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Fetal Medicine and Treatment

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Pediatric Clinical Pharmacology

Part of the book series: Handbook of Experimental Pharmacology ((HEP,volume 205))

Abstract

Fetal medicine covers a broad spectrum of conditions that can be diagnosed before birth. Different disorders will require different treatment strategies and there is often an important ontogenetic aspect on how and when treatment can be implemented. Due to the limited availability there is a general lack of knowledge on how pharmacotherapy can be provided in the most efficient way. Until recently most knowledge about how different drugs are transferred and metabolized in the human fetus is based on very limited observational studies on concentrations of drugs in fetal blood and other fetal compartments. It might be that the rapid development of other non-invasive methods for fetal diagnostics such as isolation of fetal DNA and RNA in maternal serum, NMR imaging and other techniques could in the future be explored in fetal pharmacotherapy. Introduction of new treatment strategies are often based on extrapolation from experience in neonates and adults. However some fetal conditions are very specific for this time period in life. This especially entails disturbances in development as malformations, early growth restriction and several congenital disorders. Here it might be required to introduce new treatment strategies without any previous experience in humans. Example of this ethical dilemma is gene therapy for lung growth in severe cases of diaphragmatic hernia and early growth restriction. The risk–benefit issues need to be discussed in all these alternatives. However, it is likely that the concept of the human fetus as a potential patient is still in its infancy and with an improved understanding about fetal patho-physiology there will be a continued need for better knowledge of pharmacotherapy during this crucial time period in life.

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Authors and Affiliations

  1. Division of Obstetrics and Gynecology, Department of Clinical Science, Intervention and Technology Centre for Fetal Medicine, Karolinska University Hospital, Karolinska Institutet, S-141 86, Stockholm, Sweden

    Magnus Westgren

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  1. Magnus Westgren
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Correspondence to Magnus Westgren .

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Editors and Affiliations

  1. Klinik fĂĽr Kinder- und Jugendmedizin, Univ.Klinikum Marburg, Baldingerstr. 12, Marburg, 35043, Germany

    Hannsjörg W. Seyberth

  2. Karolinska Institutet, Dept. Laboratory Medicine, Karolinska University Hostpital, Stockholm, 141 86, Sweden

    Anders Rane

  3. fĂĽr Klinische Pharmakologie (IKP), Dr. Margarete Fischer-Bosch Institut, Auerbachstr. 112, Stuttgart, 70376, Germany

    Matthias Schwab

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Westgren, M. (2011). Fetal Medicine and Treatment. In: Seyberth, H., Rane, A., Schwab, M. (eds) Pediatric Clinical Pharmacology. Handbook of Experimental Pharmacology, vol 205. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-20195-0_13

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