Pregnancy And Breastfeeding Flashcards
(23 cards)
Folic acid
Develops baby spine and decreased neural rube defects (spina bifidia)
400 mcg before conceiving and up to 12 weeks of pregnancy
If high risk given 5 mg e.g DM, epilepsy, hx
Sickle cell and thalassaemia to take throughout pregnancy as 5 mg
Vitamin D
Regulate calcium and phosphorus in the body
Provide vitamin D to the baby first few months of life
10 mcg daily
Supplementation dietary intake e.g fatty fish, fortified food
Iron
Help prevent anaemia and tiredness
Green leafy vegetables, lean red meat and dried food
Supplements advised by GP and midqife
Vitamin C
Protect cells and aids iron absorption
Citrus fruits, broccoli and tomatoes
Calcium
For the development of baby bone and teeth
Diary products, dried fruits, green leafy vegetables
What happens to medication clearance during pregnancy ?
Medication clearance increases
Due to increased cardiac output, hence renal elimination and rate of metabolism
Medication doses need to be higher in 2nd and 3rd trimester
What vaccines are recommended?
Inactivated vaccines
Not live vaccines
Need flu and whooping cough
Cytotoxic drugs and pregnancy
Teratogenic
ESP in 1st trimester avoid
Use effective contraception before during and after
Exclude pregnancy before treatment
Drugs during trimesters
1st trimester - congenital abnormalities
2nd and 3rd will affect growth and development
Term / labour - obstetric complications that can affect on baby
Asthma and pregnancy
SABA, LAMA, ICS and oral IV theophylline can be used as normal
Use steroids as normal
LRA is needed for adequate control dont withhold its use
Encourage smoking cessation
Use during lactation
Depression and pregnancy
Mo liecensed antidepressant
Risk vs benefit - specialist use
MHRA/CHM - SSRI/SNRI - small increase risk postpartum haemorrhage when used in the month before delivery
Depression and breast feeding
Highest level with citalopram and fluoxetine
Lowest with sertraline
Hypertension in breast feeding and pregnancy?
Avoid ACEi, ARB and diuretics - when pregnant
Lobetalol, Methyldopa and nifedipine MR (unliecensed)
Avoid amlodopine, diuretics, ARBS, ACEi during breastfeeding use Methyldopa and labetolol
Diabetes in pregnancy and breastfeeding
Pre existing type II DM - continue metformin, Glibenclamide and insulin if prescribe; stop others may be switched to insulin
Gestational diabetic - diet and exercise (2 week trial), metformin +/- Glibenclamide +/- insulin stop medication after birth
Breastfeeding ; insulin increase risk of hypoglycaemia post natal especially if breast feeding (meal, snack before during feeds = prevent hypo)
Epilepsy and pregnancy
Risk vs benefit - no drug is 100% safe
Monotherapy has a lowest risk
Minimise potential risk factors for seizures, sleep deprivation and stress adherence
Valproate not used unless no alternative and PPI in place
Lamotrigine safest
Oral retinoids and pregnancy
E.g Isotretinoin can cause birth defects
indicated for acne and CI in pregnancy
Highly lipophilic and can readily pass into breast milk so avoid
Infections and pregnancy
Harmful - chicken pox, group B strep, Hep B+C, herpes, HIV rubella, STI, slapped cheek syndrome
Take specimens to inform treatment
Nitrofurantoin should be avoided in term
Trimethoprim is unlikely to cause problems unless or dietry folate - antagonist avoid 1st trimester esp
Avoid; tetracyclines, aminoglycosides, quinolones, azithromycin, clarithromycin, high dose metronidazole
Pre eclampsia
High risk ; give aspirin from 12 weeks onwards if one risk factor
Type I or II, chronic HTN, CKD, autoimmune disease, increase BP pregnancy
Moderate risk give aspirin from 12 weeks if they have 2 or more risk factors
1st preg, over 40, Fam hx, multiple preg, preg interval over 10 years, bmi 35
Aspirin 75 to 150 mg daily
Smoking cessation support pregnancy
NRT preferable and not to smoke
Patches useful if patient experiences nausea and vomiting remove before bed
Avoid liquorice flavour
Intermittent therapy is preferable to patches
What drugs to avoid handling
Methotrexate
Finasteride
Cyclophosphamide
Paternal exposure
Sperm cells can take around 3 months to fully develop
Some meds taken by the father in the previous 3 months pre concentration may cause genetic faults or changes to the genetic code in sperm
Breastfeeding drugs found in High concentrations
Fluvastatin - high amount in milk
Phenobarbital - inhibits sucking reflex
Bromocrphine - inhibits lactation
Ethosuximide and lamotrigine - high in milk
Common teratogenic drugs
Chloramphenicol - grey baby syndrome
Topiramate - cleft palate
Finasteride - feminisation of male foetus
Quinolones - arthropathy
Aspirin/ NSAIDs - early closure ductus arterios
Methotrexate, trimethoprim - anti-folate
Aminoglucosides - auditory and vestibular damage in 2/3rd trimester
