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Pregnancy and Lactation: Therapeutic Considerations

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LEARNING OBJECTIVES

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LEARNING OBJECTIVES

Upon completion of the chapter, the reader will be able to:

  1. Explain the principles of embryology and teratology.

  2. Identify known teratogens and drugs of concerns during lactation.

  3. Compare the main sources of drug information during pregnancy and lactation.

  4. Evaluate the risks of a drug when taken during pregnancy or lactation.

  5. Apply a systematic approach to counseling on the use of drugs during pregnancy and lactation.

  6. Recommend the appropriate dose of folic acid to prevent congenital anomalies.

  7. Describe physiologic changes during pregnancy and their impact on pharmacokinetics.

  8. Choose an appropriate treatment for common conditions in a pregnant or lactating woman.

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KEY CONCEPTS

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  • Image not available. Although the risk of drug-induced teratogenicity is of concern, the actual risk of birth defects from most drug exposures is small.

  • Image not available. Health professionals should know which medications could be teratogenic or of concern during breast-feeding.

  • Image not available. The risk of birth defects is most often higher during organogenesis.

  • Image not available. Counsel all women of childbearing age on the use of folic acid–containing multivitamins to prevent congenital anomalies.

  • Image not available. Most drugs are safe during breast-feeding.

  • Image not available. When possible, treat conditions occurring during pregnancy with nonpharmacologic treatments instead of drug therapy.

  • Image not available. Evaluate the need for treatment, including benefits and risks. Avoid treatments that do not show evidence of benefit or that can be delayed until after pregnancy or breast-feeding.

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Medication use during pregnancy and lactation is a challenge for health professionals, as pregnant and breast-feeding women are usually excluded from clinical trials. Therefore, it is important to know on which information sources to rely, how to interpret the data retrieved from these sources, and how to communicate this information to patients. This chapter reviews the available resources that help to guide therapy, general strategies to reduce risks of drug use in pregnant and lactating women, and specific recommendations for some common conditions treated during pregnancy and lactation.

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EPIDEMIOLOGY AND ETIOLOGY

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Use of Medications During Pregnancy and Lactation

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Studies conducted in the United States have estimated that at least two-thirds of pregnant women take medications during pregnancy.1,2 Moreover, since approximately one-half of pregnancies are unplanned, many women are exposed to medications before being aware of their pregnancy.3

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The most popular medications are vitamins and minerals, analgesics, antacids, antibiotics, antiemetics, laxatives, asthma medication, cold and flu medications, and medications for topical administration (e.g., antifungals, antibiotics, corticosteroids).1,2

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One study from the Netherlands indicates that 65.9% of breast-feeding women took at least one medication (53% after exclusion of vitamins and minerals) over a 6-month period.4

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Background Risks of Anomalies in Pregnancy
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Table 47–1 describes the baseline risks of congenital anomalies and some obstetrical complications observed in the general population. This will be important when evaluating the risks associated ...

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