicals. The finding of toxic chemicals in breast milk raises important issues for pediatric practice, for the practice of public health, and for the environmental health research community. It also illuminates gaps in current knowledge including a) insufficient information on the nature and levels of contaminants in breast milk; b) lack of consistent protocols for collecting and analyzing breast milk samples; c) lack of toxicokinetic data; and d) lack of data on health outcomes that may be produced in infants by exposure to chemicals in breast milk. These gaps in information impede risk assessment and make difficult the formulation of evidence-based health guidance. To address these issues, there is a need for a carefully planned and conducted national breast milk monitoring effort in the United States. Additionally, to assess health outcomes of toxic exposures via breast milk, it will be necessary to examine children prospectively over many years in longitudinal epidemiologic studies that use standardized examination protocols that specifically assess breast milk exposures. Finally, current risk assessment methods need to be expanded to include consideration of the potential risks posed to infants and children by exposures to chemical residues in breast milk.

Adult↗