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KEY CONCEPTS

KEY CONCEPTS

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

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

  • image Although medication-induced teratogenicity is a serious concern during pregnancy, most medications can be used during pregnancy. Healthcare providers need to evaluate the risk of the medication with the risk of the untreated condition. Informed selection of pharmacotherapy is essential.

  • image Healthcare practitioners must know where to find and how to evaluate evidence related to medications used during pregnancy and lactation.

  • image Acute pregnancy issues, such as nausea and vomiting, can be treated with nonpharmacologic treatment or carefully selected pharmacotherapy.

  • image Some acute and chronic illnesses pose additional risks during pregnancy, requiring treatment with appropriately selected and monitored pharmacotherapies to minimize risk to the fetus and pregnant individual.

  • image Management of the pregnant individuals 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 outcomes.

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

BEYOND THE BOOK

BEYOND THE BOOK

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 understanding about what type of pregnancy and lactation information to expect in medication product labeling.

PATIENT CARE PROCESS

Patient Care Process for the Management of Gestational Diabetes

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Collect

  • Patient characteristics (eg, age, race, gender identity, biological sex, pregnancy status)

  • 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, and dietary discretion)

  • 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 (urine dipstick results for glucose, protein, and albumin)

Assess*

  • Risk factors and need for early screening and diagnosis (see Table 99-2)

  • Screening and diagnostic testing between 24 and 28 weeks gestation for all; first trimester testing for high-risk patients (see Table 99-2)

  • Achievement of target fasting and 1- or 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 ...

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