Pharmacotherapy during pregnancy
Last updated: August 4, 2022
Summary
Pharmacotherapy during pregnancy is an important concern for a medical professional because there are only a limited number of drugs that can be safely administered during this period. Many drugs can cause harm to the fetus in the form of defects in organogenesis, growth retardation, and functional deficits. The aim of drug selection in this period is to prescribe an agent that effectively alleviates the mother's medical complaints while ensuring the safety of the unborn fetus. This article provides a brief overview of drugs that can be used for common conditions in pregnant women. It also lists the substances that should be avoided during pregnancy.
Antibiotics during pregnancy
“Teethracycline:” teeth discoloration with tetracycline.
“A mean guy stepped on baby's ear:” Aminoglycoside can cause ototoxicity.
Other medical therapy during pregnancy
“Moms Love Healthy Newborns:” Methyldopa, Labetalol, Hydralazine, Nifedipine are safe to use during pregnancy.
Antivirals
Nevirapine should not be used as first-line therapy if avoidable!
“Don't Warry, be Heppy:” warfarin should be replaced with heparin during pregnancy.
Overview of analgesics to avoid during pregnancy [18]
|
| Harmful side effects | Recommended drugs |
NSAIDs (in the second and third trimesters) |
|
|
Metamizole |
|
Other drug classes [2][20][21]
Overview of other drugs to avoid during pregnancy |
Drugs to avoid | Harmful effects |
Steroid therapy (especially as antiallergenics) |
- Reduced birth weight
- Increased risk of preeclampsia
- Increased risk of oral and lip clefts
|
Oral antidiabetic agents |
- Pre-eclampsia
- Neonatal jaundice
- Macrosomia
-
Neonatal hypoglycemia: low blood sugars in a newborn
- Can be caused by several conditions, e.g., persistent hyperinsulinemic hypoglycemia (e.g., due to gestational diabetes), prematurity, sepsis
- May be asymptomatic or manifest with autonomic symptoms (e.g., tachycardia, sweating, tremors) and neurological symptoms (e.g., hypotonia, lethargy, seizures).
|
Methotrexate |
|
Cholestyramine |
- Fetal and maternal hemorrhage
|
Lithium |
|
Antineoplastic drugs (specifically antifolate metabolites and alkylating agents) |
|
Isotretinoin and excessive intake of vitamin A (> 8,000 IU vitamin A per day as retinol/retinyl esters) |
- High risk of miscarriage
- Multiple congenital malformations, including cardiac anomalies, facial cleft, and skeletal abnormalities
|
Misoprostol |
|
5α-reductase inhibitor |
|
Antacids | Calcium carbonate |
|
Magnesium hydroxide |
- Inhibition of uterine contractions [26]
- Might delay the onset of lactation [27]
|
“IsoTERATinoin” is a TERrible TERATogen.”
First-generation antihistamines (e.g., chlorpheniramine) may be used as antiallergenics during pregnancy. Second-generation antihistamines (e.g., loratadine, fexofenadine, cetirizine) may be considered if chlorpheniramine is not tolerated. Loratadine is the best-studied second-generation antihistamine. [28]
Type 2 diabetes during pregnancy or gestational diabetes requires insulin therapy!
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