美国国家公共电台 NPR When Pregnant Women Need Medicine, They Encounter A Void

When Pregnant Women Need Medicine, They Encounter A Void

STEVE INSKEEP, HOST:

Some pregnant women face an excruciating choice. It's whether to keep taking medications or whether to stop taking them, risking their own health to avoid any possible risk to the baby.

DAVID GREENE, HOST:

They have to decide without much good information. Drugs are rarely researched in pregnant women. Some bioethicists now want to change that. NPR's Rae Ellen Bichell has our report today in Your Health.

RAE ELLEN BICHELL, BYLINE¹: A few years ago, almost every aspect of Rosanne Mottola’s life was governed by the feeling in her gut² - literally³.

ROSANNE MOTTOLA: I experienced extreme urgency to have to use bathroom, pain, bleeding. And a lot of times, I would go the whole day without eating.

RAE ELLEN BICHELL: So that she wouldn't have to rush to the bathroom so often. Mottola has ulcerative colitis. When her disease acted up, it was painful and exhausting. The steroid treatment made it hard to sleep, and she put on so much weight that she'd get what she calls chipmunk⁴ cheeks.

MOTTOLA: So it was not easy.

RAE ELLEN BICHELL: Luckily, she and her doctor decided⁵ to try a combination of medicines.

MOTTOLA: And it did the trick. It gave me back a quality of life.

RAE ELLEN BICHELL: The 26-year-old could get on with her life. So for a while, no stress - until she got pregnant. One of the drugs Mottola was taking had shown some signs it could cause problems for a fetus⁶. And the other hadn't been studied enough in humans to know what would happen.

MOTTOLA: It made me extremely nervous. I must have had four conversations with my doctor. I kept calling him. I said, are you sure that I could do this? Are you sure this is safe? Are you sure that the baby won't be affected⁷?

RAE ELLEN BICHELL: Her obstetrician wanted more information. A pediatrician said, no way. You cannot breast-feed on those drugs. And Mottola worried that the fetus might absorb some of the drugs, potentially making it harder to fight off infections. But her gastroenterologist, who'd worked with patients like Mottola and was up to date on the latest research, reassured⁸ her time and time again that it would be fine. So in the end, she decided to stick with it.

MOTTOLA: At the end of the day, I had a very healthy pregnancy⁹. I probably felt the best I've ever felt (laughter) since my diagnosis¹⁰.

RAE ELLEN BICHELL: And these days, her one-and-a-half-year-old is up to all sorts of things.

MOTTOLA: Oh my gosh, climbing, talking - he's very inquisitive¹¹. He loves reading books. He's healthy. He's thriving. And it was the right call.

RAE ELLEN BICHELL: Even though things worked out for Mottola and her family, the doubt that she and her husband experienced during the pregnancy was not a happy place for expecting parents.

MOTTOLA: No. No, it's a scary place.

RAE ELLEN BICHELL: And unfortunately, Mottola is not alone. The CDC estimates that 70 percent of pregnant women in the U.S. will take at least one prescription¹² drug, whether it's for something like colitis or diabetes¹³ or allergies¹⁴. And Margaret Little says a lot of them are stuck in the same spot as Mottola, wondering if the drugs they need might do harm.

MARGARET LITTLE: Because there's actually shockingly little that we know about how to treat illness during pregnancy.

RAE ELLEN BICHELL: Little is a bioethicist at Georgetown University. She says there are only a dozen medications in the U.S. that are approved to be safe during pregnancy. A lot of the others go to market without any information on how they act in pregnant women.

LITTLE: Pregnant women get ill, and ill women get pregnant. The point is we need to get more information on how to use those drugs during pregnancy to make sure they're the most effective and the safest.

RAE ELLEN BICHELL: That's why she's working with a group of researchers to figure out how to get more information in a responsible way.

LITTLE: We are looking at finding ethical¹⁵ pathways to doing the needed research with pregnant women.

RAE ELLEN BICHELL: There's an understandable squeamishness toward the idea of testing medications on pregnant women. For one, there's no way for a fetus to consent to a drug trial. Secondly¹⁶, researchers, academic institutions and pharmaceutical¹⁷ companies are really afraid of what could go wrong.

LITTLE: They don't want to be the next thalidomide.

RAE ELLEN BICHELL: Decades ago, after women took thalidomide to relieve their nausea¹⁸, thousands of babies were born with birth defects, including arms and legs that looked like flippers. It jolted¹⁹ people into a fear of mixing medication and pregnancy and for a good reason. Now, drug companies and universities are really wary²⁰ that their research could end up causing birth defects. But Little and her colleagues argue that the thalidomide tragedy is exactly why drugs need to be tested in pregnant women.

LITTLE: If we had done early and safe studies on thalidomide, we would have found out before it got to market that pregnant women shouldn't take it. So the lesson of thalidomide is actually do safe and early studies on drugs around pregnancy, and we'll avoid those tragedies.

RAE ELLEN BICHELL: Instead, she says, people in the scientific community tend to run in the other direction, an attitude that can have bad repercussions²¹. In 2006, for example, researchers found that women who took a certain blood pressure medicine were more likely to have babies with heart and nervous system problems. The medication had been on the market for decades. Others found that diabetes medication just didn't work in pregnant women because their bodies process things differently, and that's not good for the woman or for the fetus.

LITTLE: There can almost be a Catch-22. Until we do the research, we don't know what the risk to the fetus is. And if we don't know what the risk to the fetus is, how can we ethically²² do the research?

RAE ELLEN BICHELL: The U.S. surmounted²³ the same issue when it came to testing children because their bodies work differently than those of adults. Legislators gave incentives²⁴ to pharmaceutical companies that tested drugs in children. But there hasn't been the same move when it comes to pregnancy, though there is a bill floating around Congress that would take a step toward addressing the knowledge gap. So in the meantime, it's up to enterprising researchers to slowly fill the void of information, people like Dr. Uma Mahadevan.

UMA MAHADEVAN: What mom wants to be on medication that hasn't been studied in pregnancy?

RAE ELLEN BICHELL: Mahadevan is a gastroenterologist at the University of California, San Francisco. A lot of her patients have health issues like Rosanne Mottola's. Sometimes, after consulting with another doctor, they'd quit their medications entirely²⁵, thinking it would be better for the pregnancy. But if their disease acted up, their options at that point were pretty ugly, like taking steroids or even having surgery while pregnant.

MAHADEVAN: These are all, you know, much more high-risk things than the medication that they were on before.

RAE ELLEN BICHELL: So she and her colleagues tracked 1,500 women with inflammatory bowel²⁶ disease to find out if two classes of common medications were safe. Here's what they found.

MAHADEVAN: There is no increase in birth defects. And that's very clear, and everyone agrees on that.

RAE ELLEN BICHELL: And that may turn out to be true in many cases, that a healthy mom is better for the fetus. But until there's more thorough research on medication taken during pregnancy, there will always be an element of uncertainty²⁷. And for many women, says Little, an agonizing²⁸ one. Rae Ellen Bichell, NPR News.

1 byline   

n.署名；v.署名

参考例句：

• His byline was absent as well.他的署名也不见了。
• We wish to thank the author of this article which carries no byline.我们要感谢这篇文章的那位没有署名的作者。

2 gut   

n.[pl.]胆量；内脏；adj.本能的；vt.取出内脏

参考例句：

• It is not always necessary to gut the fish prior to freezing.冷冻鱼之前并不总是需要先把内脏掏空。
• My immediate gut feeling was to refuse.我本能的直接反应是拒绝。

3 literally   

adv.照字面意义，逐字地；确实

参考例句：

• He translated the passage literally.他逐字逐句地翻译这段文字。
• Sometimes she would not sit down till she was literally faint.有时候，她不走到真正要昏厥了，决不肯坐下来。

4 chipmunk   

n.花栗鼠

参考例句：

• This little chipmunk is hungry.这只小花栗鼠肚子饿了。
• Once I brought her a chipmunk with a wound on its stomach.一次，我带了只腹部受伤的花栗鼠去找她。

5 decided   

adj.决定了的，坚决的；明显的，明确的

参考例句：

• This gave them a decided advantage over their opponents.这使他们比对手具有明显的优势。
• There is a decided difference between British and Chinese way of greeting.英国人和中国人打招呼的方式有很明显的区别。

6 fetus   

n.胎，胎儿

参考例句：

• In the fetus,blood cells are formed in different sites at different ages.胎儿的血细胞在不同时期生成在不同的部位。
• No one knows why a fetus is not automatically rejected by the mother's immune system. 没有人知道为什么母亲的免疫系统不会自动排斥胎儿。

7 affected   

adj.不自然的，假装的

参考例句：

• She showed an affected interest in our subject.她假装对我们的课题感到兴趣。
• His manners are affected.他的态度不自然。

8 reassured   

adj.使消除疑虑的；使放心的v.再保证，恢复信心( reassure的过去式和过去分词)

参考例句：

• The captain's confidence during the storm reassured the passengers. 在风暴中船长的信念使旅客们恢复了信心。 来自《现代英汉综合大词典》
• The doctor reassured the old lady. 医生叫那位老妇人放心。 来自《简明英汉词典》

9 pregnancy   

n.怀孕，怀孕期

参考例句：

• Early pregnancy is often accompanied by nausea.怀孕早期常有恶心的现象。
• Smoking during pregnancy increases the risk of miscarriage.怀孕期吸烟会增加流产的危险。

10 diagnosis   

n.诊断，诊断结果，调查分析，判断

参考例句：

• His symptoms gave no obvious pointer to a possible diagnosis.他的症状无法作出明确的诊断。
• The engineer made a complete diagnosis of the bridge's collapse.工程师对桥的倒塌做一次彻底的调查分析。

11 inquisitive   

adj.求知欲强的，好奇的，好寻根究底的

参考例句：

• Children are usually inquisitive.小孩通常很好问。
• A pat answer is not going to satisfy an inquisitive audience.陈腔烂调的答案不能满足好奇的听众。

12 prescription   

n.处方，开药；指示，规定

参考例句：

• The physician made a prescription against sea- sickness for him.医生给他开了个治晕船的药方。
• The drug is available on prescription only.这种药只能凭处方购买。

13 diabetes   

n.糖尿病

参考例句：

• In case of diabetes, physicians advise against the use of sugar.对于糖尿病患者，医生告诫他们不要吃糖。
• Diabetes is caused by a fault in the insulin production of the body.糖尿病是由体內胰岛素分泌失调引起的。

14 allergies   

n.[医]过敏症；[口]厌恶，反感；（对食物、花粉、虫咬等的）过敏症( allergy的名词复数 )；变态反应，变应性

参考例句：

• Food allergies can result in an enormous variety of different symptoms. 食物过敏会引发很多不同的症状。 来自辞典例句
• Let us, however, examine one of the most common allergies; hayfever. 现在让我们来看看最常见的变态反应的一种--枯草热。 来自辞典例句

15 ethical   

adj.伦理的，道德的，合乎道德的

参考例句：

• It is necessary to get the youth to have a high ethical concept.必须使青年具有高度的道德观念。
• It was a debate which aroused fervent ethical arguments.那是一场引发强烈的伦理道德争论的辩论。

16 secondly   

adv.第二，其次

参考例句：

• Secondly,use your own head and present your point of view.第二，动脑筋提出自己的见解。
• Secondly it is necessary to define the applied load.其次，需要确定所作用的载荷。

17 pharmaceutical   

adj.药学的，药物的；药用的，药剂师的

参考例句：

• She has donated money to establish a pharmaceutical laboratory.她捐款成立了一个药剂实验室。
• We are engaged in a legal tussle with a large pharmaceutical company.我们正同一家大制药公司闹法律纠纷。

18 nausea   

n.作呕，恶心；极端的憎恶(或厌恶)

参考例句：

• Early pregnancy is often accompanied by nausea.怀孕期常有恶心的现象。
• He experienced nausea after eating octopus.吃了章鱼后他感到恶心。

19 jolted   

（使）摇动， （使）震惊( jolt的过去式和过去分词 )

参考例句：

• The truck jolted and rattled over the rough ground. 卡车嘎吱嘎吱地在凹凸不平的地面上颠簸而行。
• She was jolted out of her reverie as the door opened. 门一开就把她从幻想中惊醒。

20 wary   

adj.谨慎的，机警的，小心的

参考例句：

• He is wary of telling secrets to others.他谨防向他人泄露秘密。
• Paula frowned,suddenly wary.宝拉皱了皱眉头，突然警惕起来。

21 repercussions   

n.后果，反响( repercussion的名词复数 )；余波

参考例句：

• The collapse of the company will have repercussions for the whole industry. 这家公司的垮台将会给整个行业造成间接的负面影响。
• Human acts have repercussions far beyond the frontiers of the human world. 人类行为所产生的影响远远超出人类世界的范围。 来自《简明英汉词典》

22 ethically   

adv.在伦理上，道德上

参考例句：

• Ethically , we have nothing to be ashamed about . 从伦理上说，我们没有什么好羞愧的。
• Describe the appropriate action to take in an ethically ambiguous situation. 描述适当行为采取在一个道德地模棱两可的情况。

23 surmounted   

战胜( surmount的过去式和过去分词 )； 克服（困难）； 居于…之上； 在…顶上

参考例句：

• She was well aware of the difficulties that had to be surmounted. 她很清楚必须克服哪些困难。
• I think most of these obstacles can be surmounted. 我认为这些障碍大多数都是可以克服的。

24 incentives   

激励某人做某事的事物( incentive的名词复数 )； 刺激； 诱因； 动机

参考例句：

• tax incentives to encourage savings 鼓励储蓄的税收措施
• Furthermore, subsidies provide incentives only for investments in equipment. 更有甚者，提供津贴仅是为鼓励增添设备的投资。 来自英汉非文学 - 环境法 - 环境法

25 entirely   

ad.全部地，完整地；完全地，彻底地

参考例句：

• The fire was entirely caused by their neglect of duty. 那场火灾完全是由于他们失职而引起的。
• His life was entirely given up to the educational work. 他的一生统统献给了教育工作。

26 bowel   

n.肠(尤指人肠)；内部，深处

参考例句：

• Irritable bowel syndrome seems to affect more women than men.女性比男性更易患肠易激综合征。
• Have you had a bowel movement today?你今天有排便吗？

27 uncertainty   

n.易变，靠不住，不确知，不确定的事物

参考例句：

• Her comments will add to the uncertainty of the situation.她的批评将会使局势更加不稳定。
• After six weeks of uncertainty,the strain was beginning to take its toll.6个星期的忐忑不安后，压力开始产生影响了。

28 agonizing   

adj.痛苦难忍的；使人苦恼的v.使极度痛苦；折磨(agonize的ing形式)

参考例句：

• I spent days agonizing over whether to take the job or not. 我用了好些天苦苦思考是否接受这个工作。
• his father's agonizing death 他父亲极度痛苦的死