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Chapter 9

Chapter 9. Drug Therapy During Pregnancy and Breast-Feeding. Drug Therapy During Pregnancy and Breast-Feeding. Shortage of reliable data on toxicity from drug use during pregnancy or breast-feeding. Drug Therapy During Pregnancy.

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Chapter 9

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  1. Chapter 9 Drug Therapy During Pregnancy and Breast-Feeding

  2. Drug Therapy During Pregnancy and Breast-Feeding • Shortage of reliable data on toxicity from drug use during pregnancy or breast-feeding

  3. Drug Therapy During Pregnancy • Two-thirds of pregnant women take at least one medication; most take more. • Used to treat pregnancy-related problems: nausea, constipation, and preeclampsia • Chronic disorders: hypertension, diabetes, epilepsy • Infectious diseases or cancer • Drugs of abuse: alcohol, cocaine, heroin

  4. Drug Therapy During Pregnancy • Physiologic changes during pregnancy and their impact on drug disposition and dosing • Third trimester: renal blood flow doubled and renal excretion accelerated • Tone and mobility of bowel decrease • Prolonged transit: increase in absorption

  5. Drug Therapy During Pregnancy • Placental drug transfer • All drugs can cross placenta. • Some can cross more easily than others. • Adverse reactions during pregnancy • Can adversely affect both pregnant patient and fetus • Some unique effects • Heparin causes osteoporosis. • Prostaglandins stimulate uterine contraction. • Certain pain relievers used during delivery can depress respiration in the neonate.

  6. Drug Therapy During Pregnancy: Teratogenesis • teras = a Greek word meaning “monster” • Teratogenesis = literally, “to produce a monster” • Birth defects • Gross malformations • Cleft palate, clubfoot, and hydrocephalus • Neurobehavioral and metabolic anomalies

  7. Teratogenesis • Incidence and causes of congenital anomalies • Less than 1% of all birth defects caused by drugs • Identification of teratogens very difficult • As a result, only a few drugs are considered proven teratogens.

  8. Teratogenesis • Minimizing the risk for teratogenesis • Avoid unnecessary drug use (eg, alcohol, cocaine). • 50% of pregnancies are unintended: risks for teratogenesis apply to these pregnancies, too. • Responding to teratogen exposure • Identifying details of exposure • Ultrasound scans

  9. Teratogenesis and Stage of Development • Development occurs in three stages. • Conception through week 2 • Embryonic period: weeks 3 to 8 • Gross malformations produced by teratogens • Fetal period: week 9 to term • Functions disrupted with teratogen exposure

  10. Fig. 9-1. Effects of teratogens at various stages of development of the fetus.

  11. Drug Therapy During Breast-Feeding • Drugs can be excreted in breast milk, and effects can occur in the infant. • How to decrease risk to the infant: • Take drugs immediately after breast-feeding. • Avoid drugs that have a long half-life. • Choose drugs that tend to be excluded from milk and are least likely to affect the infant. • Avoid drugs known to be hazardous.

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