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KEY CONCEPTS

KEY CONCEPTS

  • image Complex physiology surrounds the process of fertilization and pregnancy progression.

  • image Drug characteristics and physiologic changes modify drug pharmacokinetics during pregnancy, including changes in absorption, protein binding, distribution, and elimination, requiring individualized drug selection and dosing.

  • image Although drug-induced teratogenicity is a serious concern during pregnancy, most drugs required by pregnant women can be used safely. Informed selection of drug therapy is essential.

  • image Healthcare practitioners must know where to find and how to evaluate evidence related to the safety of drugs used during pregnancy and lactation.

  • image Health issues influenced by pregnancy, such as nausea and vomiting, can be treated safely and effectively with nonpharmacologic treatment or carefully selected drug therapy.

  • image Some acute and chronic illnesses pose additional risks during pregnancy, requiring treatment with appropriately selected and monitored drug therapies to avoid harm to the woman and the fetus.

  • image Management of the pregnant woman during the peripartum period not only can encompass uncomplicated pregnancies/deliveries, but can also include a wide variety of potential complications that require use of evidence-based treatments to maximize positive maternal and neonatal outcomes.

  • image Understanding the physiology of lactation and pharmacokinetic factors affecting drug distribution, metabolism, and elimination can assist the clinician in selecting safe and effective medications during lactation.

PRECLASS ACTIVITY

Preclass Engaged Learning Activity

Search the Food and Drug Administration (FDA) website (https://tinyurl.com/2ujhjm) for “Pregnancy and Lactation Labeling Rule.” Choose one link to review and then summarize the key points about the new pregnancy and lactation labeling requirements. How do they differ from pregnancy categories? Do pregnancy categories still exist? This activity is useful to enhance student understanding about what type of pregnancy and lactation information to expect in drug product labeling.

PATIENT CARE PROCESS

Patient Care Process for the Management of Gestational Diabetes

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Collect

  • Patient characteristics (eg, age, race)

  • Characteristics of the pregnancy (eg, gestational age, gravidity and parity, weight gain to date)

  • Characteristics of previous pregnancy(ies) (eg, prior gestational diabetes, birth weight of previous children, unexplained fetal demise)

  • Patient history (past medical, family, social habits, physical activity habits, dietary discretion, her birth weight)

  • Current medications (including complementary or alternative therapies) and adherence to medication schedules

  • Social and cultural issues: preferences, values, and beliefs; health literacy

  • Physical exam: height, weight, body mass index (BMI), blood pressure, heart rate

  • Labs (A1C if at high risk, urine dipstick results for glucose, protein, and albumin)

Assess*

  • High-risk factors and need for early screening and diagnosis (see Table 95-2)

  • Screening and diagnostic testing between 24 and 28 weeks gestation (see Table 95-2)

  • Achievement of target fasting and 2-hour postprandial glucose goals

  • Efficacy and adherence to dietary modifications and current antihyperglycemic regimen and alternative therapies

  • Achievement of goals for comorbidities (eg, blood pressure)

  • Assess for depression, anxiety regarding treatment, dietary habits

  • Screen for psychosocial problems and barriers to diabetes self-management

Plan*

  • Set appropriate blood glucose goals based on age, comorbidities, and ...

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