Clinical management of medications in pregnancy and lactation

Abstract

Prescription and over the counter medication use during pregnancy and lactation is exceedingly common. There are many available resources to gather information and guide patient counseling. These include primary literature, online resources, professional society recommendations, and the drug label. One must consider both disease and drug characteristics when making decisions on medication use during pregnancy and lactation. Providers can then use this information to balance the risks of fetal or neonatal exposure against the potential benefits of maternal treatment and the risks of untreated disease.

Vigilance on use of drugs, herbal products, and food supplements during pregnancy: focus on fosfomycin

“…Current evidence and epidemiological data indicate that women take at least one prescription drug during pregnancy in a range between 65-94 %. Nearly 70% of women generally take a medication in the first trimester during organogenesis [15,16]. Antibiotics result to be about the 80% of all J U S T A C…”

Transfer of antibiotics and their metabolites in human milk: Implications for infant health and microbiota

“…These fact sheets are currently available on the MotherToBaby website (https://mothertobaby.org/fact-sheets/) and will soon be available in the National Library of Medicine. The Infant Risk Center has also created other user‐friendly tools, including the MommyMeds app, although much of this information is currently behind a paywall 89 . These improvements are encouraging, but are too often buried in the vast amount of information available online.…”

Pharmacological treatment of bipolar disorder.

“…Additionally, special considerations must be made for women of childbearing age within the context of pregnancy and breastfeeding (Payne, 2017). Preconception counseling is recommended to evaluate treatment options prior to becoming pregnant (Temming, Cahill, & Riley, 2016). Adequate discussion and planning may allow for folate supplementation and, if needed, medication changes prior to conception to minimize risk of teratogenicity.…”

“…Anticonvulsants pose a greater risk and are usually advised against in women planning to become pregnant, as valproate and carbamazepine are associated with significantly elevated risk of fetal neural tube defects (Tomson et al, 2011). Conversely, anticonvulsants are frequently used during lactation as a relatively safe option with added monitoring of the newborn, with monitoring of infant blood levels if concerns arise (Temming et al, 2016).…”