Perinatal Exposure to CNS-Active Medications

The necessity of regional DOHaD centers based on programming/imprinting and embedding-like phenomena

“…[21,22] However, the main factor explaining this peculiarity of developing mammals appears to be high liposolubility of PNT drugs and corticosteroids that facilitates their passage both through placenta and blood-brain barrier. [22,23] On the other hand, it is important that PNT drugs interact with hormones. For example, phenobarbital in-31 teracts with dexamethasone in regulation of alpha1-acid glycoprotein production by hepatocytes; [24] in addition, it interferes with hepatic metabolism of sex steroids, resulting in alterations of growth hormone secretion, [25] whereas benzodiazepines provoke the diminution of the activity of hypothalamo-pituitary-adrenal axis, [26] and on the contrary, phenytoin is capable to enhance corticosterone secretion in mice.…”

Basic Principles

“…Because the placental barrier between mother and fetus is permeable to many types of substances, medications taken by the mother during pregnancy can injure especially the brain of the unborn child. It follows that pregnant women should restrict their ingestion of medications to a necessary minimum and be discouraged from self-medication (for review see Ashton 1981;Simar 1999). Some other types of medical intervention during pregnancy, such as amniocentesis, entail a risk of brain injury as well as death to the fetus (Keeling 1993b).…”

“…5. Does an isolated head injury warrant cervical spine evaluation(Laham et al 1994)?Perinatal exposure to CNS-active medications and errors in dosage or type of medication are especially problematic in pediatric therapy(Folli et al 1987;Simar 1999;Kaushal et al 2001; Committee on Drugs and Committee on Hospital Care 2003) Kaushal et al (2001). detected 616 medication errors among 10,778 prescriptions by physicians (=5.7%), 26 resulting in adverse drug reactions.…”