- Physiologic changes modify drug pharmacokinetics during pregnancy, including changes in absorption, protein binding, distribution, and elimination, requiring individualized drug selection and dosing.
- 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.
- Healthcare practitioners must know where to find and how to evaluate evidence related to the safety of drugs used during pregnancy and lactation.
- Pregnancy-influenced health issues, such as constipation, gastroesophageal reflux disease, and nausea/vomiting, can be treated safely and effectively with nonpharmacologic treatment or carefully selected drug therapy. 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.
- 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.
Upon completion of the chapter, the reader will be able to:
- 1. Discuss drug distribution alterations and factors affecting transplacental drug transfer in pregnant women.
- 2. Recommend appropriate use of folic acid to prevent or minimize the occurrence of neural tube defects.
- 3. Design appropriate treatment regimens for pregnancy-influenced acute care problems, given patient-specific information.
- 4. Compare and contrast treatment options for hypertension and preeclampsia, given patient-specific information.
- 5. Recommend appropriate treatment for pregnant patients with acute urinary tract infections and sexually transmitted diseases.
- 6. Debate the merits of providing acyclovir during the last month of pregnancy to women with a history of genital herpes.
- 7. Choose an appropriate pharmacologic agent for the treatment of migraine headache in pregnant women.
- 8. Develop treatment regimens for pregnant women with asthma based on the severity of the disease.
- 9. Recommend medications for hypertension in pregnancy and medications that should generally be avoided.
- 10. Construct appropriate antiretroviral treatment regimens for women with human immunodeficiency virus type 1 (HIV-1) during pregnancy, labor, and delivery.
- 11. Devise a strategy to ensure that a lactating mother can receive appropriate pharmacotherapy while minimizing the risk to the infant.
- 12. Compare and contrast the side-effect profiles of medications used for tocolysis.
- 13. Compare the safety and efficacy of agents used for cervical ripening and induction.
- 14. Discuss the advantages and disadvantages of parenteral opioids and epidural analgesia for labor pain.
- 15. Describe indications for administration of antibiotics for treatment of group B Streptococcus infections during pregnancy.
- 16. Formulate appropriate treatment regimens for (a) breastfeeding women, recognizing characteristics that influence drug transfer into breast milk; and (b) women with postpartum complications including mastitis and depression.
Drug use in pregnancy and lactation is a topic often underemphasized in the education of health professionals. Drug use in pregnancy and lactation is a controversial and emotionally charged area because of medicolegal and ethical implications.
Clinicians are responsible for ensuring safe and effective therapy before conception, during pregnancy and parturition, and after delivery. Active patient participation ...