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Drugs in Pregnancy - Jaber Manasia

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In this lecture, I talked about almost everything concerning the usage of medicine in pregnancy .

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Drugs in Pregnancy - Jaber Manasia

  1. 1. DRUGS IN… PREGNANCY Presented by Jaber Al-Manasia 5th year medical student
  2. 2. ALCOHOL • It causes mental and physical defects represented in distinctive abnormal stigmata. The effects are known as fetal alcohol syndrome (1)characteristic facial anomalies . (2)growth retardation (3)CNS involvement •
  3. 3. • a. Small palpebral fissures • b. Thin vermilion border • c. Smooth philtrum
  4. 4. CNS • Structural : microcephaly, agenesis of corpus callosum, cerebellar hypoplasia, hipocampus… • Neuological : epilepsy, impaired fine motor skills, hearing loss, poor gait, clumsiness… • Functional : communication, learing, behavior…
  5. 5. TOBACCO  Newborns of smoking mothers are 200 g less than those of nonsmokers’ baby.  Smoking also may cause increase incidence of subfertility, spontaneous abortion, placenta previa, placental abruption , preterm delivery.  Many studies found association between maternal smoking and hydrocephaly,microcephaly, omphalocele, gastroschisis,cleft lip and palate & hand abnormalities.
  6. 6. ANAL SIC GE • Aspirin: not increase risk of anomalies • Acetaminophen: not increase risk of anomalies • NSAIDs • indomethacin • Early closure of fetal ductus arteriosus and subsequent pulmonary hypertension • decrease fetal urine output and reduce amnionic fluid • reversible if discontinued before 34 weeks
  7. 7. ANTI-THYROID DRUGS • (carbimazole, neomercazole, thiouracil); Anti -thyroid thyroid hormone in the fetal thyroid gland causing compensatory over action of the pituitary leading to fetal goiter which may cause neonatal respiratory obstruction
  8. 8. ANTI-THYROID DRUGS • Lack of thyroid hormone will cause fetal cretinism& mental retardation. • If anti-thyroid drugs are used, they should be combined with L-Thyroxin • Radio –Active Iodine ;shouldn’t be used in pregnancy, because the fetal thyroid gland will be destroyed if Iodine 131 is ingested by the mother.
  9. 9. :HYPOTENSIVE DRUGS • Beta-Blockers; (e.g. propanol, atenalol, tenormin). placental insufficiency… hypotonia, hypoglycemia IUGR + increase in P.N.M.
  10. 10. :Hypotensive Drugs
  11. 11. :Hypotensive Drugs • ACE inhibitors ... • • • • C/I in pregnancy; Skull defects. Oligohydraminos 2ry to renal impairment in the foetus. Affects fetal blood pressure control. • Angiotensin II receptor inhibitor (Losartan, Valsartan)  should be avoided(evidence of fetal risk). risk • Methyldopa, hydralazine, calcium channel blocker: No reports of congenital defect.[C ]
  12. 12. RESPIRATORY SYSTEM • Asthma drug : Bronchodilators Salbutamol, Aminophylline & Theophylline  safe. • steroids: If administered by inhalation (safe)  no adrenal suppression. Systemic steroids : facial clefts.
  13. 13. ANTIBIOTIC DRUGS • Tetracycline; after 4th month of pregnancy it enters the fetal circulation, chelates with Ca & deposits in teeth, bones, nails. • When the teeth erupt in the infant ,they are at 1st light yellow & fluoresce in ultraviolet light & later the color fades gradually to a non florescent brown, in addition to hypoplasia of teeth leading to dental carries • Ampicillin& penicillin :safe
  14. 14. • Chloramphenicol : B.M. depression in the mother & very dangerous to premature neonate. No congenital anomalies. – Gray baby syndrome • Aminoglycosides : Although both nephrotoxicity and ototoxicity have been reported in preterm newborns and adults treated with gentamicin or streptomycin, congenital defects resulting from prenatal exposure have not been confirmed.
  15. 15. :ANTI- CONVULSANT DRUGS • Phenobarbitone, Phenytoin, Primidone ; • Retrospective study suggested that cleft lip & palate may occur in the fetus, but prospective study of 16 neonates of mother on anti-convulsant drugs showed that 7 neonates had severe coagulation defects similar to vitamin K deficiency. • Prophylactic RX of the mother with vit. K may prevent this risk.
  16. 16. DRUGS CAUSING KERNICTERUS& .JAUNDICE • They cause dissociation of the bilirubin from its protective binding to serum albumin in the fetus….. The free bilirubin diffuse readily into the CNS producing Kernicterus : e.g. the following; • Sulphonamide (sulphamethoxazole + trimethoprim) • Salicylates, Phenylbutazone • Phenothiazides.
  17. 17. Thank you

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