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Pregnancy.pptx
1. The use of drugs
during pregnancy Done by: Akynbay Moldir
Amirkulova Aisulu
2. It is believed that drugs cause about 1% of
all congenital anomalies. Virtually any
pharmacological drug can have a harmful
effect on the fetus, and therefore the
pharmacotherapy of a pregnant woman
must be strictly and clearly justified.
About 15% of women take drugs in the first
6 months of pregnancy, 75% of them - from
3 to 10 drugs. Medicines are prescribed to
pregnant women in 38% of cases of visits to
a doctor [according to WHO statistics].
3. three critical periods when the embryo and fetus are most
vulnerable to drug exposure:
I critical period(2nd week of pregnancy) - there is a great
danger of both the teratogenic effects of drugs and the
death of the embryo, followed by miscarriage;
II critical period(3-8 weeks of pregnancy - the period of
organogenesis) - toxic and teratogenic effects of drugs with
the possible development of malformations, as well as fetal
death;
III critical period(18-22 weeks) - the most significant
changes in the bioelectrical activity of the brain,
peripheral nervous system,hematopoiesis, functions of the
endocrine glands; there is a great danger of developing
genital malformations in female fetuses under the
influence of androgens.
4.
5.
6. Physiological changes leading to a change in the concentration of
drugs in the blood in pregnant women:
increase in intravascular volume
increased glomerular filtration rate
a decrease in the level of proteins in the blood
plasma, leading to a weakening of the connection of
the drug with blood proteins and an increase in the
clearance of the drug
thinning of the membrane separating the fetus from
the mother, resulting in increased transplacental
diffusion capacity, as well as the ability of drugs to
cross the placenta
decreased motor activity of the gastrointestinal tract,
accompanied by a delay in the absorption of drugs
when they are taken orally
acceleration of metabolic processes in the liver
7. Classifications
To indicate the potential risk of drugs to the fetus in most countries,
classifications of risk categories during pregnancy are used. The first
of these was introduced in Sweden in 1978 (FASS), followed by the
FDA classification (1979), which is the most widely used in the world.
Based on them, the Australian classification (ADEC) was developed in
1989.
8. A comparative analysis of the American, Swedish and
Australian classifications showed that there are many
disagreements between them, which the authors of the
analysis explain not only by differences in the definition
of categories, but also by differences in the
interpretation of the scientific literature available on
this issue.
In general, the FDA classification imposes more
stringent requirements for category A drugs. A number
of NSAIDs (ketoprofen, naproxen, sulindac, piroxicam,
ibuprofen, etc.), classified by the FDA as “B”, are
considered “C” drugs in the Swedish and Australian
classifications.
9. ClassificationFDA
- category A: medicines included in this group,harmless to
fetusthroughout pregnancy (potassium chloride, iron supplements,
multivitamins,triiodothyronine);
- category B:experimental studiesshowed no teratogenic effector
complications observed in animals are not found in children whose mothers
took drugs included in this group (insulin, aspirin,metronidazole);
- category C: teratogenic orembryotoxicactiondrug, controlled trials have
not been conducted, or the effect of the drug has not been studied
(isoniazid,fluoroquinolones, gentamicin,antiparkinsonianmedications,
antidepressants)
-Category D:drug use is associatedwith some risk to the fetus, however,
the benefits of their use outweigh the possible side effects
(diazepam,doxycycline,kanamycin,diclofenac);
- category X:proven to be teratogenicdrugs of this group, their use is
contraindicated before and during pregnancy (isotretinoin,carbamazepine,
streptomycin)
12. Pregnant women receive drugs of the same pharmacological groups
as non-pregnant women, however, their distribution according to
the frequency of prescriptions is different. Most often, vitamins
specially designed for pregnant women are prescribed during
pregnancy, followed by multivitamins, antimicrobials, analgesics,
dermatological drugs and anti-asthma drugs.
Соматическая
патология
беременной
Необходимость
приема ЛС во
время
беременности
Соотношение
риск/польза в
каждом случае
применения ЛС
14. Rules for the appointment of drugs to
ensure the safety of the fetus
carefully weigh the potential benefits of using
drugs and its potential harm (in both cases, both
for the mother and the fetus);
if possible, avoid the use of drugs in the first
trimester;
do not use combinations of drugs and several
drugs at the same time;
apply the minimum effective dose for the
minimum time;
if possible, give preference to local dosage forms;
inform pregnant women about the need to
consult a doctor about taking any drugs, including
analgesics, vitamins, dietary supplements, herbal
preparations and other means used for self-
medication;
control the intake of all drugs pregnant;
monitor the condition of the mother and fetus
during the period of drug therapy.
15. NSAIDs
During pregnancy, if necessary, the use of analgesics is recommended
to use small doses (short-term). Considered relatively
safeparacetamol and small doses of acetylsalicylic acid. When using
non-narcotic analgesics in late pregnancy due to
inhibitionprostaglandinscomplications are possible in the form of a
post-term pregnancy, bleeding in the fetus and the pregnant woman,
premature closurebotallovaduct with the formation of pulmonary
hypertension (especially often when
usingindomethacinAndvoltarena). Hemostasis disorders in newborns,
caused by the intake of aspirin by pregnant women, are
manifestedptechialrash, hematuria,subconjunctivalhemorrhage.
16. Antihypertensivefacilities
In general applicationbeta blockerscontraindicated in pregnancy.
They reduce the permeability of the placenta, worsen
uteroplacental blood flow, which is fraught with delayed fetal
development, malnutrition, and weakening of labor. The effect on
the fetus is also manifested by bradycardia, respiratory depression,
hypoglycemia, jaundice. However, whensupraventriculartachycardia
can be usedpropranololAndpindolol.
Introductionmagnesium sulfatepregnant before childbirth can lead
to a decrease in skeletal muscle tone and severe lethargy of the
newborn.
Applicationthiazidediureticscan cause thrombocytopenia and
electrolyte imbalance.
ACE inhibitor- various disorders in the fetus - renal failure, neonatal
hypotension, patent ductus arteriosus, respiratorydistress-
syndrome, pulmonary hypoplasia, intrauterine death, which is
associated with the effects of ACE inhibitors on the kidneys. It is
also possible to violateossificationzygomatic bone in a child.
Nifedipine-causes minor side effects in the form of tachycardia,
headaches, hot flashes.
17. Hormonal drugs
In girls born to pregnant women who, at the 8-17th
week of pregnancy, tookdiethylstilbesterolincreases the
risk of developingadenocarcinomasvagina, as well as
anatomical and functional defects of the female genital
organs: transverse folds on the cervix, T-shaped uterus,
uterine hypoplasia, ovarian dysfunction.
Estrogens andprogestinsshould not be used in the first 4
months of pregnancy due to the risk of cardiac and
limb developmental disorders and the possibility of
developingpseudohermaphroditismin boys.
The teratogenic effect of hormonal contraceptives has
been described as a syndromeVACTERL(vertebral, anal,
cardiac, tracheal,esophageal, renal anomalies, and
abnormal limb formation).
The teratogenic effect of ACTH is manifested in the
splitting of the hard palate.
GCS in pregnant women should be used withcautiondue
to the possibility of adrenal hypoplasia.
18. Anticoagulants
Heparindoes not cross the placenta and, if
necessary, can be used in pregnant women.
Indirect anticoagulantspass through the placenta
unchanged and can cause hemorrhages
infetus.Infirst trimester of pregnancy, indirect
anticoagulants have andembryotoxic, and
teratogenic effects (hypoplasia of the nose,
shortening of the arms,short-fingeredness, eye
atrophy, cataract, anomaly in the development of
limbs).
Often, anticoagulants lead to miscarriages,
intrauterine fetal death and hemorrhagic
manifestations in newborns.Streptokinasedoes not
cross the placenta, and therefore it can be used in
normal doses during pregnancy.
19. Anticonvulsants
Difeninin 10% of cases, it causes intrauterine growth
retardation, various structural disorders of the facial
skull (short saddle nose), anomalies of the heart and
genital organs, terminal phalanges of the fingers
(absence of nails).
During pregnancy, preference is given to safer drugs
(barbiturates andbenzodiazepines). The latter in some
cases cause in newbornscoagulopathy, characterized by
an increase in partialthromboplastintime and a decrease
in the concentration of factors 2, 7, 9, 10 (in newborns,
bleeding occurs already on the first day after birth,
which can lead to bleeding into the pleural or
abdominal cavity). Vitamin K is recommended for
prevention.
20. Hypoglycemic drugs
If it is necessary to prescribe
drugs of this group, preference is
given to insulin. Sulfonylurea
derivatives are safer than
biguanides. However, in order to
avoid the development of
hypoglycemia in the newborn,
they should be discontinued 4
days before the expected birth.
21. Antibacterial drugs
The safest for the fetus arepenicillin, ampicillin
Receptioncephalosporinscan lead to hypoprothrombinemia as a result of
a decrease in vitamin K metabolism in the liver and an increased risk of
bleeding.
Sulfonamidesshould not be taken during pregnancy as they may be
teratogenic and increase jaundice late in pregnancy, increasing the risk
of bilirubin encephalopathy. Especially dangerous are long-acting
sulfonamides, as well as combined drugs (co-trimoxazole).
Nitrofuran preparations(nitrofurantoin, furazidin, furazolidone) easily
pass through the placenta and accumulate in the amniotic fluid; they
can cause hemolysis in the fetus. Their appointment at the end of
pregnancy is undesirable.
Metronidazolehas an embryotoxic effect in the first trimester of
pregnancy.
24. Tetracycline
The use of even small doses of
tetracycline in late pregnancy
can cause yellow staining of the
child's teeth, their hypoplasia,
as well asslowing down the
development of the bone
skeleton.
Large doses of tetracycline,
especially in late pregnancy,
when administered parenterally
can causeacute fatty
degeneration of the fetal liver.
![ It is believed that drugs cause about 1% of
all congenital anomalies. Virtually any
pharmacological drug can have a harmful
effect on the fetus, and therefore the
pharmacotherapy of a pregnant woman
must be strictly and clearly justified.
About 15% of women take drugs in the first
6 months of pregnancy, 75% of them - from
3 to 10 drugs. Medicines are prescribed to
pregnant women in 38% of cases of visits to
a doctor [according to WHO statistics].](data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7)