Medications in Pregnancy and Lactation

Abstract

One of the least-developed areas of clinical pharmacology and drug research is the use of medication during pregnancy and lactation. This article is the first in a two-part series designed to familiarize physicians with many aspects of the drugs they commonly prescribe for pregnant and breast-feeding women. Almost every pregnant woman is exposed to some type of medication during pregnancy. Although the majority of pregnant and breast-feeding women consume clinically indicated or over-thecounter drug preparation regularly, only few medications have specifically been tested for safety and efficacy during pregnancy. There is scant information on the effect of common pregnancy complications on drug clearance and efficacy. Often, the safety of a drug for mothers, their fetuses, and nursing infants cannot be determined until it has been widely used. Absent this crucial information, many women are either refused medically important agents or experience potentially harmful delays in receiving drug treatment. Conversely, many drugs deemed "safe" are prescribed despite evidence of possible teratogenicity. Novel research and diagnostic applications evolving from the opportunities presented by the advances in genomics and proteomics are now beginning to affect clinical diagnosis, vaccine development, drug discovery, and unique therapies in a modern diagnostic-therapeutic framework-part of the new scientific field of theranostics. This review critically explores a number of recently raised issues in regard to the use of several classes of medications during gestation and seeks to provide a general and concise resource on drugs commonly used during pregnancy and lactation. It also seeks to make clinicians more aware of the controversies surrounding some drugs in an effort to encourage safer prescribing practices through consultation with a maternal-fetal medicine specialist and through references and Web sites that list up-to-date information.

Treatment Considerations for Patients With Neuropathic Pain and Other Medical Comorbidities

“…Folic acid supplementation is recommended before conception and during pregnancy for mothers using certain antiepileptics (eg, carbamazepine) to decrease the risk of neural tube defects. 55 The lidocaine patch has not been studied in pregnancy; however, because its effect is local, systemic effects are presumed to be minimal. Nevertheless, this product should be used during pregnancy only if needed.…”

“…54 When pharmacotherapy is being considered during pregnancy and lactation, the crucial question is, Does the benefit of the drug outweigh its risks? 55 Experience with the use of drugs for NP during pregnancy is derived mainly from patients with epilepsy and severe depression. These conditions may be detrimental and even lifethreatening if untreated during pregnancy, which is not the case with NP.…”

Safety of disease-modifying drugs for multiple sclerosis in pregnancy: current challenges and future considerations for effective pharmacovigilance

“…Even when the drug is no longer detectable in the body, the biochemical and physiological effects of drugs on the body may persist such that harm to the fetus is still possible. In utero exposure at different stages of pregnancy with the same drug can result in different outcomes [54]. Pregnancy loss occurs most commonly during the first 2 weeks after conception, whereas congenital anomaly and impaired brain or growth development often occur later in pregnancy [54].…”

Micro Hardness of Dental Tissues Influenced by Administration of Aspirin During Pregnancy

“…Oral and dental structures are frequently the sites of adverse drug reactions (Seymour & Rudralingham, 2008). Almost every pregnant woman is exposed to some type of medication during pregnancy (Buhimschi & Weiner, 2009). It was also reported that drugs or physical agents can adversely affect the human teeth during their embryonic development and after their eruption into the oral cavity (Billings et al, 2004).…”