Drugs in Pregnancy and Lactation

Question 1

__% of pregnant women take at least one Rx drug

Answer 1

60

Question 2

What are 4 reasons pregnant women take Rx drugs?

Answer 2

1) Pregnancy SEs (nausea, constipation, pre-eclampsia)
2) Chronic disorders
3) Acute illness
4) Drugs of abuse

Question 3

Cardiac output (CO) increases throughout pregnancy

Answer 3

Highest immediately post-partum

Question 4

CO, stroke volume, and heart rate increases throughout pregnancy

Answer 4

• 50% CO increase
• 30% SV increase
• 15-20% HR increase

Question 5

Plasma and blood volume and red blood cell mass increase throughout pregnancy

Answer 5

Decline immediately postpartum

Question 6

Albumin levels increase throughout pregnancy

Answer 6

Hematocrit increases until 20 weeks, then slightly declines by 32 weeks

Question 7

What are 5 major functions of the placenta?

Answer 7

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

Question 8

When does teratology present itself?

Answer 8

At time of delivery

Question 9

Name 5 reasons why it is hard to prove that a drug is teratogenic:

Answer 9

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

Question 10

To prove that a drug is a teratogen, what 3 criteria must be met?

Answer 10

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

Question 11

No proof for teratogenicity means…

Answer 11

no safety in pregnancy

Question 12

What is Shepard’s Principles of Teratology?

Answer 12

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)

Question 13

Name 2 factors that affect the results of teratogenic drugs:

Answer 13

1) Time when drug is taken in pregnancy

2) Drug dose

Question 14

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?

Answer 14

• organ structure/formation

- gross formations

Question 15

What developments happen in fetal period (9-40 weeks)? If a teratogenic drug is taken during this time, what is the result?

Answer 15

• organ function/subtructure

- function problems (learning deficits, behavioural abnormalities)

Question 16

What are the AEs diethylstilbestrol (DES)?

Answer 16

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

Question 17

DES indication:

Answer 17

Prevent miscarriages in high risk pregnancies

Question 18

Thalidomide indication:

Answer 18

1) anti-emetic

2) sleeping pill

Question 19

Name 6 malformations as a result of taking thalidomide during first trimester:

Answer 19

1) phocomelia: underdevelopment of limbs
2) congenital heart defects
3) eye defects
4) urogenital defects
5) GI defects
6) hearing loss

Question 20

Is Prozac considered safe to take by pregnant women?

Answer 20

Unestablished. Women of childbearing age should not take Prozac unless under MD recommendation (benefit vs risk)

Question 21

Depression in pregnancy affects ___% of pregnant women

Answer 21

20

Question 22

What is the DOC for treating depression in pregnant women?

Answer 22

SSRI (safe in dysmorphology and neurobehaviour)

Question 23

What are the recent findings regarding SSRI use by pregnant women?

Answer 23

• Recent reports of excess cardiac malformations (mostly with paroxetine) –> FDA & HC added warning
• More recent meta-analysis indicated no increased risk

Question 24

What is neonatal discontinuation syndrome? What is its result?

Answer 24

• Women d/c tx due to reception of risk

- Results in high morbidity

Question 25

Even when exposed to non-teratogenic drugs, women assign __% teratogenic risk

Answer 25

25

Question 26

What can prevent unnecessary pregnancy terminations due to perception of teratogenic risk?

Answer 26

Evidence-based counselling

Question 27

Following Chernobyl disaster, half of all pregnancies in Athens were terminated

Answer 27

Women exposed to diagnostic radiation assigned a major teratogenic risk