Chapter 24

1. Chapter 24 Pregnancy and Breast-Feeding

2. Pregnancy and Breast-Feeding • Teratogenesis • From the Greek (producing a monster) • Difficult to identify drugs that are teratogenic • Teratogenic effects may not be evident for many years after birth • Timing and exposure varies from drug to drug 2

3. Pregnancy and Breast-Feeding • Pregnancy Trimesters • During the first trimester of pregnancy the fetus’ organs are forming. • This is the most critical time for teratogenicity. • Oftentimes, the woman does not know she is pregnant during the first six weeks of the first trimester. • The second trimester is the ideal time for dental prophylaxis. She is usually most comfortable during this time. • During the third trimester the woman is usually beginning to feel uncomfortable and it is difficult for to be in the prone position. • Drugs that could effect the newborn child should not be given at this time. 3

4. FDA Pregnancy Categories for Medication Use • Category A • Adequate studies have failed to demonstrate a risk to fetus (in first trimester) and no evidence of risk in later trimesters; possibility of fetal harm appears remote. • Thyroid supplements (levothyroxine), vitamins (folic acid, riboflavin; vitamins A, D, and C) 4

5. FDA Pregnancy Categories for Medication Use • Category B • Animal studies have failed to demonstrate a risk to the fetus, and there are no adequate studies in pregnant women; or animal studies show an adverse effect on the fetus but well-controlled studies in pregnant women have failed to demonstrate a risk to the fetus. • Acetaminophen, opioids, penicillins, cephalosporins, erythromycin, prednisone, caffeine, sulfonamides, cimetidine, fluoxetine, insulin, NSAIDs 5

6. FDA Pregnancy Categories for Medication Use • Category C • Animal studies have shown an adverse effect on the fetus and there are no adequate studies in humans, or no studies are available in either animals or women. Potential benefits may warrant its use. • Epinephrine, phenylpropanolamine, trimethobenzamide, aspirin, atropine, promethazine, theophylline, lisinopril, potassium chloride, disulfiram, acyclovir, propranolol 6

7. FDA Pregnancy Categories for Medication Use • Category D • Positive evidence of human fetal risk based on adverse reaction data, but potential benefits in serious situations may warrant its use. • Warfarin, tetracycline, phenytoin, diazepam, trimethadione, lorazepam, amitriptyline 7

8. FDA Pregnancy Categories for Medication Use • Category X • Studies in animals or humans have demonstrated fetal abnormalities and/or there is positive evidence of human fetal risk, and the risks clearly outweigh any potential benefits. • Isotretinoin, diethylstilbestrol, phencyclidine (PCP), triazolam, X-rays, chemotherapy 8

9. Managing Pregnant Dental Patients • Avoid elective dental treatment except in the second trimester. • Avoid any unnecessary drugs, especially during the first trimester. • If drugs are needed, check the FDA categories to choose the safest. • Minimize periodontal problems, perform oral prophylaxis before pregnancy or during second trimester; monitor for periodontal conditions. • Avoid radiographs unless absolutely necessary; use lead apron. • Pay particular attention to periodontal disease because it has been associated with low-birth-weight newborns. • Position patient in recumbent position in last trimester with right hip elevated (not Trendelenburg). • If morning sickness is a problem, schedule an afternoon appointment. • Give frequent breaks for urination, especially during the first trimester. 9

10. Nursing Safety Options to Consider for Breast-Feeding Patients • Take the medicine just prior to nursing. • Pump and store breast milk prior to starting medicine. • Pump and dump breast milk until therapy is completed. • Stop nursing. • Follow the FDA pregnancy categories to determine whether or not the drug can be given to a nursing mother. 10