Pregnancy/lactation

G (gravida)

how many pregnancies

P (para)

how many times they’ve given birth

when does most organ development occurs

0-12 weeks/first trimester

pregancy need; calcium

1000mg/d

pregnancy needs; vitamin d

600iu/d

pregnancy needs; iron

27mg/d

OLD pregnancy categories

A/B/C/D/X

old pregnancy category; a

controlled studies in animals AND women; show no risk in the first trimester

old pregnancy category; b

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

old pregnancy category; c

animal studies have shown harm to fetus, but no studies in pregancy women. use if benefit outweights risk

old pregnancy category; d

positive evidence of risk to baby, but benefits may outweigh risks in life threatning/or serious disease

old pregnancy category; x

fetal abnormalities are known; use is contraindicated in pregnancy

immunizations in preganncy

inactivated flu during flu season; Tdap at 27-36 weeks; RSV/Abryvso for those at 32-36weeks in between sep-jan. no live vaccines

preeclampsia

complication of pregancny that has elevated bp and evidence of organ damage (kidney or liver). Occurs after 20 weeks. May lead to ecalmpsia (seizure and death)

preeclampsia prevention

low-dose aspisring after first trimester for those at risk

preeclampsia high risk groups

diabetes, renal diseas, hx preeclampsia, chronic htn

CI in pregnancy; acne

isotretinoin, topical retinoids

CI in pregnancy; antibiotics

quinolones, tetracyclines

CI in pregnancy; anticoagulants

warfarin

CI in pregnancy; dyslipidemia, HF, HTN

statins, RAAS inhibitors

CI in pregnancy; hormones

most (estradiol, progesterone, raloxifene, duavee, testerone, contraceptives)

CI in pregnancy; migraine

dhe, ergotamine

CI in pregnancy; other important teratogens

hydroxyurea, lithium, MTX, misoprostol, NSAIDs, paroxetine, ribarine, thalidomide, topiramte, wt loss drugs, valproic acid

treatment in pregnancy; motion sickness, n/v

lifestyle first

pyroxidine (vit b6) + doxylamine

pyroxidine (vitb6) + doxylamine

bonjesta, diclegis

treatment in pregnancy; gerd/heartburn

lifestyle first

calcium antacids

treatment in pregnancy; flatulence

simethicone

simethocone

gas-x, mylan

treatment in pregnancy; constipation

lifestyle first

fiber (psyllium, polycarbophil, methylcellulose)

last; docuasate or polytheylne glycol

treatment in pregnancy; coug, cold, allergis

first line; cromolyn

second; first gen antihistamines (chlorpheirmamine DOC, then benadryl)

second gen-non sedating now also recommended (loratidine and certirizine)

nasal steroids needed? budesonide prefferred, all safe

treatment in pregnancy; pain

non-drug. APAP first line. avoid NSAIDS/ASA espically 20 weeks plus. opioid ONLY if no alternativestreatment in pregnancy;

treatment in pregnancy; asthma

maintenace; budesnoide preferred, all fine. tighter control

treatment in pregnancy; IDA

supplemental iron, prenatl vitamins with iron

treatment in pregnancy; htn

labetolol, nifedeipine xr, methyldopa.

treatment in pregnancy; diabetes

life style

insulin preferred

metformin and glyburide sometimes used

treatment in pregnancy; anticoagulation

VTE; lmwh preferred.

Mechanical valve; LMWH until 13th week, then switched back to warfarin. Switch back to LMWH close to pregancny

treatment in pregnancy; hypothyroidism

increase levothyroxine 30-50%

treatment in pregnancy; hyperthyroidism

mild cases; do not treat

both PTU and methimazole have fetal risk.

First trimester; PTU preferred, then after swicht to methimazole.

Methimazole generally preferred (except for first trimester)

treatment in pregnancy; infection

PCNs, cephalopsroins, erythromycin, azithromycintreatment in pregnancy;

treatment in pregnancy; vaginal fungal infections

topical antifungals x7d. AVOID fluconazole

treatment in pregnancy; uti

cephalexin 500mg po q6h x 7; amoxicillin 500mg po q8h x 7 days

avoid SMX/TMP and nitrofurantoin during 1st trimester, and do not use in last 2 weeks of pregancy

lactation diet consideration

increase for 330/400kcal/d and continue prenatual vitmains and omega 3 vitamin supplemnts

breastfeeding BABY supplements

10mcg (400iu) of vit d supplementaion daily

iron 1mg/kg/d after 4 months

what types of drugs are extreted into breast milk

non-ionized, small molecular weight, low volume distribution, high lipid solubility

can you breast feed with HIV

not recommended in us; espicially if not on ART or do not have sustained viral supression

Specific drugs to avoid during pregnancy

ampehtatmines, amiodarone, ergotamines, lihtium, metronidazole, phenobarbitals, statin