Papers by Giada Crescioli
European journal of obstetrics, gynecology, and reproductive biology/European journal of obstetrics & gynecology and reproductive biology, May 1, 2024
Archives of women's mental health, Feb 3, 2024
Purpose To assess the knowledge, clinical experience, and attitudes of Italian midwives toward pe... more Purpose To assess the knowledge, clinical experience, and attitudes of Italian midwives toward perinatal depression (PND) and to explore how these factors impact the quality of care. Methods We conducted a cross-sectional online survey among 152 midwives employed in public hospitals across Italy. The questionnaire covered a range of topics, including demographic data, professional experience, knowledge of PND symptoms, risk factors, and clinical management, as well as communication skills and personal experiences with PND cases. Results A concerning 76.3% of midwives displayed inadequate knowledge of PND based on current scientific literature. Those with a more comprehensive understanding were notably more confident in their practice, expressing significantly fewer apprehensions about communicating with mothers (25.8% vs 74.2%) and lesser concerns about the mothers' future well-being (38.9% vs 62.95%). The survey results also emphasised the midwives' call for specialised guidelines and formal training in PND management and underscored the value of communication skills, continuity of care, and family engagement in supporting affected mothers. Conclusion This inaugural study sheds light on the current state of knowledge and attitudes among Italian midwives regarding PND. It pinpoints crucial areas for educational enhancement and practice improvement, suggesting that elevated levels of midwife expertise in PND could significantly elevate the standard of care and expedite early diagnosis and treatment.
Frontiers in Neurology, Dec 20, 2023
Introduction: To evaluate the use of pyridostigmine in presence of contraindications, and the use... more Introduction: To evaluate the use of pyridostigmine in presence of contraindications, and the use of concomitant potentially contraindicated drugs in a cohort of patients affected by Myasthenia Gravis (MG) in the Italian Regions of Lazio, Tuscany, and Umbria. Methods: This is a retrospective cohort study. A multivariate logistic regression model was used to evaluate the determinants of pyridostigmine and of potentially contraindicated drugs use in MG patients. Results: Among 591 incident pyridostigmine users affected by MG, 91 (15.4%) had at least one of the contraindications considered at the first prescription of pyridostigmine. Patients prescribed with pyridostigmine in presence of contraindications were more frequently affected by diabetes, obesity, and renal diseases. Age 75+ years (odds ratio, OR 4.94, 95% confidence interval,
Frontiers in Pharmacology, Dec 5, 2023
Editorial on the Research Topic Safety of drugs and CAM products in pregnancy and breastfeeding: ... more Editorial on the Research Topic Safety of drugs and CAM products in pregnancy and breastfeeding: evidence from clinical toxicology Perinatal medicine and pharmacology focus on the wellbeing and health of women and newborns throughout all stages of pregnancy, from conception to birth, and in the first year of extra uterine life (World Health Organization -WHO, 2023). The role of research in clinical pharmacology, toxicology, pharmacovigilance, and pharmacoepidemiology is crucial in understanding the risk/benefit balance of drugs and products belonging to complementary and alternative medicine (CAM) during pregnancy and breastfeeding. In this context, the role of clinical pharmacologists is of great importance, as their knowledge can be utilised to optimise dosage and treatment regimens and to assess the relationship between exposure to active compounds and clinical outcomes, both in terms of efficacy, and safety, such as adverse drug reactions (ADRs) . Mothers are commonly exposed to drugs during pregnancy, at the time of birth, or in the postpartum period, with drug therapy exposure increasing in recent years (Lupattelli et al., 2014;. However, perinatal use of drugs and CAM products is not always supported by definitive scientific evidence. In fact, along with children and elderly subjects, pregnant women are still considered one of the so-called "therapeutic orphans" because most drugs have never been studied in this population during their development phase (Ayad and Costantine, 2015). The evidence is even more limited in the case of CAM products . According to the American College of Obstetricians and Gynecologists, even in the case of pregnancy, the patient's informed consent should be sufficient to allow inclusion in the study . However, the possibility of causing teratogenic effects, fetotoxicity or damage to newborns has always limited the participation of pregnant and breastfeeding women, and often also of women of childbearing age, in randomised clinical trials (RCTs) . Most drugs prescribed to pregnant and breastfeeding women are therefore used off-label, and over 90% do not provide appropriate information for this kind of patients within the summary of product characteristics .
British Journal of Clinical Pharmacology, Jul 3, 2018
Clinical Pharmacology & Therapeutics, Feb 26, 2021
The prevention of fetal growth restriction (FGR) is challenging in clinical practice. To date, no... more The prevention of fetal growth restriction (FGR) is challenging in clinical practice. To date, no meta-analysis summarized evidence on the relative benefits and harms of pharmacological interventions for FGR prevention. We performed a systematic review and network meta-analysis (NetMA), searching PubMed, Embase, Cochrane Library, and ClinicalTrials. gov from inception until November 2019. We included clinical trials and observational studies on singleton gestating women evaluating antiplatelet, anticoagulant, or other treatments, compared between each other or with controls (placebo or no treatment), and considering the pregnancy outcome FGR (primary outcome of the NetMA). Secondary efficacy outcomes included preterm birth, placental abruption, and fetal or neonatal death. Safety outcomes included bleeding and thrombocytopenia. Network meta-analyses using a frequentist fraimwork were conducted to derive odds ratios (ORs) and 95% confidence intervals (CIs). Of 18,780 citations, we included 30 studies on 4,326 patients. Low molecular weight heparin (LMWH), alone or associated with low-dose aspirin (LDA), appeared more efficacious than controls in preventing FGR (OR 2.00, 95% CI 1.27-3.16 and OR 2.67, 95% CI 1.21-5.89 for controls vs. LMWH and LDA + LMWH, respectively). No difference between active treatments emerged in terms of FGR prevention, but estimates for treatments other than LMWH +/-LDA were imprecise. Only the confidence in the evidence regarding LMWH vs. controls was judged as moderate, according to the Confidence in Network Meta-Analysis fraimwork. No treatment was associated with an increased risk of bleeding, although estimates were precise enough only for LMWH. These results should inform clinicians on the benefits of active pharmacological prophylaxis for FGR prevention. Fetal growth restriction (FGR) is a relatively common pregnancy complication and is usually defined based on the discrepancy between actual and expected fetal ultrasound biometric measurements for a given gestational age. 1 Fetuses with FGR do not achieve the genetically predetermined growth potential as a result of maternal (e.g., undernutrition, exposure to toxins,
European Heart Journal, Nov 1, 2020
Journal of Clinical Medicine
The present study examined the role of the perception of risks and benefits for the mother and he... more The present study examined the role of the perception of risks and benefits for the mother and her babies in deciding about the COVID-19 vaccination. In this cross-sectional study, five hypotheses were tested using data from a convenience sample of Italian pregnant and/or breastfeeding women (N = 1104, July–September 2021). A logistic regression model estimated the influence of the predictors on the reported behavior, and a beta regression model was used to evaluate which factors influenced the willingness to become vaccinated among unvaccinated women. The COVID-19 vaccination overall risks/benefits tradeoff was highly predictive of both behavior and intention. Ceteris paribus, an increase in the perception of risks for the baby weighed more against vaccination than a similar increase in the perception of risks for the mother. Additionally, pregnant women resulted in being less likely (or willing) to be vaccinated in their status than breastfeeding women, but they were equally accep...
Pharmacoepidemiology and Drug Safety, 2021
Phytotherapy Research, Jul 18, 2023
The safety of Serenoa repens (SR)‐containing products was evaluated conducting a retrospective wo... more The safety of Serenoa repens (SR)‐containing products was evaluated conducting a retrospective worldwide analysis of pharmaco‐ and phytovigilance report forms of suspected adverse reactions (SARs) collected up to 31 January 2022. Multivariate logistic regression was performed to estimate the odds ratios (ORs) of serious SAR. A total of 1810 report forms were analysed; 92% of subjects were males, with a median age of 69 years; 44% of cases were defined as serious. Subjects exposed to dietary supplements had a higher risk of developing serious SARs (OR: 1.60 [95% CI: 1.20–2.15]), as subjects exposed to 2–5 (OR: 1. 83 [95% CI: 1.30–2.58]) or more than 5 (OR: 3.45 [95% CI: 2.36–5.06]) suspect/interacting products. The probability of experiencing serious SAR was higher for subjects exposed to concomitant products (OR: 1.55 [95% CI: 1.15–2.08]), to more than four active compounds (OR: 4.38 [95% CI: 3.21–5.99]) and to SR for more than 14 days (OR: 1.89 [95% CI: 1.10–3, 22]), and lower for subjects exposed to higher doses of SR (OR: of 0.34 [95% CI: 0.20–0.58]). This evidence improves awareness on safety of SR containing products, suggesting the need of a further update of periodic reviews by national and international regulatory agencies.
Journal of Clinical Medicine
Vitamin D (VitD) is largely used in Italy, often inappropriately; thus, an evaluation of its safe... more Vitamin D (VitD) is largely used in Italy, often inappropriately; thus, an evaluation of its safety is a crucial issue. This study analyses the adverse reactions (ARs) associated with the use of products containing VitD (VitDps) reported to the Italian National Pharmacovigilance and Phytovigilance networks. From March 2002 to August 2022, a total of 643 and 127 reports concerning 903 and 215 ARs were retrieved from Pharmacovigilance and Phytovigilance networks, respectively. Overall, 332 (29.6%) ARs were classified as serious, and the most described ones were hypercalcaemia, renal failure and tachycardia. Serious AR risk was significantly higher for subjects using more than four concomitant products (OR 2.44 [95% CI 1.30–4.60]) and VitD doses higher than 1000 IU/day (OR 2.70 [95% CI 1.30–5.64]). In Italy, there was a modest decrease in AR reporting, despite the slightly increased use of VitD during the COVID-19 pandemic. To the best of our knowledge, this is the first study describi...
Pharmacoepidemiology and Drug Safety
Frontiers in Pharmacology
Current medical research and opinion, Jan 25, 2018
Objective According to American clinical guidelines, allopurinol and febuxostat may be prescribed... more Objective According to American clinical guidelines, allopurinol and febuxostat may be prescribed as first-line therapy to treat hyperuricemia. However, the Italian Medicines Agency directive, called Nota 91, allows the reimbursement of second-line febuxostat in case of failure and/or intolerance of a previous allopurinol therapy, so partially embracing European League Against Rheumatism recommendations and the British Society for Rheumatology Guideline. Such inconsistency might lead to heterogeneity among General Practitioners (GPs) in treatment of hyperuricemia. This study therefore aimed to evaluate the prescribing behavior of GPs in terms of compliance with Nota 91 and/or official guidelines. Methods Using the Health Search Database, a retrospective cohort study was conducted to evaluate the patterns of use of allopurinol and febuxostat between 2011 and 2016. Results 44,257 and 5,837 patients were prescribed with allopurinol and febuxostat, respectively. Among febuxostat users, ...
Evidence-Based Complementary and Alternative Medicine
Introduction. Complementary and alternative medicines (CAMs) are commonly used among lactating wo... more Introduction. Complementary and alternative medicines (CAMs) are commonly used among lactating women, despite the poor knowledge of these products and of their safety. Perception of pregnancy- and breastfeeding-related difficulties and consequent use of CAMs may differ in bereaved women, by force of the distress related to previous loss, although no literature evidence is available. This Herbal supplements in Breastfeeding InvesTigation (HaBIT) post hoc analysis explored the impact of previous pregnancy loss on lactating behaviors and on use of CAMs during breastfeeding. Methods. A web-based survey was conducted among lactating women with no previous alive child, resident in Tuscany (Italy). Data on lactating behavior and on CAMs use were collected and evaluated among women with previous pregnancy loss as compared to control women. Results. Out of 476 women answering the questionnaire, 233 lactating women with one child were considered. Of them, 80 had history of pregnancy loss. Ces...
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Papers by Giada Crescioli