Drugs in Pregnant Women Incidence 90 of pregnant women have or develop medical problems that require them to take more than one prescription drug during pregnancy Shephard amp Lemire 2007 ID: 932195
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Slide1
Chapter 6
Special Populations: Pregnant and Nursing Women
Slide2Drugs in Pregnant Women
Incidence
90% of pregnant women have or develop medical problems that require them to take more than one prescription drug during pregnancy
(Shephard & Lemire, 2007)
The average patient uses five to nine
different drugs during pregnancy
4% of pregnant women take more than 10 drugs during pregnancy
65% of women admit to self-administration of drugs during pregnancy
Slide3Principles of Teratology: Incidence and Types of Malformations
Thalidomide
CNS depressant that was used in the 1960s as a sedative-hypnotic agent and to reduce the nausea and vomiting of pregnancy
The drug was said to increase the rate of dysmelia by 80%, up to a rate of about 3:1000 to 5:1000 births
Reported malformations resulted when thalidomide was taken on days 21 to 36 after conception (days 34 to 50 post menses)
Slide4Principles of Teratology: Incidence
and Types of Malformations
Determinants of Teratogenicity
Timing of the drug exposure
The most important determinant of the teratogenicity of an agent is the timing of the drug exposure
During the fetal period (57 days to term), major
malformations are not likely to occur
Yet organ systems formed during the embryonic
period may be damaged by exposure in the second or third trimesters (Schardein & Macina, 2006; Weiner &
Buhimschi, 2003; Shephard & Lemire, 2007)
Anomalies are likely to involve functional aspects such as mental development and reproduction or fetal
growth
Slide5Principles of Teratology: Incidence and Types of Malformations
Determinants of Teratogenicity (cont’d)
Placental influence
Determining Teratogenic Potential of Drugs
Counseling Pregnant Patients About Drug Use
Slide6Common Conditions Requiring Treatment During Pregnancy
Physiologic Changes
Nausea and Vomiting
UTI
Asthma
Infection
Epilepsy
Slide7Common Conditions Requiring Treatment During Pregnancy
Diabetes
Hypertension
STIs
Depression
Slide8Hazards to Mothers and
Their Children
Isotretinoin (Accutane)
Vaccinations
Rubella
Caffeine
Alcohol
Nicotine and Smoking
Cocaine
Marijuana
Slide9Drugs in Breastfeeding Mothers
Transfer of Drugs
Assessing Risk vs. Benefit
Management of Interruption or Weaning
Any recommendation to interrupt breastfeeding or to wean must clearly outweigh the benefits
conferred by nursing