Drugs Used

in Pregnancy

Prepared byMohammad Alauddin

Pharmacist – United Hospital LTD.

MEDICATION DURING PREGNANCY

During pregnancy, some medications are safe and some are not. Some require a higher than usual dose, and some doses change with the advancing pregnancy. Drugs should be given only if the potential benefit justifies the potential risk to the fetus."

CATEGORIES

The pregnancy category of a drug is  an  assessment  of  the  risk  of fetal injury occurred by that drug.

CATEGORIES

The  U.S.  Food  and  Drug Administration  has  generated  a grading  system  for  medications used  during  pregnancy.  The categories  are  A,  B,  C,  D,  and  X. The  significance  of  these categories are :-

CATEGORY ADefinitions

Drugs  that  have  been  tested  for safety during pregnancy and have been found to be safe. 

CATEGORY AClinical Application

For  all  practical  purposes,  there  are no  Category  A  drugs.   Drugs,  and some multivitamins This includes folic acid,  vitamin  B6,  and  thyroid medicine classified as Category A.

CATEGORY BDefinitionsDrugs  that  have  been  used  a  lot during pregnancy and do not appear to cause major birth defects or other problems.

CATEGORY BClinical Application

• Category  B  drugs  include  vitamins, acetaminophen  (Napa),  famotidine (famotid),  prednisolone  (cortan), insulin  (for  diabetes),  and  ibuprofan (inflam)  before  third  trimester, ibuprofen should not take during the last three months of pregnancy.

CATEGORY CDefinitions

• Drugs  that  are  more  likely  to  cause problems for the mother or fetus. Also includes drugs for which safety studies have  not  been  finished. Drugs should be given only if the potential benefit justifies the potential risk to the fetus.

CATEGORY CClinical Application

• There  are  some  reasons  to  be  more concerned  about  these  drugs  than Category B drugs. If the pregnant patient will benefit from a Category C drug, it  is generally  used.  These  drugs  include fluconazole  (Fluda),  and  ciprofloxacin (Xirocip), some antidepressants are also included in this group.

CATEGORY DDefinitions

• Drugs that have clear health risks for the  fetus.  but  the  benefits  from  use in  pregnant  woman  may  be acceptable  despite  the  risk  (e.g.,  if the  drug  is  needed  in  a  life-threatening situation or for a serious disease.)

CATEGORY DClinical Application

• Category  D  drugs  includes  -  alcohol, lithium  (used  to  treat  manic depression),  phenytoin  (eptoin),  and most  chemotherapy  drugs  to  treat cancer.  They  should  be  used  during pregnancy  only  when  no  alternatives available.

CATEGORY XDefinitions

• Drugs  that  have  been  shown  to cause  birth  defects  and  should never  be  taken  during  pregnancy. The  drug  is  contraindicated  in women  who  are  or  may  become pregnant."

CATEGORY XClinical Application

• Category  X  drugs  should  not  be  used during pregnancy. This  includes drugs to treat  skin  conditions  like  cystic acne (Accutane), a sedative (thalidomide) etc.

COMMONLY USED DRUGS IN PREGNANCY AND THEIR CATEGORIES

Drugs Categories

Analgesics and Antipyretics (zydol)

B and C

Acetaminophen(Napa)  B

Phenacetin(vicks)  B

Aspirin(Ecosprin) C

Antiemetics(Emistat) B and C

Doxylamine(gestrenol)  B

Meclizine(emezin) B

COMMONLY USED DRUGS IN PREGNANCY AND THEIR CATEGORIES

Drugs Categories

Cyclizine(marezine) B

Dimenhydrinate(pedeamine)  B

Antibiotics B, C and DPenicillin, Ampicillin, 

Amoxycillin, B

Cloxacillin Cephalosporins  B

Erythromycin(erocine) B

Gentamicin(gentin) C

COMMONLY USED DRUGS IN PREGNANCY AND THEIR CATEGORIES

Drugs Categories

Amikacin(kacin) C/D

Streptomycin D

Sulphonamides(burnsil) B/D

Tetracyclines(tetrax) D

Amoebicides(Filmet)

Anthelmentics -

COMMONLY USED DRUGS IN PREGNANCY AND THEIR CATEGORIES

Drugs Categories

Albendazol B

Mebendazole  B

Antimalarials C

Antifungals C

Anti TB Drugs B and CEthambutol  B

INH  C

COMMONLY USED DRUGS IN PREGNANCY AND THEIR CATEGORIES

Drugs Categories

Pyrazinamide  C

Vitamins -

B,C,D,E,folic acid  A

Hormones -

Thyroxin  A

Androgens  X

Estrogens  X

COMMONLY USED DRUGS IN PREGNANCY AND THEIR CATEGORIES

Drugs Categories

Progestogens -

Hydroxyprogestrone  D

Medroxyprogestrone  D

Norethindrone  X

Norgestrel  X

Bronchodilators  C

COMMONLY USED DRUGS IN PREGNANCY AND THEIR CATEGORIES

Since it is not a complete list, patients are advised to check the drug label of each drug before taking them during pregnancy.

SAFE MEDICATION TO TREAT DURING PREGNANY

• Allergy Benadryl (diphenhydramine).

• Cold and Flu Tylenol (acetaminophen)      Saline nasal drops or spray     Warm salt/water gargle

• Constipation Colace        Metamucil

SAFE MEDICATION TO TREAT DURING PREGNANY

• First Aid OintmentBacitracinJ&J First-Aid CreamNeosporinPolysporin.

• RashesBenadryl creamCaladryl lotion or creamHydrocortisone cream or ointment.

WHAT CAN I EAT IF I AM NOT FEELING WELL?

Pregnancy symptoms vary.Some  woman  may  have  difficulty with  morning  sickness,  diarrhea,  or constipation.  Here  are  a  few suggestions  on  how  to  deal  with these symptoms.

Morning sickness For morning sickness, try eating crackers, before you get out of bed. Eat small meals more frequently throughout the day. Avoid fatty, fried foods.

Constipation Increase your fiber intake by eating high fiber  and  fresh  fruits  and  vegetables. Also, make sure you are drinking plenty of water - at least eight glasses per day.

Diarrhea  Increase your intake of foods containing pectin  and  gum  fiber  to  help  absorb excess  water.  Good  choices  include: applesauce, bananas, white rice, refined wheat bread, and smooth peanut butter.

Heartburn Eat small frequent meals throughout the day.  Try  drinking  a  glass  of milk  before your meal. Avoid caffeine. Try not to  lie down after eating a meal.

MEDICATIONS SAFE IN PREGNANCY

• Some antibiotics namely  Amoxycillin,  Ampicillin, Cephalosporins, Erythromycin.

• Levothyroxine.• Acetaminophen.• Folic Acid and Vitamin B6.• Methyl dopa, and hydralazine.• Insulin.• Heparin.

MEDICATIONS CONTRAINDICATED IN PREGNANCY

• Some drugs in category X that are contraindicated in  pregnancy  and  their  effects  on  the  fetus  are listed below:-

• Vitamin A and its derivatives - Accutane(Isotretinoin), can cause Birth defects.

• Thalidomide –          Seal like limbs and other defects.

MEDICATIONS CONTRAINDICATED IN PREGNANCY

• Diethylstilbestrol –                  Causes cancer of the vagina or cervix in female children during their teenage years.

• Warfarin (Warin) –                  Causes multiple birth defects.

• Danazol (Danzol) –                Causes malformations in sex organs of female fetus.

MEDICATIONS CONTRAINDICATED IN PREGNANCY

• Simvastatin (Avastin)and other statins – Cholesterol is needed for fetal growth and its reduction by statins could harm the fetus

• Finasteride (pronor) – Though finasteride is normally not prescribed to women, pregnant women should not handle broken or crushed tablets since it can get absorbed through the skin and affect the sex organ.

MEDICATIONS CONTRAINDICATED IN PREGNANCY

• Testosterone (Testanon) –         Can cause birth defects.

• Oral contraceptives- Can cause birth defects.

• Dutasteride (Urodart) –              Affects the sex organ development of the fetus.

• Methotrexate (Trexonate)– Causes cleft palate along with multiple defects.

MEDICATIONS CONTRAINDICATED IN PREGNANCY

• Aspirin –   Aspirin  and  other  drugs  containing salicylate  are  not  recommended  during pregnancy, especially during the last three months.  Acetylsalicylate,  a  common ingredient  in  many  OTC  painkillers,  may make  a  pregnancy  last  longer  and  may cause  severe  bleeding  before  and  after delivery.

(PDA)- failure of closure of ductus Arteriosus usually present in every fetus before birth, infants after birth.

NSAIDs causes patent ductus arteriosus (PDA).

NSAID induced patent ductus arteriosus

Ebstein’s anomaly - congenital heart defect in which the opening of the

tricuspid valve is displaced towards the right in fetus of the pregnant

women.

Lithium salts (Lithosan SR) causes

Ebstein's anomalyCongenital heart defect in which the opening of the

tricuspid valve is displaced towards the right

Phocomelia (limb deformities)- results in various abnormalities to the face, limbs, ears, nose, vessels and many other in fetus of the pregnant women.

Thalidomide causes

Thalidomide caused Phocomelia

Folic acid deficiency caused Neural tube defects.

(Spina bifida, Encephaly,

Encephalocele)

Valproic acid(epilim) causes decreased absorption of Folic acid and leads to deficiency

of folic acid which may results in neural tube defects in the fetus.

Spina bifidaSpina bifida is a developmental congenital disorder caused by the incomplete closing of the embryonic neural tube Some vertebrae overlying the spinal cord are not fully formed and remain infused and open.

EncephalyAnencephaly (without brain) is a neural tube defect that occurs when the head end of the neural tube fails to close, usually during the 23rd and 26th days of pregnancy.

EncephaloceleEncephaloceles  are characterized by the skull that are sac-like and covered with membrane. They can be a groove down the middle of the upper part of the skull, between the forehead and nose, or the back of the skull.

Paroxetine (oxat) (Selective serotonin re-uptake

inhibitor).

Causes cardiac defects.

Paroxetine causes

cardiac defects in fetus

Alcohol induced Fetal Alcohol Syndrome

Fetal alcohol syndrome (FAS) is a pattern of mental and physical defects that can develop in a fetus in association with high levels of alcohol consumption during pregnancy. Alcohol crosses the placental barrier and can stunt fetal growth or weight, create distinctive facial stigmata, damage neurons and brain structures, which can result in psychological or behavioral problems, and cause other physical damage.

Valproic acid induced Fetal Valproate Syndrome

Valproate syndrome include facial features, tall forehead, medial deficiency of eyebrows, lat nasal bridge, broad nasal root. Valproic acid is contraindicated in pregnancy, as it decreases the intestinal reabsorption of folate (folic acid), which leads to neural tube defects. 

Children exposed to carbamazepine(tegretol)

If taken by a pregnant mother, Carbamazepine can cause birth defects that include:- cardiovascular and urinary tract anomalies, cleft palate, fingernail hypoplasia, developmental delays, and intrauterine growth restrictions.

Phenytoin induced Fetal Hydantoin Syndrome

Fetal hydantoin syndrome, also called fetal dilantin syndrome is a group of defects caused to the developing fetus by exposure to the teratogenic effects of phenytoin or carbamazepine.

Fetal hydantoin syndrome

Fetal hydantoin syndrome

Busulfan and chlorambucil (chemotherapy) induced cleft palate

Opoid analgesic induced

Drug withdrawal syndromes

Drug withdrawal syndromes

Isotretinoin (Vitamin A derivative)induced

Fetal defects

Fetal defects

Smoking Induced

Fetal defects like Cleft palate,

Premature births,Low birth weight,

Abortions.

Smoking Induced

Your care during pregnancySpares the life of fetus.

Why should fetus suffer For The mistakes of the

negligent mother.

If you want to a fetus free from Birth defects, plan your pregnancy in

advance. If you do not plan, at least Take folic acid as a routine Supplementation and save the baby from birth defects

Once you know that you are pregnant,

stop taking drugs that you already taking and consult Physician if want to continue

the same treatment , Unless otherwise, it is considered

as an emergency, do not take any medication. If you want to take, consult physician.

Please remember Your wealth of knowledge

regarding drug use in pregnancy,

Is the ultimate health of your fetus

God is the wonderful creator of fetus

Mother is a guard of health of the fetus

Gynecologist is the guide of the mother

This Presentation is Dedicated to My Mother

Thank you