lecture 4. pregnant

Question 1

Medications during Pregnancy

Answer 1

Can affect all stages of pre- and postnatal development.

Drugs are particularly harmful during the FIRST TRIMESTER (when they’re most susceptible to being influenced by meds)

May cause fetal malformations, restricted growth, functional defects, death.

Question 2

Health and Development

Answer 2

High risk pregnancies require medications.

Smoking and alcohol can also affect the fetus.

Some OTC medications have harmful effects. (even though they’re usually lower dose)

Improper nutrition can also have effects on the fetus.

Question 3

Drug administration during pregnancy and lactation

Answer 3

Avoidance or caution should be taken. (especially in first trimester)

GESTATIONAL DIABETES or HYPERTENSION need to be treated. (need to be treated as they pose a risk to the fetus)

UTIs AND STIs also need treatment. (can be the inflammatory part that is dangerous)

Question 4

Pharmacotherapy in the pregnant patient

Answer 4

Effect must be considered before administration

-Ability to cross the placenta

-Physiological and anatomical changes during pregnancy – hormones

-Changes in cardiac output, plasma volume, regional blood flow, renal blood flow

Question 5

Toxic effects and responses

Answer 5

Chromosomal and genetic disorders (defects)
Infertility (for parent, not the fetus)
Intrauterine death
Spontaneous abortions (miscarriage)
Low birth weights
Prematurity
Functional disorders
Birth defects

Effects may be seen long after birth (Ex. Carcinogenicity)
*Ex. when the moms took it, a much higher proportion of their daughters developed a kind of reproductive cervical cancer in their 20s (sons were affected the exact same way)… not a result of what the child did, but rather what the mother took when she was pregnant

Question 6

Pharmacokinetics

Answer 6

ADME mostly by the mother. (ex. metabolism mostly done by the mom, the fetus doesn’t really have capacity to do it)

Amniotic fluid is a different route of exposure for the fetus (an exposure for the fetus, anything that goes through the placenta can go into amniotic fluid for the fetus to be exposed to)

During pregnancy, GI motility, distribution to plasma proteins is DECREASED but other resorptive, distributive, metabolic and excretive processes are INCREASED.

Total body water may INCREASE by up to 81% during pregnancy.

Question 7

Drug effects on the newborn

Answer 7

Drugs cross the placenta by PASSIVE DIFFUSION

Conjugated steroid and peptide hormones DO NOT CROSS

Question 8

Drugs used during pregnancy

Answer 8

Nearly 80% of pregnant women use prescription or OTC medications.

LIPID-SOLUBLE drugs ENTER BREAST MILK (and water soluble ones)

Exposure to occupational and environmental agents is also common. (can cause issues)

Question 9

Toxic states

Answer 9

Reproductive and developmental toxicity

Teratology (the study of congenital abnormalities, their causes, and the treatment options available for those affected)

Embryotoxicity and fetotoxicity

EDUCATION IS KEY TO PREVENTION

Question 10

Recreational drugs and nursing: Alcohol

Answer 10

Nursing infants receive about 10% of the mother’s alcohol –which can change the taste of the milk. (not usually enough to get the baby drunk)

Question 11

Nicotine

Answer 11

Smoking has been linked to poor milk supply, poor nursing, restlessness and vomiting by the infant.

Nicotine and metabolites pass into the breast milk.

Second hand smoke also has nicotine.

Question 12

Opiates

Answer 12

ALL OPIATES PENETRATE BREAST MILK

Infants become addicted to opiates. (they cry a lot?)

Question 13

Caffeine

Answer 13

Absorbed into the breast milk

Metabolized more slowly in the infant (weeks)

Normal amounts are well tolerated

High amounts may cause irritability, poor sleep, and POOR IRON absorption.

People tolerate caffeine differently

Question 14

Cannabis

Answer 14

Stored in the BRAIN and FAT

May delay motor development.

Should not breast feed if a regular user. (can be transferred through it?)

Question 15

Cocaine

Answer 15

Cleared from breast milk more quickly than cannabis

Effects include hypertonia (too much muscle tone), tachycardia (↑HR), excitation and trembling.

People who die of it often die of CARDIOVASCULAR issues rather than CNS effects

Question 16

Vaccinations during pregnancy and lactation

Answer 16

Best if given before pregnancy

None are known to cause fetal effects

Vaccinate if BENEFITS EXCEED the risks

Pertussis (whooping cough) vaccine is given during THIRD TRIMESTER of pregnancy.
- More risky to give to newborns, this is how we protect them from whooping cough

No vaccinations are contraindicated during lactation

*Feeling unwell after getting a vaccine often tells us that our bodies had a immune response to it which is good (immunological response)