• Clinical science

Pharmacotherapy during pregnancy

Abstract

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 learning card 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

Drug Effects Drugs of choice
Tetracycline
  • Bone damage
  • Malformation and permanent yellow discoloration of the primary teeth
Aminoglycoside
Trimethoprim/sulfonamide combinations
Chloramphenicol
  • Gray baby syndrome: syndrome associated with chloramphenicol accumulation in the body, leading to ashen gray color of the skin, cardiovascular collapse, and abdominal distention
Clarithromycin
  • Embryotoxic
Fluoroquinolones

References:[1][2][3][4][5]

Other medical therapy during pregnancy

Antihypertensives

Drugs to avoid Harmful effects Recommended drugs
Diuretics
  • Reduction of placental perfusion, particularly in the third trimester.
ACE inhibitors
  • First trimester: cardiovascular and central nervous system malformations
  • Second and third trimesters: fetal kidney damage or death
Angiotensin-receptor blockers
Atenolol

Antifungals

Drugs to avoid Harmful effects Recommended drugs

Ketoconazole, flucytosine, and griseofulvin

  • Teratogenic and/or embryotoxic
Itraconazole, fluconazole (> 300 mg)
Iodides

Antivirals

Drugs to avoid Harmful effects Recommended drugs
Efavirenz

Ribavirin

  • Preterm birth
  • Significant teratogenic and/or embryocidal effects
Interferon α
Ribavirin and Interferon α combination
Didanosine and stavudine combination
  • Lactic acidosis and hepatic failure leading to death
Nevirapine
  • Potentially fatal hepatotoxicity

Nevirapine should not be used as first-line therapy if avoidable!

Anticoagulants

Drugs to avoid Harmful effects Recommended drugs

Warfarin

  • Heparin: anticoagulant of choice
  • Aspirin (ASA)
    • Low doses may be prescribed for high-risk preeclampsia.
    • High doses should be especially avoided in the third trimester .
Phenprocoumon
Non-vitamin K oral anticoagulants (apixaban, rivaroxaban, dabigatran)
  • The data available does not suggest a high risk of embryopathy, but, because of significant data gaps, they are to be avoided in pregnancy.

Analgesics

Drugs to avoid Harmful effects Recommended drugs
NSAIDs (in the second and third trimesters)
Metamizole

Thyroid agents

Drugs to avoid Harmful effects Recommended drugs
Radioiodine therapy (absolutely contraindicated)
  • L-thyroxine
Methimazole , carbimazole, thiamazole

Antiepileptics

Drugs to avoid Harmful effects Recommended drugs

Phenytoin

Carbamazepine

  • Individualized treatment based on seizure type and most tolerated drug
Valproate

Antiemetics during pregnancy

80% of pregnant women are affected by nausea and, potentially, vomiting, which may be treated with:

Other drug classes

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
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)
  • Multiple congenital malformations, including facial cleft and skeletal abnormalities
Misoprostol

First-generation antihistamines (e.g., chlorpheniramine) may be used as antiallergenics during pregnancy!

Type 2 diabetes during pregnancy or gestational diabetes requires insulin therapy!
References:[6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][4][4][4][4][25][26][27][28][29][30][31]