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Chapter 47. Pregnancy and Lactation: Therapeutic Considerations

Student Questions

When analyzing information on the safety of a drug exposure during pregnancy, which one of these statements is true?

A. Medications use during pregnancy is the leading cause of congenital anomalies.

B. There is a baseline risk of major malformations of about 3% at birth in the general population.

C. Animal studies are of more value than human data to inform on teratogenic risk of a drug.

D. The fetogenesis period is the most at risk period for structural congenital anomalies following a teratogenic exposure.

Answer: B

Option A: Incorrect. Medications are the cause of less than 1% of congenital anomalies.

Option B: Correct. The leading cause of congenital anomalies is genetic. Animal studies have several limits to study human teratology. The organogenesis (or embryogenesis) is the most at risk period for structural congenital anomalies.

Option C: Incorrect. Not teratogenic effects in animals are also seen in humans

Option D: Incorrect. The organogenesis period is the most at risk period for structural congenital anomalies following a teratogenic exposure.

Which of the following key points is appropriate when considering the use of lamotrigine during breast-feeding?

A. It is contraindicated to use lamotrigine during breast-feeding.

B. Lamotrigine blood concentration of a breast-fed infant can be up to 10% to 50% of simultaneous maternal blood concentration.

C. Several cases of severe rash have been reported in breast-fed infants whose mothers were taking lamotrigine.

D. When mothers who take lamotrigine breast-feed, the drug is usually undetectable in the infants' serum.

Answer: B

Option A: Incorrect. The use of lamotrigine is not contraindicated during breast-feeding.

Option B: Correct. An infant breast-feed by a mother treated with lamotrigine can have therapeutic serum levels of lamotrigine. A follow-up is required for potential sideeffects (eg, rash, sedation, weight gain).

Option C: Incorrect. No cases of severe rash have been reported in breast-fed infants whose mothers were taking lamotrigine.

Option D: Incorrect. When mothers who take lamotrigine breast-feed, concentrations in infants serum can be up to 50% of the mother's serum concentration.

Which one of the following periods is considered the organogenesis (embryogenesis) period?

A. Days 1 to 14 postconception

B....

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