Use of drugs in pregnancy pdfPresentation Transcript
Use of Drugs In Pregnancy
SANDIP KUMAR BAIDYA
Masters of Pharmacy
1) Principles of prescribing during pregnancy:
2) Physiologic changes during pregnancy.
3) Risk category of drugs during pregnancy
4) List of drugs.
6)Hypertension in pregnency
7)HIV in pregnancy
8) Clinical trial reports of HPV during pregnency
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
Use the lowest effective dose.
Use drugs for the shortest period necessary.
If possible, give drug intermittently.
Risk category of drugs during pregnancy
The FDA-assigned pregnancy categories as used in the Drug Formulary
are as follows:
Adequate studies in pregnant woman have failed to demonstrate a risk to
foetus. E.g. Magnesium sulphate, thyroxine.
Adequate human studies are lacking, but animal studies have failed to
demonstrate a risk to foetus. E.g. Penicillin , amoxicillin.
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 .
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
Studies in animals or humans have demonstrated foetal abnormalities
and potential risk clearly outweighs possible benefits. E.g. Estrogens .
LIST OF DRUGS USED IN PREGNANCY
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
Human Teratogenic Drug
Phocomelia, multiple defects
Cleft platelet, multiple defects
Depressed nose, eye, hand defects;
growth retardation .
Other natural defects
Low IQ baby, growth retardation .
Foetal goiter, cardiac and other
Virilization of female feotus
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
Management of hypertensive disorder during pregnancy:
Effects of chronic hypertension on pregnancy:
Fetal Growth restriction
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
(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.
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
Hydralazine – a positive test occurs but no adverse
Methyldopa ,atenelol may be used if no other choice.
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.
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.
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.
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
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.
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.
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