In general, drugs should not be used during pregnancy unless absolutely necessary because many can harm the fetus. About 2 to 3% of all birth defects.

Uses of drugs in pregnancy

DR: Abir Moheidin Said

Uses of drugs in pregnancy

In general, drugs should not be used during pregnancy unless absolutely necessary because many can harm the fetus. About 2 to 3% of all birth defects result from the use of drugs other than alcohol.

Sometimes drugs are essential for the health of the pregnant woman and the fetus.

Uses of drugs in pregnancy

a pregnant woman should consult her health care practitioner. A health care practitioner may recommend that a woman take certain vitamins and minerals during pregnancy.

Uses of drugs in pregnancy

• Drugs that a pregnant woman takes during pregnancy can affect the fetus in several ways:

• They can act directly on the fetus, causing damage, abnormal development (leading to birth defects), or death.

• They can cause the muscles of the uterus to contract forcefully, indirectly injuring the fetus by reducing its blood supply or triggering preterm labor and delivery.

Uses of drugs in pregnancy

• They can alter the function of the placenta, usually by causing blood vessels to narrow (constrict) and thus reducing the supply of oxygen and nutrients to the fetus from the mother. Sometimes the result is a baby that is underweight and underdeveloped.

Antianxiety

Antianxiety drug› Diazepam Some Trade Names VALIUM

When the drug is taken late in pregnancy, depression, irritability, shaking, and exaggerated reflexes in the newborn

Antibiotics

Tetracycline

› Slowed bone growth, permanent yellowing of the teeth, and increased susceptibility to cavities in the baby

› Occasionally, liver failure in the pregnant woman

Antibiotics

Nitrofurantoin

› In women or fetuses with G6PD deficiency, the breakdown of red blood cells

Streptomycin &kanamycin› Damage to the fetus's ear, resulting in

deafness

Antibiotics

Chloramphenicol

› Gray baby syndrome› In women or fetuses with glucose-6-

phosphate dehydrogenase (G6PD) deficiency, the breakdown of red blood cells

Antibiotics

Fluoroquinolones (such as ciprofloxacin)

› Possibility of joint abnormalities (seen only in animals)

Anticoagulants

Heparin› When the drug is taken a long time,

osteoporosis and a decrease in the number of platelets (which help blood clot) in the pregnant woman

Warfarin

› Birth defects› Bleeding problems in the fetus and the

pregnant woman

Anticonvulsants

Carbamazepine Some Trade Names TEGRETOL

› Some risk of birth defects› Bleeding problems in the newborn, which

can be prevented if pregnant women take vitamin K by mouth every day for a month before delivery or if the newborn is given an injection of vitamin K soon after birth

Anticonvulsants

Phenobarbital &phenytoin › Same Like carbamazepine

trimethadione

› Increased risk of miscarriage› High (70%) risk of birth defects, including a

cleft palate and defects of the heart, face, skull, hands, and abdominal organs

Anticonvulsants

Valproate

› Some (1%) risk of birth defects, including a cleft palate and defects of the heart, face, skull, spine, and limbs

Antihypertensives

Drugs to lower high blood pressure may be needed by pregnant women who have had high blood pressure before pregnancy or who develop it during pregnancy. Either type of high blood pressure increases the risk of problems for the woman and the fetus

Antihypertensives can markedly reduce blood flow to the placenta if they lower blood pressure too rapidly in pregnant women. So pregnant women who have to take these drugs are closely monitored.

Antihypertensives

Angiotensin-converting enzyme (ACE) inhibitors

› When the drugs are taken late in pregnancy, kidney damage in the fetus, a reduction in the amount of fluid around the developing fetus (amniotic fluid), and defects of the face, limbs, and lungs

Antihypertensives

Beta-blockers› When some beta-blockers are taken during

pregnancy, a slowed heart rate and low blood sugar level in the fetus and possibly slowed growth

Thaizide diuretics› A decrease in the levels of oxygen, sodium,

and potassium and in the number of platelets in the fetus's blood

› Slowed growth

Chemotherapy drugs

Actinomycin, Bulsufan,chlorambucil, cyclophosphamide,methotrxate

› Birth defects such as underdevelopment of the lower jaw, cleft palate, abnormal development of the skull bones, spinal defects, ear defects, and clubfoot

› Slowed growth

NSAIDs

Asprin and others salicylates, ibuprofen and naproxin› When the drugs are taken in large doses, a

delay in the start of labor, premature closing of the connection between the aorta and artery to the lungs (ductus arteriosus), jaundice, and (occasionally) brain damage in the fetus and bleeding problems in the woman during and after delivery and in the newborn

› When the drugs are taken late in pregnancy, a reduction in the amount of fluid around the developing fetus

Sex hormones

Danazol

› When this drug is taken very early in pregnancy, masculinization of a female fetus's genitals, sometimes requiring surgery to correct

Synthetic progestins (but not the low doses used in oral contraceptives)› Same as those for danazol

Sex hormones

Diethylstilbestrol(DES)

› Abnormalities of the uterus, menstrual problems, and an increased risk of vaginal cancer and complications during pregnancy in daughters

› Abnormalities of the penis in sons

Thyroid drugs

methimazole› An enlarged or underactive thyroid gland

in the fetus› Scalp defects in the newborn

Propylthiouracil› An enlarged or underactive thyroid gland

in the fetus Triiodothyronine

› An overactive and enlarged thyroid gland in the fetus

Radioactive iodine

Destruction of the thyroid gland in the fetus

When the drug is given near the end of the 1st trimester, very overactive and enlarged thyroid gland in the fetus

Vaccines (live virus)

Vaccine for German measles (rubella) and chickenpox (varicella)› Potential infection of the placenta and

developing fetus

Vaccines for measles, mumps, polio, or yellow fever› Potential but unknown risks

Vaccines

Other vaccines (such as those for cholera, hepatitis A and B, plague, rabies, tetanus, diphtheria, and typhoid) are given to pregnant women only if they are at substantial risk of developing that particular infection. However, all pregnant women who are in the 2nd or 3rd trimester during the influenza (flu) season should be vaccinated against the influenza virus.

Opioids

Opioids, such as heroin, methadone and morphine: readily cross the placenta, the fetus may become addicted to them and may have withdrawal symptoms 6 hours to 8 days after birth

However, use of opioids rarely results in birth defects.

Use of opioids during pregnancy increases the risk of complications during pregnancy, such as miscarriage, abnormal presentation of the baby, and preterm delivery. Babies of heroin users are more likely to be small.

THANKS