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Use of drugs in pregnancy pdf Use of drugs in pregnancy pdf Presentation Transcript

  • Use of Drugs In Pregnancy SANDIP KUMAR BAIDYA Masters of Pharmacy Pharmacology GCTS sandipbaidya@hotmail.com 1
  • Content 1) Principles of prescribing during pregnancy: 2) Physiologic changes during pregnancy. 3) Risk category of drugs during pregnancy 4) List of drugs. 5) Teratogenisity 6)Hypertension in pregnency 7)HIV in pregnancy 8) Clinical trial reports of HPV during pregnency 2
  • Principles of prescribing during pregnancy:  Where possible use non drug therapy.  Prescribing drugs only when definitely needed.  Choose the drug having the best safety record over time.  Avoid newer drug, unless safety is clearly established.  Over the counter drug cannot be assumed to be safe. As far as possible, avoid medication in the initial 10 weeks of gestation.  Use the lowest effective dose.  Use drugs for the shortest period necessary.  If possible, give drug intermittently. 3
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  • Risk category of drugs during pregnancy The FDA-assigned pregnancy categories as used in the Drug Formulary are as follows: Category A Adequate studies in pregnant woman have failed to demonstrate a risk to foetus. E.g. Magnesium sulphate, thyroxine. Category B Adequate human studies are lacking, but animal studies have failed to demonstrate a risk to foetus. E.g. Penicillin , amoxicillin. Category C Animal studies have shown an adverse effect on the foetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks. E.g. Morphine, codeine . 5
  • Category D There is evidence of human foetal risk, but potential benefits from use of the drug may be acceptable despite the potential risks. E.g. Aspirin Category X Studies in animals or humans have demonstrated foetal abnormalities and potential risk clearly outweighs possible benefits. E.g. Estrogens . 6
  • LIST OF DRUGS USED IN PREGNANCY 7
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  • TERATOGENICITY It refers to capacity of the drug to cause foetal abnormalities when administered to the pregnant mother. The placenta does not strictly constitute a barrier and any drug can cross it to go to the greater or lesser extent. The thalidomide disaster resulting in thousands of babies born with phocomelia (1958-61). Women exposed to non-teratogens assigned a risk of 24% for major malformations. Risk in general population 5.6% May be important factor in decision to terminate pregnancy. 9
  • Human Teratogenic Drug Drug Abnormalities Thalidomide Phocomelia, multiple defects Anticancer drug Cleft platelet, multiple defects Methotrexate Foetal death Androgen Cardiac effect Warfarin Depressed nose, eye, hand defects; growth retardation . Phenytoin Cleft lip/palate. Sodium valporate Other natural defects Alcohol Low IQ baby, growth retardation . Lithium Foetal goiter, cardiac and other abnormalities. Progestins Virilization of female feotus 10
  • Benzodiazepines Meta-analysis  studies showed no association between fetal exposure to BZDs and risk for major malformations or oral cleft Case-control studies showed that risk for major malformations or oral cleft alone was increased. Use around delivery - “floppy infant” Cleft lip and palate 11
  • Management of hypertensive disorder during pregnancy: Effects of chronic hypertension on pregnancy: Premature birth Fetal Growth restriction Fetal demise Placenta abruption Cesarean deliveries 12
  • Effects of hypertension on pregnancy A sustained BP reading above 140/90mm Hg during pregnancy has implication both for the mother and fetus. Reduction of BP clearly reduces the risk. Two types of situation are possible : (a) A woman with preexisting essential hypertension becomes pregnant. (b) Pregnancy include hypertension ; as in toxaemia in pregnancy – preeclampsia. Toxaemic hypertension is associated with a hyper adrenergic state . Decrease in plasma volume and increase in vascular resistance. 13
  • Antihypertensive drug to be avoided during pregnancy: Diuretics : tend to reduce blood volume – increase risk of fetal wastage. Placental infection , stillbirth. ACE inhibitors: risk of fetal damage, growth retardation. Nonselective beta blockers: Propranolol has been implicated to cause low birth weight, decrease placental size . Antihypertensive drug found safer during pregnancy: Prazosin – provided that postural hypertension can be avoided . Hydralazine – a positive test occurs but no adverse implication. Methyldopa ,atenelol may be used if no other choice. 14
  • HIV and Pregnancy Mother-to-child transmission of HIV: the passing of HIV from a woman infected with HIV to her baby during pregnancy, during labor and delivery, or by breastfeeding. CD4 count: CD4 cells, also called T cells or CD4+ T cells, are white blood cells that fight infection. HIV destroys CD4 cells, making it harder for the body to fight infections. A CD4 count is the number of CD4 cells in a sample of blood. A CD4 count measures how well the immune system is working. 15
  • Use of drug: Zidovudine: It is a analogue of thymidine. Given to the Pregnant mother and then to the new born infant, it can reduced mother to aby transmission by more than 20 % . Most of the drug metabolised in to the liver , only 20 % of active form being excreted in the urine. Single standed virial RNA (Inhibit by Zidovudine triphosphate) Double standed virial DNA Aciclovir, ganciclovir can be use to HIV patients. 16
  • Obesity in pregnancy Overweight and obesity are common findings in women of reproductive age in the world; as 32% of 35- to 64-year-old women are overweight and 21% obese. Risks to the mother an increased risk of pre-eclampsia. Pregnancy is associated with wide-ranging cardiovascular changes through increased oxygen demand. Obesity-induced changes have profound effects on cardiac, endothelial and vascular function which is dependent on the duration of obesity. Diabetes and Pregnancy Gestational diabetes occurs in 2–5% of pregnant women in the world. It is usually diagnosed after 24 weeks of gestation. Any inflammatory process, including acute and chronic periodontal infection, can make diabetes control more difficult. Poorly controlled diabetes is associated with adverse pregnancy outcomes such as preeclampsia, congenital anomalies, and largefor gestational age newborns. 17
  • Pregnancy and Infant Outcomes in the Clinical Trials of a Human Papillomavirus: OBJECTIVE: To present a combined analysis of the pregnancy outcomes for women aged up to 45 years in phase III clinical studies. METHODS: Twenty thousand five hundred fifty-one women aged 15–45 years received quadrivalent HPV vaccine and placebo at day 1 and months 2 and 6. Urine pregnancy tests were performed immediately before each injection. Participants testing positive were not vaccinated. Women who became pregnant after enrolment were discontinued from further vaccination until resolution of pregnancy. RESULTS: During the studies, 1,796 vaccine and 1,824 placebo recipients became pregnant, resulting in 2,008 and 2,029 pregnancies with known outcomes. No significant differences were noted overall for the proportions of pregnancies resulting in live birth, foetal loss. A total of 40 neonates born to vaccinated women and 30 neonates born to women given placebo. 18
  • Liver disease during pregnancy Acute viral hepatitis is the most common cause of jaundice in pregnancy. The course of most viral hepatitis infections (e.g., hepatitis A, B, C and D) is unaffected by pregnancy, Rate of transmission of the virus during pregnancy depends on the virus. For instance transmission of hepatitis A virus is very rare, but perinatal transmission could occur. 19
  • Reference 1) KD Tripathi; Essential of Medical Pharmacology; JB Medical Publishers; sixth edition; 2008 2) HP Rang , MM Dale , JM Ritter, RJ Flower; Rang & Dale pharmacology; sixth edition; 2007 3) Arun Kumar Mitra, Pralhad S. Patki, S.K. Mitra; Liver disorders during pregnancy and their management; 2008; 105 (4): 193-196 4) Suzanne M. Garland, FRANZCOG, Ad Eundem, Kevin A. Ault,Stanley A. Gall, Jorma Paavonen, Heather L. et al ; Pregnancy and Infant Outcomes in the Clinical Trials of a Human Papillomavirus Type 6/11/16/18 Vaccine; 2009; vol 114 5) Natalia Sirimi1, Dimitrios G. Goulis2; Obesity in pregnancy; Aristotle University of Thessaloniki, Greece; 2010, 9(4):299-306 20
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