Conditions and Mgmt in Pregnancy

What is the first-line treatment for morning sickness, nausea, and vomiting during pregnancy?

lifestyle modifications: avoid an empty stomach, eat smaller more frequent meals, drink plenty of water, avoid spicy or odorous foods, and avoid environmental triggers

What natural product could be used for morning sickness?

Ginger

If lifestyle modifications fail, what is the first line treatment for morning sickness, nausea, and vomiting in pregnancy?

Pyridoxine (vitamin B6) with or without doxylamine

What prescription combination contains doxylamine/pyridoxine for nausea and vomiting during pregnancy?

Bonjesta and Diclegis

What is hyperemesis gravidarum?

Severe nausea and vomiting causing weight loss, dehydration, and electrolyte imbalance that may require hospitalization

What is first-line treatment for GERD/heartburn during pregnancy?

lifestyle modifications: eat smaller more frequent meals, avoid foods that worsen GERD

What is first line treatment for GERD/heartburn in pregancy if symptoms occur while sleeping?

elevate the head of the bed and avoid eating 3 hours before sleep

What is preferred if lifestyle measures fail to control GERD/heartburn during pregnancy?

Antacids (Calcium carbonate /Tums)

What can be added for GERD/heartburn during pregnancy if antacids do not provide relief?

H2 receptor antagonists, PPIs, or sucralfate

What is the preferred treatment for flatulence during pregnancy?

Simethicone (Gas-X, Mylicon)

What is first-line treatment for constipation during pregnancy?

Increase fluid intake, dietary fiber intake, and physical activity

If lifestyle measures fail to relieve constipation during pregnancy, what is the next line treatment?

fiber via psyllium, calcium polycarbophil, or methylcellulose with adequate fluids

What are 3rd line treatment options for constipation in pregnancy?

Docusate and polyethylene glycol

Why can constipation worsen during pregnancy in patients taking prenatal vitamins?

Many prenatal vitamins contain iron, which can worsen constipation

What is first-line treatment for cough, cold, or allergies during pregnancy?

Cromolyn

What is the preferred second-line treatment for allergies during pregnancy?

First-generation antihistamines, especially chlorpheniramine as the drug of choice or diphenhydramine

Which non-sedating second-generation antihistamines are often recommended during pregnancy?

Loratadine and cetirizine

Which intranasal steroid is preferred for chronic allergy symptoms during pregnancy?

Budesonide, although all intranasal steroids are considered safe

When should oral decongestants such as pseudoephedrine be avoided during pregnancy?

First trimester

What should be remembered about dextromethorphan and guaifenesin during pregnancy?

They have limited pregnancy/lactation safety data but are sometimes used

What type of cough/cold medication formulation should be avoided during pregnancy?

Liquid formulations containing alcohol

What is the first-line analgesic for mild pain during pregnancy?

Acetaminophen

Which analgesics should generally be avoided during pregnancy, especially at ≥20 weeks gestation?

NSAIDs including aspirin, except low-dose aspirin for preeclampsia prevention

What fetal complications can NSAIDs cause during pregnancy?

Premature closure of the fetal ductus arteriosus and fetal kidney problems leading to low amniotic fluid

When should opioids be used during pregnancy?

Only when there are no alternatives

What is the preferred maintenance therapy for asthma during pregnancy?

Budesonide, although all inhaled corticosteroids (ICS) are considered safe

Can long-acting beta-agonists (LABAs) be continued during pregnancy?

Yes, with an inhaled corticosteroid if needed

What is preferred rescue therapy for asthma during pregnancy?

ICS-formoterol or albuterol

What formulation of budesonide is used in a nebulizer?

Budesonide Respules

How is iron deficiency anemia treated during pregnancy?

Supplemental iron or prenatal vitamins containing iron

Which medications are preferred for hypertension during pregnancy?

Labetalol, nifedipine extended-release, and methyldopa

Which antihypertensive drug classes are contraindicated during pregnancy?

ACE inhibitors, ARBs, aliskiren, and sacubitril/valsartan (Entresto)

What is the preferred medication for diabetes during pregnancy when lifestyle measures are insufficient?

Insulin

Which oral diabetes medications are sometimes used during pregnancy?

Metformin and glyburide

Which antibiotics are generally considered safe during pregnancy?

Penicillins including amoxicillin and ampicillin, cephalosporins, erythromycin, and azithromycin

Which antibiotic classes should be avoided during pregnancy?

Fluoroquinolones due to cartilage damage and tetracyclines due to teeth discoloration

How should vaginal fungal infections be treated during pregnancy?

Topical antifungals such as creams or suppositories for 7 days

Which antifungal should be avoided for vaginal fungal infections during pregnancy?

Fluconazole

What are preferred regimens for a UTI during pregnancy?

Cephalexin 500 mg PO Q6H for 7 days or amoxicillin 500 mg PO Q8H for 7 days

What are alternative antibiotics for UTIs during pregnancy?

Nitrofurantoin, SMX/TMP, and fosfomycin

When should nitrofurantoin and SMX/TMP be considered last-line during pregnancy?

During the first trimester

When should nitrofurantoin and SMX/TMP NOT be used during pregnancy?

During the last 2 weeks of pregnancy

Should asymptomatic bacteriuria be treated during pregnancy?

Yes, bacteriuria must be treated even when asymptomatic

What complications can untreated bacteriuria cause during pregnancy?

Pyelonephritis, premature birth, and perinatal mortality

What are the potential fetal consequences if a woman contracts toxoplasmosis during pregnancy?

Miscarriage, stillbirth, or damage to the baby's brain and eyes

How can women be tested for toxoplasmosis before pregnancy?

IgM and IgG testing

What exposures should pregnant women avoid to reduce the risk of toxoplasmosis?

Dirty food and water, unpasteurized dairy products, and cat feces including cat litter boxes

What is the preferred anticoagulant for treating VTE during pregnancy?

Low molecular weight heparin (LMWH)

Why is LMWH preferred over unfractionated heparin (UFH) for VTE treatment during pregnancy?

Ease of administration

What is recommended for VTE prophylaxis during pregnancy?

Pneumatic compression devices with or without LMWH, which is preferred over UFH

When is the risk of VTE increased in pregnancy?

During pregnancy and the first 6 weeks postpartum

Which anticoagulant is teratogenic and should generally be avoided during pregnancy?

Warfarin

Are oral factor Xa inhibitors and direct thrombin inhibitors recommended during pregnancy?

No, they have not been adequately studied in pregnancy

How is LMWH monitored during pregnancy when monitoring is needed?

Peak anti-Xa levels drawn 4 hours after the dose

How is UFH monitored during pregnancy?

aPTT

How is chronic warfarin therapy generally managed during pregnancy in women with mechanical heart valves or inherited thrombophilias?

Convert to LMWH during pregnancy

When may a pregnant patient with a mechanical heart valve be switched back to warfarin?

After the 13th week of pregnancy, then switch back to LMWH close to delivery

What is the treatment for hypothyroidism during pregnancy?

Levothyroxine with dose increased by 30-50%

Why must hypothyroidism be treated during pregnancy?

Untreated hypothyroidism can cause miscarriage or stillbirth, preeclampsia, low birth weight, cognitive impairment, and growth retardation

Do mild cases of hyperthyroidism during pregnancy always require treatment?

No, mild cases may not require treatment

What is preferred before pregnancy in a patient with hyperthyroidism?

Normalize maternal thyroid function before pregnancy and use contraception until the condition is controlled

Which medications can be used for Graves' disease during pregnancy?

Methimazole and propylthiouracil (PTU)

Which antithyroid drug is generally preferred during pregnancy?

Methimazole, except during early pregnancy

Which antithyroid drug is preferred during the first trimester?

Propylthiouracil (PTU)

What major toxicity is associated with both PTU and methimazole?

Liver damage

What can uncontrolled maternal hyperthyroidism cause during pregnancy?

Premature delivery and low birth weight

Is radioactive iodine appropriate during pregnancy?

No, radioactive iodine is teratogenic and should not be used