The use of prescription medications and non-prescription medications during lactation in a prospective Canadian cohort study.

BACKGROUND: A lack of safety data on postpartum medication use presents a potential barrier to breastfeeding and may result in infant exposure to medications in breastmilk. The type and extent of medication use by lactating women requires investigation. METHODS: Data were collected from the CHILD Cohort Study which enrolled pregnant women across Canada between 2008 and 2012. Participants completed questionnaires regarding medications and non-prescription medications used and breastfeeding status at 3, 6 and 12 months postpartum. Medications, along with self-reported reasons for medication use, were categorized by ontologies [hierarchical controlled vocabulary] as part of a large-scale curation effort to enable more robust investigations of reasons for medication use. RESULTS: A total of 3542 mother-infant dyads were recruited to the CHILD study. Breastfeeding rates were 87.4%, 75.3%, 45.5% at 3, 6 and 12 months respectively. About 40% of women who were breastfeeding at 3 months used at least one prescription medication during the first three months postpartum; this proportion decreased over time to 29.5% % at 6 months and 32.8% at 12 months. The most commonly used prescription medication by breastfeeding women was domperidone at 3 months (9.0%, n = 229/2540) and 6 months (5.6%, n = 109/1948), and norethisterone at 12 months (4.1%, n = 48/1180). The vast majority of domperidone use by breastfeeding women (97.3%) was for lactation purposes which is off-label (signifying unapproved use of an approved medication). Non-prescription medications were more often used among breastfeeding than non-breastfeeding women (67.6% versus 48.9% at 3 months, p < 0.0001), The most commonly used non-prescription medications were multivitamins and Vitamin D at 3, 6 and 12 months postpartum. CONCLUSIONS: In Canada, medication use is common postpartum; 40% of breastfeeding women use prescription medications in the first 3 months postpartum. A diverse range of medications were used, with many women taking more than one prescription and non-prescription medicines. The most commonly used prescription medication by breastfeeding women were domperidone for off-label lactation support, signalling a need for more data on the efficacy of domperidone for this indication. This data should inform research priorities and communication strategies developed to optimize care during lactation.

Patient values and preferences on polypharmacy and deprescribing: a scoping review.

Background Understanding how patient values and preferences towards polypharmacy and deprescribing have been studied is important to gain insight on current knowledge in this area and to identify knowledge gaps. Aim To describe methods and outcomes for studying patient values and preferences towards polypharmacy and deprescribing, and to identify gaps in the existing literature. Method A scoping review was conducted on English-language studies that examined patient preferences and values related to polypharmacy and/or deprescribing among community-dwelling adults. MEDLINE, Embase, PubMed, PsycINFO, EconLit, Social Science Citation Index, Science Citation Index Expanded, International Pharmaceutical Abstracts, and CINAHL/AgeLine were searched. Results Thirty articles were included. Surveys (n = 17, 56.7%), interviews/focus groups (n = 9, 30.0%), and mixed methods (n = 3, 10.0%), were commonly used methods. Patients Attitudes Towards Deprescribing (PATD) was the most common tool used (n = 9, 30.0%). Twelve themes related to attitudes, social pressure, and control of polypharmacy/deprescribing were identified. The most frequently-encountered themes included desire or willingness to reduce medication load and influence of healthcare provider on medication use. Conclusion PATD was commonly used to assess preferences and values towards polypharmacy and limited knowledge on patient-important outcomes were addressed. Future research should focus on shared decision-making and communicating risk versus benefit of medications.

Dietary flaxseed oil reduces adipocyte size, adipose monocyte chemoattractant protein-1 levels and T-cell infiltration in obese, insulin-resistant rats.

BACKGROUND: Adipocyte dysfunction is characterized by an increase in adipocyte size and changes to their adipokine profiles. Immune cell infiltration into adipose tissue is thought to contribute to the metabolic complications of obesity, with local and systemic consequences for the inflammatory status of the obese individual. Dietary interventions with omega-3 fatty acids from marine sources have been successful at reducing inflammation. The aim of this study was to determine whether flaxseed oil containing the plant-based omega-3 fatty acid α-linolenic acid (ALA) is an effective modulator of inflammation and adipocyte dysfunction. METHODS: Seventeen-week old male fa/fa and lean Zucker rats were fed a control diet (faCTL, lnCTL) and fa/fa rats were fed an ALA-rich flaxseed oil supplemented diet (faFLAX) for 8 weeks. Adipose tissue and serum were collected and analyzed for cytokine (IL-6, IL-10, IL-18, IL-2, IFN-γ, TNF-α), haptoglobin, monocyte chemoattractant protein-1 (MCP-1) and adipokine (leptin, adiponectin) levels. Splenocytes were isolated and ex vivo mitogen-stimulated cytokine production was measured. Digital images of adipose tissue sections were used to quantify adipocyte area. Macrophage and T-cell infiltration were assessed in adipose tissue by immunohistochemistry. RESULTS: faFLAX rats had 17% smaller adipocytes and 5-fold lower MCP-1 levels in adipose tissue than faCTL rats. Adipose tissue levels of IL-10 were 72% lower in the faFLAX group compared to baseline, and TNF-α levels decreased 80% (equal to lnCTL levels) in the faFLAX group compared to faCTL. There were no changes in ex vivo cytokine production by splenocytes between faFLAX and faCTL. Macrophage infiltration was not different among groups; however, faFLAX rats had less T-cell infiltration than faCTL rats. CONCLUSIONS: Dietary intervention with ALA-rich flaxseed oil in obese Zucker rats reduced adipocyte hypertrophy, protein levels of inflammatory markers MCP-1 and TNF-α, and T-cell infiltration in adipose tissue. Modest improvements to other parameters of obesity were also observed. The results suggest that, due to its ability to improve adipocyte function, ALA-rich flaxseed oil confers health benefits in obesity.