Drugs in pregnancy

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Drugs in Pregnancy and Lactation are of different categories than drugs are used in general ill health to normal woman but special caution is required in prior category.

Significance:

  • Drugs that crosses the placental barrier effects the foetus directly
  • Drugs that do not cross placental barrier effects foetus by constricting placental blood vessels, altering maternal physiology.

Effect of drugs on foetus depends on

  • Foetal age at the time of exposure to drug.
  • Potency and dosage of the drug
  • Before 20th day after fertilization – all / nothing effect
  • 20-56 days after fertilization – teratogenicity
  • 2nd and 3rd trimester – altered functioning, growth of organs.

FDA Classification of drugs in pregnancy:

Category

Examples

Effect on fetus

A

Diphenhydramine, Heparin, Paracetamol, Insulin

No effects

B

Metformin

Corticosteroids

Hypoglycaemia

Orofacial clefts

C

Fluoroquinolones

Bone growth retardation and pain

D

Aspirin

Aminoglycosides

Habit forming agents

Thyroid medicines

Abortion , delayed labour

Ototoxicity

Congenital malformations

Goiter

X

Warfarin

Danazol


Isotretinoin

Thrombocytopenia

Female fetul masculinization

Abortion

Goal:

  • Is to reduce the foetal risks

Prescription contains:

  • Antiemetics – vomiting
  • Antacids – acidity
  • Antihistamine – allergy
  • Analgesics – pain
  • Antimicrobials – infection
  • Diuretics – peripheral edema
  • Hypnotics – sleep inducers
  • Tranquilizers – anxiety, psychosis
  • Social and illicit drugs – Smoking, Alcohol, cocaine
  • Vaccines

Contraindications:

  • All antihypertensives except methyldopa
  • Isotretinoin
  • Warfarin
  • Methotrexate
  • Live vaccines
  • Antidepressants (paroxetine)
  • All live vaccines except influenza vaccine but vaccinations for cholera, hepatitis A and B, measles, mumps, plague, poliomyelitis, rabies, tetanus-diphtheria, typhoid, and yellow fever may be given if risk of infection to foetus is minimal
  • Vitamin A > 10,000 IU/day
  • Higher intake of aspartame (dietary sugar)

Counselling on side effects

  • Antidepressants – tapering
  • Antihypertensives – rebound hypertension

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