Fri Apr 17, 2009 2:47 pm
drugs and health during pregnancy
Pregnancy induces significant changes in the functions of the body’s systems and in its fluid and tissue composition. It is helpful to consider how these changes are likely to affect drug dosing and drug interactions in the pregnant women.
Drugs have effects on developing fetuses. Administered as an anti-anxiety and anti-nausea agent in the first trimester, thalidomide caused limb-reduction defects in one third of the fetuses exposed. The drug had been determined safe initially so several years passed and thousands of deformed infants were born before this was recognized.
The definition of a teratogen includes a broad range of abnormal development, including complete pregnancy loss, structural abnormalities, abnormal growth and long-term functional defects. Drug effects can be unexpected and delayed and can affect target organs at their time of most rapid development.
Drugs affecting the unborn child
Alcohol
Chemotherapeutic agents (i.e., antimetabolites and alkylating agents)
Anticonvulsants (i.e., trimethadione, valproic acid, phenytoin, and carbamezapine)
Androgens
Warfarin
Danazol
Diethylstilboestrol
Lithium
Isotretinoin and other retinoids
Thalidomide
Athough nearly all drugs are present in breast milk following maternal ingestion, few are absolutely contraindicated or should be avoided by nursing mothers (i.e., amiodarone, aspirin, barbiturates, benzodiazepines, carbimazole, combined oral contraceptives, cytotoxic drugs, ephedrine, and tetracyclines).
The FDA has established five drug categories known to cause birth defects if taken during pregnancy
Studies in women fail to demonstrate a risk to the fetus in the first trimester and the possibility of fetal harm seems remote (e.g., folic acid and levothyroxine).
Studies have shown an adverse effect that is not yet confirmed in women in the first trimester (e.g., amoxycillin and ceftriaxone).
Drugs to be given only if there is significant benefit ie. after seeking medical advice, as these dugs might have potential risk to the fetus (eg., nifedipine and omeprazole).
There is enough evidence of human fetal risk and only to be used in special medical conditions only if the doctor recommends (e.g., phenytoin and propylthiouracil).
These drugs should not to be used in women who are pregnant (e. g., misoprostol, warfarin, and isotretinoin). Their usage poses fetal abnormalities, or evidence of fetal risk.
Antibiotics during pregnancy:
Those considered safe (i.e., penicillin and erythromycin base, stearate or ethylsuccinate)
Those that probably are safe but to be used with caution (i.e., azithromycin, metronidazole, nitrofurantoin)
Those that are contraindicated in pregnancy (i.e., tetracycline, fluroquinones, and erythromycin estolate)
Drugs contraindicated during breast feeding Drugs Comments
Anticancer drugs General hazards with the use of methotrexate and cyclophosphamide
Bromocriptine Suppresses lactation
Chloramphenicol Affects the bone marrow
Ergot alkaloids Hazards of migraine
Clemastine Drowsiness
Phenindione Haemorrhage
Drugs that should be avoided or used with caution during pregnancy Drugs Comments
Alcohol High dose may affect the infant
Aminophylline Try to avoid
Amiodarone Significant amounts present in milk
Aminoglycosides Try to avoid
Antibiotics Use with caution
Aspirin Avoid high repeated doses
Atropine Try to avoid
Benzodiazepines Sedation with repeated doses
Calciferol Hypercalcaemia in high doses
Carbimazole Thyroid problems
Chlorpromazine Drowsiness
Clindamycin Bloody stools
Corticosteroids Avoid high doses
Corticosteroids Avoid high doses
Diuretics Some may suppress lactation
Iodine It is concentrated in milk
Isoniazid Convulsions
Laxatives Try to avoid them
Lithium Avoid, but if used careful monitoring is required
Meprobamate High milk concentration
Metronidazole Discontinue breast feeding for 12-24 hours after a single dose, avoid breast feeding if repeated doses used
Nalidixic acid Avoid as far as possible
Nitrofurantoin Avoid them
Opioid analgesics Withdrawal symptoms may occur in infants of addicted mothers
Penicillin Safe except for allergy
Phenobarbitone Drowsiness if used in high concentrations
Reserpine Respiratory problems may occur
Sex hormones Oestrogens, progestogens and androgens suppress lactation in high doses
Sulphonamides Should be avoided as far as possible
Drugs have effects on developing fetuses. Administered as an anti-anxiety and anti-nausea agent in the first trimester, thalidomide caused limb-reduction defects in one third of the fetuses exposed. The drug had been determined safe initially so several years passed and thousands of deformed infants were born before this was recognized.
The definition of a teratogen includes a broad range of abnormal development, including complete pregnancy loss, structural abnormalities, abnormal growth and long-term functional defects. Drug effects can be unexpected and delayed and can affect target organs at their time of most rapid development.
Drugs affecting the unborn child
Alcohol
Chemotherapeutic agents (i.e., antimetabolites and alkylating agents)
Anticonvulsants (i.e., trimethadione, valproic acid, phenytoin, and carbamezapine)
Androgens
Warfarin
Danazol
Diethylstilboestrol
Lithium
Isotretinoin and other retinoids
Thalidomide
Athough nearly all drugs are present in breast milk following maternal ingestion, few are absolutely contraindicated or should be avoided by nursing mothers (i.e., amiodarone, aspirin, barbiturates, benzodiazepines, carbimazole, combined oral contraceptives, cytotoxic drugs, ephedrine, and tetracyclines).
The FDA has established five drug categories known to cause birth defects if taken during pregnancy
Studies in women fail to demonstrate a risk to the fetus in the first trimester and the possibility of fetal harm seems remote (e.g., folic acid and levothyroxine).
Studies have shown an adverse effect that is not yet confirmed in women in the first trimester (e.g., amoxycillin and ceftriaxone).
Drugs to be given only if there is significant benefit ie. after seeking medical advice, as these dugs might have potential risk to the fetus (eg., nifedipine and omeprazole).
There is enough evidence of human fetal risk and only to be used in special medical conditions only if the doctor recommends (e.g., phenytoin and propylthiouracil).
These drugs should not to be used in women who are pregnant (e. g., misoprostol, warfarin, and isotretinoin). Their usage poses fetal abnormalities, or evidence of fetal risk.
Antibiotics during pregnancy:
Those considered safe (i.e., penicillin and erythromycin base, stearate or ethylsuccinate)
Those that probably are safe but to be used with caution (i.e., azithromycin, metronidazole, nitrofurantoin)
Those that are contraindicated in pregnancy (i.e., tetracycline, fluroquinones, and erythromycin estolate)
Drugs contraindicated during breast feeding Drugs Comments
Anticancer drugs General hazards with the use of methotrexate and cyclophosphamide
Bromocriptine Suppresses lactation
Chloramphenicol Affects the bone marrow
Ergot alkaloids Hazards of migraine
Clemastine Drowsiness
Phenindione Haemorrhage
Drugs that should be avoided or used with caution during pregnancy Drugs Comments
Alcohol High dose may affect the infant
Aminophylline Try to avoid
Amiodarone Significant amounts present in milk
Aminoglycosides Try to avoid
Antibiotics Use with caution
Aspirin Avoid high repeated doses
Atropine Try to avoid
Benzodiazepines Sedation with repeated doses
Calciferol Hypercalcaemia in high doses
Carbimazole Thyroid problems
Chlorpromazine Drowsiness
Clindamycin Bloody stools
Corticosteroids Avoid high doses
Corticosteroids Avoid high doses
Diuretics Some may suppress lactation
Iodine It is concentrated in milk
Isoniazid Convulsions
Laxatives Try to avoid them
Lithium Avoid, but if used careful monitoring is required
Meprobamate High milk concentration
Metronidazole Discontinue breast feeding for 12-24 hours after a single dose, avoid breast feeding if repeated doses used
Nalidixic acid Avoid as far as possible
Nitrofurantoin Avoid them
Opioid analgesics Withdrawal symptoms may occur in infants of addicted mothers
Penicillin Safe except for allergy
Phenobarbitone Drowsiness if used in high concentrations
Reserpine Respiratory problems may occur
Sex hormones Oestrogens, progestogens and androgens suppress lactation in high doses
Sulphonamides Should be avoided as far as possible