drugs and pregnancy - which drugs can be taken in pregnancy
What about drug ?
So , which ones are dangerous ?
Almost all illicit drugs, such as heroin and cocaine, pose a risk to pregnant women. Legal materials, such as alcohol and tobacco are also dangerous, and even medical drugs, both prescription and over-the counter, can be harmful. To her health and the health of her baby , a woman should avoid all of them as much as possible, from the time she first plans to become pregnant, or learns she is pregnant.
About 2 to 3% of all birth defects result from the use of drugs .
Most of the body organs and systems of the baby-to-be are formed within the first ten weeks or so of pregnancy (calculated from the date of the last menstrual period). During this stage, some drugs—and alcohol in particular—can cause malformations of such parts of the developing fetus as the heart, the limbs, and the facial features.
After about the tenth week, the fetus should grow rapidly in weight and size. At this stage, certain drugs may damage organs that are still developing, such as the eyes, as well as the nervous system. Continuing drug use also increases the risk of miscarriage and premature delivery. But the greatest danger drugs pose at this stage is their potential to interfere with normal growth. Intrauterine growth retardation (IUGR) is likely to result in a low-birthweight baby—a baby born too early, too small, or both. Low-birthweight babies require special care and run a much higher risk of severe health problems or even death.
How can these drugs reach our baby ?
Drugs taken by a pregnant woman reach her baby primarily by crossing the placenta, the same way taken by oxygen and nutrients, which are needed for the fetus's growth and development
Drugs that a pregnant woman takes during pregnancy can affect the fetus in several ways:
• They can attack the baby directly, causing damage, abnormal development of his organs(leading to birth defects), or even death.
• They can hinder the function of the placenta, usually by causing blood vessels to narrow (constrict) and thus reducing the supply of oxygen and nutrients to the fetus from the mother. Sometimes the result is a baby that is underweight and underdeveloped.
• They can cause the muscles of the uterus to contract forcefully, indirectly injuring the fetus by reducing its blood supply or triggering preterm labor and delivery.
How Drugs Cross the Placenta
Some of the fetus's blood vessels are contained in tiny hairlike projections (villi) of the placenta that extend into the wall of the uterus. The mother's blood passes through the space surrounding the villi (intervillous space). Only a thin membrane (placental membrane) separates the mother's blood in the intervillous space from the fetus's blood in the villi. Drugs in the mother's blood can cross this membrane into blood vessels in the villi and pass through the umbilical cord to the fetus.
Categories of Risk for Drugs During Pregnancy
The Food and Drug Administration (FDA) classifies drugs according to the degree of risk they pose for the fetus if they are used during pregnancy
A These drugs are the safest. Well-designed studies in people show no risks to the fetus.
B Studies in animals show no risk to the fetus, and no well-designed studies in people have been done.
or
Studies in animals show a risk to the fetus, but well-designed studies in people do not.
C No adequate studies in animals or people have been done.
or
In animal studies, use of the drug resulted in harm to the fetus, but no information about how the drug affects the human fetus is available.
D Evidence shows a risk to the human fetus, but benefits of the drug may outweigh risks in certain situations. For example, the mother may have a life-threatening disorder or a serious disorder that cannot be treated with safer drugs.
X Risk to the fetus has been proved to outweigh any possible benefit.
Some drugs can have effects after they are stopped
For example
Isotretinoin( ACCUTAN)
a drug used to treat skin disorders, is stored in fat beneath the skin and is released slowly. Isotretinoin can cause birth defects if women become pregnant within 2 weeks after the drug is stopped. Therefore, women are advised to wait at least 3 to 4 weeks after the drug is stopped before they become pregnant.
Vaccines made with a live virus (such as the rubella and varicella vaccines) are not given to women who are or might be pregnant. Other vaccines (such as those for cholera, hepatitis A and B, plague, rabies, tetanus, diphtheria, and typhoid) are given to pregnant women only if they are at substantial risk of developing that particular infection. However, all pregnant women who are in the 2nd or 3rd trimester during the influenza (flu) season should be vaccinated against the influenza virus.
Drugs to lower high blood pressure (antihypertensives) may be needed by pregnant women who have had high blood pressure before pregnancy or who develop it during pregnancy. Either type of high blood pressure increases the risk of problems for the woman and the fetus
However, antihypertensives can markedly reduce blood flow to the placenta if they lower blood pressure too rapidly in pregnant women. So pregnant women who have to take these drugs are closely monitored
Two types of antihypertensives—angiotensin-converting enzyme (ACE) inhibitors (capoten) and thiazide diuretics (hygroton )—are usually not given to pregnant women because these drugs can cause serious problems in the fetus
Digoxin
used to treat heart failure and some abnormal heart rhythms, readily crosses the placenta. But it typically has little effect on the baby before or after birth
Most antidepressants appear to be relatively safe when used during pregnancy
Some Drugs That Can Cause Problems During Pregnancy*
Antianxiety drug
( Diazepam)
DIASTAT & VALIUM
When the drug is taken late in pregnancy, depression, irritability, shaking, and exaggerated reflexes in the newborn
Antibiotics
Chloramphenicol
CHLORAMPHENICOL
Gray baby syndrome
In women or fetuses with glucose-6-phosphate dehydrogenase (G6PD) deficiency, the breakdown of red blood cells
Fluoroquinolones
Ciprofloxacin CILOXAN & CIPRO
, ofloxacin FLOXIN & OCUFLOX
, levofloxacin LEVAQUIN & QUIXIN
, and norfloxacin NOROXIN
Possibility of joint abnormalities (seen only in animals)
Kanamycin Damage to the fetus's ear, resulting in deafness
Nitrofurantoin
FURADANTIN & MACRODANTIN
In women or fetuses with G6PD deficiency, the breakdown of red blood cells
Streptomycin Damage to the fetus's ear, resulting in deafness
Sulfonamides
Sulfasalazine AZULFIDINE
trimethoprim
- sulfamethoxazole
When the drugs are given late in pregnancy, jaundice and possibly brain damage in the newborn (much less likely with sulfasalazine
AZULFIDINE
In women or fetuses with G6PD deficiency, the breakdown of red blood cells
Tetracycline
SUMYCIN
Slowed bone growth, permanent yellowing of the teeth, and increased susceptibility to cavities in the baby
Occasionally, liver failure in the pregnant woman
Anticoagulants Heparin When the drug is taken a long time, osteoporosis and a decrease in the number of platelets (which help blood clot) in the pregnant woman
Warfarin
COUMADIN
Birth defects
Bleeding problems in the fetus and the pregnant woman
Anticonvulsants
Carbamazepine
TEGRETOL
Some risk of birth defects
Bleeding problems in the newborn, which can be prevented if pregnant women take vitamin K by mouth every day for a month before delivery or if the newborn is given an injection of vitamin K soon after birth
Phenobarbital
LUMINAL
Same as those for carbamazepine
TEGRETOL
Phenytoin
DILANTIN
Same as those for carbamazepine
TEGRETOL
Trimethadione
TRIDIONE
Increased risk of miscarriage
High (70%) risk of birth defects, including a cleft palate and defects of the heart, face, skull, hands, and abdominal organs
Valproate
DEPKINE
Some (1%) risk of birth defects, including a cleft palate and defects of the heart, face, skull, spine, and limbs
Antihypertensives Angiotensin-converting enzyme (ACE) inhibitors
When the drugs are taken late in pregnancy, kidney damage in the fetus, a reduction in the amount of fluid around the developing fetus (amniotic fluid), and defects of the face, limbs, and lungs
Beta-blockers When some beta-blockers are taken during pregnancy, a slowed heart rate and low blood sugar level in the fetus and possibly slowed growth
Thiazide diuretics A decrease in the levels of oxygen, sodium, and potassium and in the number of platelets in the fetus's blood
Slowed growth
Chemotherapy drugs
Actinomycin
SEE DACTINOMYCIN
Possibility of birth defects (seen only in animals)
Busulfan
MYLERAN
Birth defects such as underdevelopment of the lower jaw, cleft palate, abnormal development of the skull bones, spinal defects, ear defects, and clubfoot
Slowed growth
Chlorambucil
LEUKERAN
Same as those for busulfun
Cyclophosphamide
LYOPHILIZED & CYTOXAN
Same as those for busulfun
Mercaptopurine
PURINETHOL
Same as those for busulfun
Methotrexate
TREXALL
Same as those for busulfun
Vincristine
Possibility of birth defects (seen only in animals)
Mood-stabilizing drug
Lithium
LITHOBID
Birth defects (mainly of the heart), lethargy, reduced muscle tone, poor feeding, underactivity of the thyroid gland, and nephrogenic diabetes insipidus in the newborn
Nonsteroidal anti-inflammatory drugs (NSAIDs)
Aspirin
BAYER
and other salicylates
Ibuprofen
ADVIL MOTRIN
Naproxen
ALEVE ANAPROX NAPROSYN
When the drugs are taken in large doses, a delay in the start of labor, premature closing of the connection between the aorta and artery to the lungs (ductus arteriosus), jaundice, and (occasionally) brain damage in the fetus and bleeding problems in the woman during and after delivery and in the newborn
When the drugs are taken late in pregnancy, a reduction in the amount of fluid around the developing fetus
Oral antihyperglycemic drugs
Chlorpropamide
DIABINESE
A very low blood sugar level in the newborn
Inadequate control of diabetes in the pregnant woman
When the drug is taken early in pregnancy by a woman with type 2 diabetes, possibility of increased risk of birth defects
Tolbutamide Same as those for chlorpropamide
DIABINESE
Sex hormones
Danazol
When this drug is taken very early in pregnancy, masculinization of a female fetus's genitals, sometimes requiring surgery to correct
Diethylstilbestrol (DES) Abnormalities of the uterus, menstrual problems, and an increased risk of vaginal cancer and complications during pregnancy in daughters
Abnormalities of the penis in sons
Synthetic progestins (but not the low doses used in oral contraceptives) Same as those for danazol
Skin treatments Etretinate Birth defects, such as heart defects, small ears, and hydrocephalus
(sometimes called water on the brain)
Isotretinoin
ACCUTANE
Same as those for etretinate
Mental retardation (intellectual disability)
Risk of miscarriage
Thyroid drugs
Methimazole
TAPAZOLE
An enlarged or underactive thyroid gland in the fetus
Scalp defects in the newborn
Propylthiouracil An enlarged or underactive thyroid gland in the fetus
Radioactive iodine Destruction of the thyroid gland in the fetus
When the drug is given near the end of the 1st trimester, very overactive and enlarged thyroid gland in the fetus
Triiodothyronine
THYROLAR
An overactive and enlarged thyroid gland in the fetus
Vaccines
(live virus) Vaccine for German measles (rubella) and chickenpox (varicella) Potential infection of the placenta and developing fetus
Vaccines for measles, mumps, polio, or yellow fever Potential but unknown risks
Alcohol
Alcohol is one of the most dangerous drugs for pregnant women, especially in the early weeks. In the mother’s body, alcohol breaks down chemically to a cell-damaging compound that is readily absorbed by the fetus. Heavy drinking during early pregnancy greatly increases the risk of a cluster of birth defects known as fetal alcohol syndrome. This cluster includes a small skull (microcephaly), abnormal facial features, and heart defects, often accompanied by impeded growth and mental retardation. Heavy drinking in later pregnancy may also impede growth.
It is not known whether light to moderate drinking can produce these effects. However, even if the risk is low, the stakes are very high. Medical experts agree that a woman should avoid alcohol entirely when she decides to become pregnant, or at least when the first signs of pregnancy appear. Even such mild beverages as beer and wine coolers should be off limits
Tobacco
Smoking during pregnancy appears to raise the risk of miscarriage or premature labor. But the primary danger is hindered fetal growth. Nicotine depresses the appetite at a time when a woman should be gaining weight, and smoking reduces the ability of the lungs to absorb oxygen. The fetus, deprived of sufficient nourishment and oxygen, may not grow as fast or as much as it should
Marijuana
Studies of marijuana use by pregnant women are inconclusive, because marijuana is often used with other drugs, such as tobacco and alcohol. Like them, it is associated with premature birth and low-birthweight babies.
SO, what drugs can be taken ????
Some Medications Considered Safe for Use During Pregnancy
Condition Medication
Asthma • Budesonide inhaled or nasal spray (Pulmicort®, Rhinocort ®)
Bladder infection (UTI) • Nitrofurantoin (Macrobid®)
- Avoid in first trimester.
- Avoid in patients with possible G6PD deficiency
• Penicillin, ampicillin, cephalosporins,Augmentin
Cough • Dextromethrophan (Robitussin DM sugar free ®)
Constipation • Metamucil® , Citrucel®,
• Docusate (Colace®, Ducolax ®)
• Milk of magnesia.
• Polyethyelene glycol (Miralax®)
Diabetes • Insulin
• Glyburide (Micronase®)
• Metformin (Glucophage®)
Diarrhea • Loperamide (Imodium A-D ®)
Gas • Simethicone (Gas-X ®, Mylicon ®, Phazyme ®)
Gastroesophageal reflux disease (GERD), • Ranitidine (Zantac®)
• Cimetidine (Tagamet®)
Hayfever, sneezing, runny nose, itchy watery eyes • Chlorpheniramine (Chlor-Trimeton ®,Efidac ®,
Teldrin ®)
• Diphenhydramine (Benadryl ®) Clemastine (Tavist Allergy ®)
Headache or fever: • Acetaminophen (APAP,Paracetamol,Panadol, Tylenol®)
Heartburn • TUMs®
Hemorrhoids • Tucks®
• Preparation H®
• Anusol®
High blood pressure • Methyldopa (Aldomet®)
Hyperprolactinemia • Bromocriptine (Parlodel®)
• Carbergoline (Dostinex®)
Hypothyroidism • Thyroid hormone
• Levothyroxine (Synthroid ®, Levoxyl ®)
Infection • Acyclovir (Zovirax ®)
• Azthitromycin (Zithromax ®)
• Cepaholosporins
examples: Cephalexin (Keflex®),
Cefazolin (Ancef ®), cefaclor (Ceclor®)
• Clindamycin (Cleocin®)
• Erythromycin
• Penicillins
example Amoxicillin (Amoxil®),
Amoxicillin Clavulanate (Augmentin®),
methicillin, carbenicillin
• Metronidazole (Flagyl®)
Insomnia
• Doxylamine (Unisom Sleep Tabs® )
Motion sickness • Dimenhydrinate (Dramamine ®)
Nasal congestion
• Pseudoephedrine (Sudafed ®)
-Avoid in first trimester.
Nasal congestion, sneezing, runny nose, itchy watery eyes • Actifed Cold and Allergy ®
Ingredients: Triprolidine, Pseudoephedrine
-Avoid in first trimester.
Nasal congestion, sneezing, runny nose, itchy watery eyes, fever, and headache • Actifed Cold and Sinus ®
Ingredients: Acetaminophen, Chlorpheniramine,
Pseudoephedrine- Avoid in first trimester.
Nausea
• Ginger
• Pyridoxine 25 mg PO TID WITH
Unisom Sleep Tabs (Doxylamine Succinate 25 mg) 1/2 tablet TID
• Metoclopramide (Reglan ® )
Preeclampsia • Magnesium sulfate
Vaginal yeast infection • Clotrimazole cream (Gyne-Lotrimin®)
