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E-raamat: Inclusion of Pregnant and Lactating Persons in Clinical Trials: Proceedings of a Workshop

  • Formaat: 146 pages
  • Ilmumisaeg: 07-Mar-2023
  • Kirjastus: National Academies Press
  • Keel: eng
  • ISBN-13: 9780309696401
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  • Formaat: 146 pages
  • Ilmumisaeg: 07-Mar-2023
  • Kirjastus: National Academies Press
  • Keel: eng
  • ISBN-13: 9780309696401
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Approximately 4 million pregnant people in the United States give birth annually, and 70 percent of these individuals take at least one prescription medication during their pregnancy. Yet, due to a number of historical, ethical, legal, scientific, and societal issues, pregnant and lactating persons are often excluded from clinical trials. As a result, pregnant and lactating persons are often taking drugs based on limited information about the benefits and risks to themselves and their developing or newborn baby.



The National Academies Forum on Drug Discovery, Development, and Translation convened a workshop in June 2022 for stakeholders to examine the current state of evidence generation for drug products used by pregnant and lactating persons and discuss barriers and opportunities for including these populations in clinical trials. This publication summarizes the presentations and discussion of the workshop.

Table of Contents



Front Matter 1 Introduction 2 Effects of Evidence Gaps in Clinical Treatment for Pregnant and Lactating Persons 3 The Legal Landscape 4 Lessons Learned 5 Potential Practical Solutions for Including Pregnant and Lactating Persons in Clinical Trials 6 Promising Innovative Approaches to Evidence Generation 7 A Path Toward Inclusion Appendix A: References Appendix B: Workshop Agenda Appendix C: Biographical Sketches of the Workshop Planning Committee, Speakers, and Staff
Boxes xv
Abbreviations and Acronyms xvii
1 Introduction
1(8)
Background
3(5)
Organization of the Proceedings
8(1)
2 Effects of Evidence Gaps In Clinical Treatment for Pregnant and Lactating Persons
9(10)
Challenges for Pregnant and Lactating Persons
10(2)
Challenges for Clinicians
12(2)
Outcomes of Exclusion
14(1)
Willingness of Pregnant and Lactating Individuals to Participate in Clinical Trials
15(4)
3 The Legal Landscape
19(24)
Navigating Legal Barriers and Liability Risks
20(5)
Perspectives on Liability
25(4)
Institutional Policies and Practices that Promote Inclusion in Research
29(2)
Regulatory Efforts to Promote Inclusion in Research
31(2)
Addressing Legal and Regulatory Concerns
33(5)
Opportunities to Address Liability Concerns: Breakout Discussion Highlights
38(5)
4 Lessons Learned
43(14)
Lessons Learned from COVID-19 Vaccine Trials
44(2)
Lessons Learned from Drug Trials for Mood Disorders
46(2)
Perspectives on Evidence Generation
48(4)
Additional Lessons
52(5)
5 Potential Practical Solutions for Including Pregnant and Lactating Persons In Clinical Trials
57(8)
Factors that Affect Inclusion
58(2)
Practical Suggestions
60(5)
6 Promising Innovative Approaches To Evidence Generation
65(14)
Incorporating Real-World Evidence
66(3)
Pharmacologic Approaches to Evidence Generation
69(2)
Improving Safety in the Postmarket Setting: A Regulatory Perspective
71(2)
Facilitating the Implementation of Innovative Approaches to Evidence Generation
73(2)
Opportunities to Improve Evidence Generation for Pregnant and Lactating Persons: Breakout Discussion Highlights
75(4)
7 A Path Toward Inclusion
79(10)
Progress Toward Implementing the PRGLAC Task Force Recommendations
80(5)
Pathways Forward
85(2)
Closing Remarks
87(2)
APPENDIXES
A References
89(4)
B Workshop Agenda
93(12)
C Biographical Sketches of the Workshop Planning Committee, Speakers, And Staff
105