Drugs in Pregnancy and Lactation Flashcards
(27 cards)
__% of pregnant women take at least one Rx drug
60
What are 4 reasons pregnant women take Rx drugs?
1) Pregnancy SEs (nausea, constipation, pre-eclampsia)
2) Chronic disorders
3) Acute illness
4) Drugs of abuse
Cardiac output (CO) increases throughout pregnancy
Highest immediately post-partum
CO, stroke volume, and heart rate increases throughout pregnancy
- 50% CO increase
- 30% SV increase
- 15-20% HR increase
Plasma and blood volume and red blood cell mass increase throughout pregnancy
Decline immediately postpartum
Albumin levels increase throughout pregnancy
Hematocrit increases until 20 weeks, then slightly declines by 32 weeks
What are 5 major functions of the placenta?
1) Transfers nutrients and O2 from mother to fetus
2) Helps remove waste products from fetus to mother
3) Produces hormones, peptides, and steroids
4) Links mother’s and fetus’ circulation
5) Protects fetus from drugs, toxins that may be found in maternal blood
When does teratology present itself?
At time of delivery
Name 5 reasons why it is hard to prove that a drug is teratogenic:
1) Incidence of congenital anomalies is low
2) Animal tests may not be applicable
3) Exposure needs to be prolonged
4) Controlled exp cannot be done in humans
5) Hard to identify and link neurodevelopment and behavioural issues
To prove that a drug is a teratogen, what 3 criteria must be met?
1) Drug must cause a specific set of malformations
2) Drug must act only bw 4-7 weeks of gestation
3) Malformation incidence should increase w/ increasing dose and exposure duration
No proof for teratogenicity means…
no safety in pregnancy
What is Shepard’s Principles of Teratology?
1) Agent must be present during critical periods of development
2) Acts directly on embryo
3) Experimental models corroborating findings on fetus or placenta (eg: biological plausibility)
Name 2 factors that affect the results of teratogenic drugs:
1) Time when drug is taken in pregnancy
2) Drug dose
What developments happen in the first trimester (3-8 weeks, embryonic period)? If a teratogenic drug is taken during this time, what is the result?
- organ structure/formation
- gross formations
What developments happen in fetal period (9-40 weeks)? If a teratogenic drug is taken during this time, what is the result?
- organ function/subtructure
- function problems (learning deficits, behavioural abnormalities)
What are the AEs diethylstilbestrol (DES)?
1) Mothers: vaginal cancer (if taken early in pregnancy)
2) Female baby: born with vaginal, cervical carcinomas + uterine anomalies
3) Male baby: abnormal genitals, sperm defects
DES indication:
Prevent miscarriages in high risk pregnancies
Thalidomide indication:
1) anti-emetic
2) sleeping pill
Name 6 malformations as a result of taking thalidomide during first trimester:
1) phocomelia: underdevelopment of limbs
2) congenital heart defects
3) eye defects
4) urogenital defects
5) GI defects
6) hearing loss
Is Prozac considered safe to take by pregnant women?
Unestablished. Women of childbearing age should not take Prozac unless under MD recommendation (benefit vs risk)
Depression in pregnancy affects ___% of pregnant women
20
What is the DOC for treating depression in pregnant women?
SSRI (safe in dysmorphology and neurobehaviour)
What are the recent findings regarding SSRI use by pregnant women?
- Recent reports of excess cardiac malformations (mostly with paroxetine) –> FDA & HC added warning
- More recent meta-analysis indicated no increased risk
What is neonatal discontinuation syndrome? What is its result?
- Women d/c tx due to reception of risk
- Results in high morbidity
