Mollie Wood

A picture of a chocolate labrador curled up on a pile of throw pillows and looking sleepily at the camera

Weekly Ruport: bad news cycle means more emotional support pillows

As a post script, I also want to say that I find the “medically necessary” language around APAP use ridiculous and insulting. Do they think pregnant women are taking acetaminophen for fun? Or mistaking the pills for candy?

Prenatal paracetamol exposure and neurodevelopmental outcomes in preschool‐aged children Background Recent studies have suggested an association between prenatal paracetamol exposure and adverse neurodevelopmental outcomes in children. However, these findings may be confounded by unmeas...

PPE 2019 study: onlinelibrary.wiley.com/doi/full/10.1111/ppe.12568

Neurodevelopmental problems at 18 months among children exposed to paracetamol in utero: a propensity score matched cohort study Abstract. Background: Previous studies showed that children exposed to paracetamol during fetal life might have an increased risk of neurodevelopmental pro

IJE 2015 study: academic.oup.com/ije/article/...

Annotations and Reflections Click on the article title to read more.

You wouldn’t know it from this thread, but other people have opinions about APAP in pregnancy and neurodevelopmental outcomes. @perdamkier.bsky.social in particular has written a lot about the topic, including this piece: onlinelibrary.wiley.com/doi/10.1111/...

...for specific conditions during pregnancy. Active comparator designs would strengthen these types of studies significantly, particularly for conditions where “no treatment” is not a realistic or ethical recommendation.

People taking high doses of APAP for long periods of time aren’t irresponsible, they’re desperate. Most frustratingly, APAP isn’t a particularly good drug for chronic pain conditions. All of which is to say: I think research needs to focus more on comparing clinically meaningful treatments...

Patterns and predictors of analgesic use in pregnancy: a longitudinal drug utilization study with special focus on women with migraine - BMC Pregnancy and Childbirth Background Few studies have investigated the drug utilization patterns and factors predicting drug use in pregnant women with migraine. This longitudinal drug utilization study aimed to describe patte...

And in this small study done in a single hospital in Norway, we saw many women switching from previous migraine treatments to APAP, and reporting high levels of pain not managed by APAP: bmcpregnancychildbirth.biomedcentral.com/articles/10....

Polypharmacy and comorbidities during pregnancy in a cohort of women with migraine - Mollie E Wood, Rebecca C Burch, Sonia Hernandez-Diaz, 2021 Objective To describe longitudinal patterns of medication use throughout pregnancy in women with migraine. Methods We used the IBM MarketScan healthcare claims...

But it is critical to understand what is driving high-dose, long-duration APAP use in pregnancy. In this descriptive study of migraine in pregnancy, we saw decreasing use of other drugs and increases in APAP: journals.sagepub.com/doi/10.1177/...

My pet hypothesis, for which I only have indirect evidence, is something like this: I think it is possible that very high doses of APAP over extended periods of time (i.e., 500+mg daily for multiple weeks) could cause neurodevelopmental differences in exposed fetuses.

Why is acetaminophen so hard to study? Reason 4: dose, duration, and timing of use are likely important, which amplifies the measurement problem (Reason 1), makes the confounding problem worse (Reason 2), and is further hampered by the selection problem (Reason 3).

...how do we think about the counterfactual here? The children with prenatal APAP exposure might not have been born, had their parent not used APAP.

Why is acetaminophen so hard to study? Reason 3: studies of neurodevelopment almost always condition on a live birth. But untreated fever in early pregnancy can lead to miscarriage, so...

...much of the use for pain conditions is among people who were managed on a different (more effective) drug before pregnancy and then switched when they became pregnant.

Why is acetaminophen so hard to study? Reason 2: there is a huge range of reasons for using APAP, all of which have different relationships with neurodevelopment. People take APAP for pain and fever, yes, but...

Some studies have used biomarkers (urine, meconium), but APAP is metabolized quickly so these measures are only a snapshot for specific time windows.

Why is acetaminophen so hard to study? Reason 1: it’s hard to measure. Acetaminophen (APAP) is available over the counter and by prescription, alone or in combination with other medications. Studies often rely on parental recall, which varies in accuracy, or prescription fills, which miss OTC use.

I’ve also written a commentary about some of the challenges (posted here by @dremilyrsmith.bsky.social ) bsky.app/profile/drem...

I’ve published 2 papers on acetaminophen in pregnancy and neurodevelopmental outcomes, both as methods supervisor for a doctoral student who was the first author, from the MoBa study. I’ll drop the links at the end of the thread- both are open access either via PMC or the journal website.

It’s hard to know whether talking about these things is helpful or just gives them more oxygen, but the current acetaminophen fire is already roaring so here we go. Most importantly: ACOG affirms their position that acetaminophen is safe in pregnancy bsky.app/profile/acog...

...either pull the (accepted!!) paper and resubmit somewhere with free open access, or self-archive the submitted version of the manuscript (essentially a post hoc preprint) to PMC and then update to accepted version after embargo. Any other options I'm not considering? What have others done? (3/3)

...but there was no budget in the F for OA fees (and the T32 no longer exists 😢). Asked journal to waive OA fee given circumstances (nope), looked for institution funding to support (lol). I think the remaining options are... (2/3)

I'm hoping for advice from NIH funded researchers re the updated OA policy (grants.nih.gov/grants/guide...). Specifically: I have students funded on an F31 or T32 whose papers were submitted this spring and accepted after 7/1. Per policy, those papers must be OA from pub date... (1/3)

A slide presented at the 18 September ACIP meeting (linked in the post). Links to CDC run studies on COVID vaccine safety in pregnancy. A list of outcomes not associated with COVID vaccination in pregnancy in these studies, including miscarriage, stillbirth, preterm birth, major birth defects, maternal or infant ICU admission.

Props to the CDC staff who presented the science at yesterday’s #ACIP meeting.

Key points relating to #CovidVaccination in #pregnancy…

1. No increased risk of any problems in pregnancy, at birth, or for infants

1/

www.cdc.gov/acip/downloa...

Euler diagrams, maybe, from someone who said "you-ler" for an embarrassingly long time?

Yep! At UNC, epid doc students write a dissertation proposal (usually a background/lit review plus planned methods). Committee reviews written proposal, and there is an oral defense/exam. Timing is after passing qual. exams.

Photo of four women smiling.

I don't know how many of my ISPE friends (and enemies...?) are on here, but (a) the ISPE Peer Mentoring program is currently taking applications and (b) it's GREAT, you should probably sign up. Link: www.pharmacoepi.org/get-involved...

The thing about middle age is that one of your hips always lies and the other always tells the truth.

I went to a talk last year and remember thinking: did he just say we should use AI to create study samples? Not for simulation studies, but to answer an applied question? I must have misheard, that’s clearly bonkers.

Anyway, here we are.

1. The philosophy of science sometimes gets an unearned reputation as a purely academic exercise that offers little by way of concrete tools for advancing research.

This is wrong.

And today, as we grapple with how AI is changing the nature of scientific activity, it's desperately wrong.