Talib Department of Obstetrics and Gynecology College of medicine Diyala University Lec 3 4th stage 20212022 When considering drugs in pregnancy there are 4 different scenarios A pregnant woman who has ingested a drug and is seeking information about its possible consequences ID: 1046101
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2. Ass. Prof. Dr. Sawsan Talib Department of Obstetrics and GynecologyCollege of medicine/ Diyala UniversityLec 3 /4th stage /2021-2022
3. When considering drugs in pregnancy there are 4 different scenariosA pregnant woman who has ingested a drug and is seeking information about its possible consequences A pregnant woman with a medical condition for which a drug is usually prescribed - what is the safest and most effective drug to use? A woman planning pregnancy who requires long term medication seeks your advice about the teratogenicity of that medication Safe drugs to use in a woman of childbearing age
4. Drugs in pregnancy. Average drugs used in pregnancy is 3.1/pregnancy(other than vitamins) .Mostly used without prescription, before realizing pregnancy. Commonly used drugs include. Antiemetic, antacids, antihistamines, analgesics, antibiotics, antihypertensive, tranquilizers, hypnotics and diuretics. Fortunately most drugs do not appear to adversely affect the fetus.
5. Teratogen causes permanent alteration in the structure and/or function of an organ, during the embryonic or fetal life.The teratogens may be chemical agents (drugs) or physical agents (radiation, heat). The dose (amount) and duration of teratogen exposure may cause variable response from no effect level to lethal level. Final results either: death, malformation, IUGR and functional disorder.
6. GA and teratogenicity
7. Principles of safe prescribing:Is there a non pharmacological alternative? Do the benefits outweigh the risks? Extra caution in the first trimester Use drugs tested by TIME in WOMEN Choose the least harmful drug for the minimum time possible
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25. Antihypertensive drugs in PregnancyAldometHydralazineBeta blockersCa channel blockersThiazidesACE InhibitorsACCCCD↑risk of CNS & CHD defects 3-fold in 1st trimester, ?cause fetal death in 3rd trimester
26. Psychiatric Drugs for PregnancyMost anti-depressants are Category CExcept for Moclobemide & MAO Inhibitors (B3)Tricyclics slightly safer than SSRI’sFluoexetine is the SSRI with the lowest known riskParoxetine is teratogenic (D) Benzodiazepines and Barbiturates are (C)Benzo’s particularly bad because they accumulate in the fetusAnd the neonate metabolises them slowlyBut barbiturates actually hasten the resolution of neonatal jaundice
27. Thalidomide – a lesson in medicine
28. ThalidomideDeveloped in Germany in 1954Promoted as a tranquiliser and anti emeticTaken by thousands of pregnant womenResulted in >10,000 children with birth deformitiesMcBride in Australia and Lenz in Germany raised the alarmWithdrawn in 1961Has found new uses as an immune modulator & for multiple myeloma
29. Teratogenic action of ThalidomideInserts itself into DNA of embryonic promotor zones for ears, limbs and eyes15+ possible mechanisms of actionInhibits the angiogenic networkWill have different teratogenic effects when taken at different stages of pregnancy
30. Lessons from ThalidomideThe placental barrier is not effective against most orally administered drugsAnimal teratogenic testing can be misleadingDrug companies have a powerful commercial agendaBut are not the sole culprits in a tragedy such as this
31. Drugs and Lactation:Most drugs which circulate in the blood will appear in breast milkBut The dose which reaches the infant is smallAnd In general it is inappropriate to deny the BABY and the MOTHER the benefits of breastfeeding
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33. X Rays and Pregnancy: The first 4 weeks of amenorrhoea is not a critical period of radiosensitivity in humans Risk of microcephaly is linear from 8 - 15wAnd ? no threshold Thereafter threshold is 50-150 radsChest Xray is <1 radIVP is about 15 radsCT may involve 15 rads
34. If a pregnant woman is exposed to radiation:Carefully calculate the dose involved Consult the best available authorityCounsel along the same lines as for a woman inadvertently exposed to a drug
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