Drug use in pregnancy and lactation

ACOG:

organization that publishes guidelines for safe and effective drug use in conditions impacting women, including pregnancy

During pregnancy, how much folate is needed per day:

600 mcg per day

Pregnant women fro 10-50 years old require how much calcium and vitamin D:

1,000 mg per day of calcium and 600 IU per day of vitamin D

Why is folate important for women to take while pregnant?

to prevent neural tube defects in babies

Pregnancy category A:

women show no risk in 1st trimester. risk of fetal harm is remote

Pregnancy category B:

animal studies have not demonstrated a fetal risk, but no well controlled studies are available in pregnant women

Pregnancy category C:

animal studies have shown harm fetus, but there are no well controlled studies in pregnant women. use only if potential benefits may outweigh the risk

Pregnancy category D:

positive evidence of risk of the human fetus is available , but the benefits may outweigh the risk with life threatening or serious disease.

Pregnancy category X:

use is contraindicated in pregnancy

New pregnancy category. 8.1 (pregnancy)

risk of adverse development outcomes

encouraged to participate in registries which exist for select disease states and drugs

New pregnancy category 8.2 (lactation):

includes whether the drug/metabolites are present in human milk

New pregnancy category 8.3 ( females and males of reproductive potential):

included any effects on fertility and requirements for pregnancy testing and contraception

Drugs that areteratogenic:

isotretinoin

topical retinoids

quinolones

tetracyclines

warfarin

ACE-Inhibitors/ARBs

Statins

Entresto

estradiol

progesterone

duavee

testosterone

contraceptives

raloxifene

DHE

ergotamine

hydroxyurea

lithium

methotrexate

NSAIDs

paroxetine

weight loss drugs

valproic acid/divalproex

thalidomide

topiramate

ribavirin

finastride

Drug reference for pregnant patients:

Brigg’s Drug in Pregnancy and Lactation

elevated blood pressure and evidence of organ damage during pregnancy:

Preeclampsia

ACOG guidelines for prevention of preeclampsia:

low dose aspirin at the end of the 1st trimester of pregnancy

1st line treatment of morning sickness:

lifestyle first: avoid an empty stomach, eat smaller more frequent meals

drug treatment: pyroxidine ± doxylamine

Treatment of GERD/Heartburn in pregnancy:

calcium carbonate

Treatment of gas in pregnancy:

simethicone

Treatment of constipation in pregnancy:

lifestyle modifications: increase fluid intake, increase dietary fiber intake and increased physical activity

drug treatment: psyllium, calcium polycarbophil

Treatment of common cough/cold/allergies in pregnancy:

1st line: cromolyn

2nd line: 1st generation antihistamines (chlorpheniramine)

chronic allergies: budesonide is preferred

avoid liquid formulations that contain alcohol

Treatment for pain in pregnancy:

1st line: acetaminophen

avoid NSAIDs including aspirin( except low dose for preeclampsia)

Treatment of asthma in pregnancy:

maintenance therapy: budesonide

rescue therapy: ICS-formoterol or albuterol

Treatment of hypertension in pregnancy:

labetalol

nifedipine extended release

methyldopa

Treatment of diabetes in pregnany:

preferred treatment is insulin

Treatment of vaginal fungal infection in pregnancy:

topical antifungals x7 days

Treatment of UTIs in pregnancy:

cephalexin: 500 mg by mouth every 6 hrs for x7 days

Amoxicillin: 500 mg by mouth every 8 hours x7 days

alternatives: nitrofurantoin, bactrim and fosfomycin

Treatment of VTE in pregnancy:

LMWHs

prophylaxis: pneumatic compression devices ± LMWHs

Do not use warfarin because it is teratogenic

Treatment of hypothyroidism in pregnancy:

levothyroxine : 30-50% dose increase during pregnancy

Treatment of hyperthyroidism in pregnancy:

PTU is preferred in 1st trimester

Babies who are breastfeed should recieve:

400 IU of vitamin D supplementation daily

iron supplementation: 1mg/kg daily nafter 4 months of age

True/False: If a patient has HIV they should not breastfeed the baby

True

Which stage of pregnancy is the most susceptible to birth defects caused by teratogens?

1st trimester of pregnancy