Jackson Hannah, Grzeskowiak Luke, Enticott Joanne, Wise Sarah, Callander Emily
School of Public Health, Faculty of Health, University of Technology Sydney, New South Wales, Australia.
College of Medicine and Public Health, Flinders University, South Australia, Australia.
Lancet Reg Health West Pac. 2023 Oct 10;42:100934. doi: 10.1016/j.lanwpc.2023.100934. eCollection 2024 Jan.
Structural factors that contribute to health disparities (e.g., population-level policies, cultural norms) impact the distribution of resources in society and can affect medication accessibility; even in high-income countries like Australia. Industry practices and regulatory approaches (e.g., a conservative approach to testing medicines in pregnant women) influence the availability of safety and efficacy data necessary for the licencing and funding of prescription medications used during pregnancy. Consequently, pregnant women may be prescribed medications outside of regulatory or funder-approved indications, posing risks for both prescribers and pregnant women and potentially compromising equitable access to medications. This review examines the regulatory and legislative structural factors that contribute to health disparities and perpetuate the deeply ingrained social norm that we should be protecting pregnant women clinical research rather than safeguarding them such research. Addressing these challenges requires a renewed commitment to integrated, woman-centred maternal healthcare and strengthened collaboration across all sectors.
Australian Government Research Training Program Stipend from the University of Technology Sydney, National Health and Medical Research Council (NHMRC) Fellowship, Channel 7 Children's Research Foundation Fellowship (CRF-210323).
导致健康差异的结构性因素(如人口层面的政策、文化规范)影响社会资源分配,进而可能影响药物可及性;即便在澳大利亚这样的高收入国家亦是如此。行业惯例和监管方式(如对孕妇用药测试采取保守方法)会影响孕期使用的处方药获批许可和获得资助所需的安全性及有效性数据的可得性。因此,孕妇可能会被开具超出监管机构或资助方批准适应症范围的药物,给开处方者和孕妇都带来风险,还可能损害药物的公平可及性。本综述探讨了导致健康差异并使“我们应保护孕妇参与临床研究而非保护她们免受此类研究影响”这一根深蒂固的社会规范长期存在的监管和立法结构性因素。应对这些挑战需要重新致力于综合的、以女性为中心的孕产妇医疗保健,并加强各部门之间的协作。
悉尼科技大学澳大利亚政府研究培训计划奖学金、国家卫生与医学研究委员会(NHMRC)奖学金、七号台儿童研究基金会奖学金(CRF - 210323)。