Anda di halaman 1dari 8

Drugs Use In Pregnancy

ANALGESICS AND ANTIINFLAMMATORY DRUGS


DRUGS
Acetaminophen
Aspirin

Indomethacin

Ibuprofen
Diclofenac

Piroxicam

FDA PREGNANCY
CATEGORIES
B

NATURE OF EFFECT

Acetaminophen is analgesic-antipyretic of choice for use near


term.
rd
C (D if full-dose aspirin in 3 Maternal aspirin use late in gestation can cause increased
trimester)
bleeding at delivery and delay the onset of labor.
Neonatal prolong constriction of ductus arteriosus, pulmonary
hypertension, platelet function, bleeding, intracranial
hemorrhage.
B (D if use long term than 48 Premature closure of ductus arteriosus, neonatal pulmonary
hrs or after 34-week
hypertension.
gestation)
B (D if use in the 3rd
Similar to aspirin and indomethacin.
trimester)
BM (D if use in the 3rd
Inhibition of labor, prolongation of pregnancy and suppression of
trimester)*
fetal renal function. If use in the 3rd trimester close to delivery,
persistant pulmonary hypertension of the newborn may occur.
B (D if use in the 3rd
Inhibition of labor, prolongation of pregnancy. If use in the 3rd
trimester)
trimester close to delivery, persistant pulmonary hypertension of
the newborn may occur.

ANTICOAGULANTS
DRUGS
Heparin

FDA PREGNANCY
CATEGORIES
C

Warfarin

ANTICONVULSANTS
DRUGS
FDA PREGNANCY
CATEGORIES

NATURE OF EFFECT
Heparin is usually the drug of choice for anticoagulation during
pregnancy, especially during the 1st trimester and intrapartum.
Warfarin may produce the Fetal Warfarin Syndrome or Warfarin
Embryopathy include nasal hypoplasia, neonatal respiratory
distress, axial skeleton and proximal femur are affected,
spontaneous abortion, stillbirths, CNS defects.
NATURE OF EFFECT

Phenytoin

Sodium
valproate
Carbamazepine
Phenobarbital

D
C
D

Mild-to-moderate growth deficiency , wide anterior fontanelle,


hypertelorism, depressed nasal bridge, short nose with bowed
upper lip, cleft lip and palate, hypoplasia of distal phalanges with
small nails, digitalized thumb, short neck, rib anomalies,
hirsutism, pulmonary or aortic valvular stenosis, ventricular
septum defects.
High forehead, epicanthal folds, broad nasal bridge, long
philtrum, small mouth, cleft lip, neural tube defect, hypospadias.
Craniofacial defect, neural tube defects.
Cleft lip and palate, cardiac defects.

ANTIMICROBIAL DRUGS
DRUGS
Penicillins
Cephalosporins
Erythromycin

Aminoglycoside
s
Chloramphenic
ol
Tetracyclines

Fluoroquinolone
s
(e.g.
Ciprofloxacin,
Norfloxacin,
Ofloxacin)
Sulfonamides
(e.g.
Sulfadiazine )

FDA PREGNANCY
CATEGORIES
B
B
B

C
C

D; B (topical)

B (D at term)

NATURE OF EFFECT
Penicillins are without teratogenic risk.
Cephalosporins are thought to be without teratogenic risk.
Pregnant women are at increased risk for hepatotoxicity caused
by erythromycin estolate. There is no evidence that erythromycin
is harmful to the fetus.
Congenital hearing loss, deafness.
Risk for development of blood dyscrasias and aplastic anemia.
Particular caution should be exercised near term because the
Gray Baby syndrome is resulted.
Tetracyclines have been reported to cause congenital
abnormalities, particularly staining of the teeth and retardation of
the developing skeletal system.
Fluoroquinolones were shown to cause erosion of the cartilage
and other arthropathies in fetuses. These drugs should not be
used in pregnancy.

Evidence associating sulfonamide use near term with


hyperbilirubinemia, hemolytic anemia (in G-6-PD deficiency),
competition of albumin site-neonatal kernicterus.

Co-Trimoxazole

Metronidazole

BM*

Do not use at term to avoid kernicterus in the new born and use
during pregnancy only if risk outweigh the benefits since folic
acid metabolism may be effected.
The manufacturer and the Centers for Disease Control (CDC)
consider metronidazole to be contraindicated during 1st trimester
in patients with trichomoniasis. Use for trichomoniasis during the
2nd and 3rd trimester may be acceptable if alternate therapies
have failed.

CARDIOVASCULAR DRUGS
DRUGS

FDA
PREGNANCY
CATEGORIES

NATURE OF EFFECT

-Amiodarone

-Digoxin

Neonatal hypothyroidism with or without goiter, as well as


hyperthyroidism.
Digoxin is not a teratogen. It may be given to pregnant women to
treat fetal CHF and supraventricular tachycardia. Maternal
digitalis toxicity has been associated with fetal toxicity.

Antiarrhythmics

-Adrenergic blocking
agents
-Atenolol
-Pindolol
-Metoprolol
-Propranolol

Angiotensin-converting
enzyme (ACE)
inhibitors
(e.g. Captopril, enalapril,
lisinopril, fosinopril)

C
B
B
C

These agents are thought to be generally safe in pregnancy but


these have also been associated with intrauterine growth
retardation and neonatal hypoglycemia and hypotension.

Fetal abnormalities, including death can be caused and these


drugs should not be used in pregnancy.

A small, transient decrease in uterine activity occurred with all

Calcium channel
blocking agents
(e.g. Nifedipine, diltiazem,

verapamil)

doses.

Diuretics
-Hydrochlorothiazide
(HCTZ)
-Furosemide

B
C

-Amiloride 5 mg.+ HCTZ


50 mg.
(Moduretic)

BM*

Isosorbide dinitrate

CM*

Hydralazine

Methyldopa
Reserpine

B (oral); C (IV)
C

Neonatal hypoglycemia, hyponatremia, hypokalemia and


thrombocytopenia.
Crosses the placenta. Increases fetal urine production, electrolyte
disturbances reported.
Animal studies using amiloride alone had not shown adverse
effects in the fetus but in human studies some newborns had
hypospadias, renovascular hypertension.
No reports on the use in human pregnancy. If produces
embryotoxicity in rabbits.
Hydralazine is the parenteral drug of choice used in pregnancy.

Antihypertensive of choice used in pregnancy.


Produces edema of the nasal mucosa in the neonate,
hypothermia and bradycardia.

GASTROINTESTINAL DRUGS
DRUGS

FDA
PREGNANCY
CATEGORIES

NATURE OF EFFECT

The safety of antacid use during the 1st trimester of pregnancy


has not been established. 2nd and 3rd trimester use appears to be
without adverse effects.

Antacid
-Magnesium hydroxide
-Aluminium hydroxide
-Sucralfate

Antiulcer
H2-blocker
-Cimetidine
-Famotidine
-Ranitidine
-Nizatidine

Proton-Pump Inhibitor
-Omeprazole

C
B

Sucralfate is poorly absorbed and no adverse effects to the fetus


have been reported.

B
B
B
C

Crosses the placenta. Available evidence suggests safe use


during pregnancy and breast-feeding.

CM*

Severe congenital anomalies; anencephaly, severe talipes in


human. Long term high dose consumption was carcinogenic in
rats, producing gastrointestinal tumors.

Laxative
-Bulk laxatives
(psyllium)
- Mineral oil
- Castor oil
Metoclopramide

These are agent of choice.

C
X
B

Mineral oil should be avoided.


Castor oil may cause pelvic congestion.
Crosses the placenta. Available evidence suggests safe use
during pregnancy and breast-feeding.

SEDATIVE AND HYPNOTICS


DRUGS
Benzodiazepines
(e.g. Clorazepate,
Diazepam, Lorazepam)
Phenobarbital

FDA PREGNANCY
NATURE OF EFFECT
CATEGORIES
D
Neonatal depression, apnoeic spells, floppy baby syndrome
(muscular relaxation, poor sucking, disturbances in
thermoregulation and regurgitation), withdrawal symptom.
D
Neonatal depression, neonatal feeding difficulties, neonatal
bleeding, withdrawal symptom.

ANTIDIABETIC AGENTS
DRUGS
Sulfonylureas (e.g.
Chlorpropamide,
glyburide, glipizide)
Biguanides (e.g.
Metformin)
Insulin

FDA PREGNANCY
CATEGORIES
C

B
B

NATURE OF EFFECT

May cause prolonged hypoglycemia or hyperinsulinism in the


newborn.
Does not cross the placenta. Insulin is the drug of choice for the
control of diabetes mellitus during pregnancy.

SEX HORMONE
DRUGS

FDA PREGNANCY
NATURE OF EFFECT
CATEGORIES
Diethyl Stilbestrol (DES)
X
DES causes a number of reproductive tract abnormalities in both
female and male offspring exposed in utero.

Estradiol
Progesterone

X
X ; B (oral capsules
per manufacturer)

Vaginal adenosis, Feminization of male fetus, hypotrophic testis,


abnormal spermatogenesis, epididymal cyst.
It may produces the VACTERL syndrome (vertebral, anal,
cardiovascular, tracheal, esophageal, renal and limb defects)

RESPIRATORY DRUGS
DRUGS
Antitussives
-Codeine

-Dextromethorphan

FDA PREGNANCY
CATEGORIES

NATURE OF EFFECT

C (D if used for
prolonged periods
or in high dose at
term)
C

Typical symptoms of narcotic withdrawal were noted in the infants


shortly after birth but not in the mother.

Toxicity in the fetus and newborn after the use of


dextromethorphan.

Bronchodilators
-Aminophylline
-Theophylline

C
C
BM*

-Terbutaline

Theophylline is the bronchodilator of choice for asthma and


COPD in the pregnant patient but should have theophylline
concentration monitored frequently for dosage adjustments.
Only rare reports of serious toxicity in the fetus or newborn have
appeared.

ANTIHISTAMINES AND NASAL DECONGESTANTS


DRUGS
FDA PREGNANCY
NATURE OF EFFECT
CATEGORIES
Chlorpheniramine
B
These agents use during pregnancy has not been associated
Cetirizine
B
with an increase risk of fetal malformation.
Loratadine
B
Diphenhydramine
B
Dimenhydrinate
B
Pseudoephedrine
C
Some study shown about six major birth defect categories:
cardiovascular defects, oral clefts, spina bifida, polydactyly, limb
reduction defects and hypospadias.
Tripolidine
CM*
Cardiovascular, spina bifida, polydactyly and limb reduction
defects.

MISCELLANEOUS
DRUGS
Smoking

Caffeine
Alcohol

Isotretinoin
Lithium
Corticosteriods

FDA PREGNANCY
NATURE OF EFFECT
CATEGORIES
X
Increased Perinatal Risk: Spontaneous abortion, Preterm birth,
Intrauterine growth restriction/small for gestation age 100 to 320
g. reduction in expected birthweight
Increased Postnatal Risk: Small head circumference; decreased
auditory, language and cognitive performance; low IQ; increased
incidence of asthma, bronchitis, pneumonia; increased risk of
sudden infant death syndrome.
Should be avoided High dose (>7 cups/day); low birth weight(<2,500 g.),
neurological impairment, growth retardation.
X
Fetal Alcohol Syndrome includes Intrauterine Growth Retardation
(IUGR), microcephaly, postnatal growth deficiency,
developmental delay, mental retardation and craniofacial
anomalies.
X
Isotretionin is potent teratogen (e.g. CNS, cardiac anomalies,
facial abnormalities, deafness and blindness)
D
Neonatal hypotonia, poor sucking power, diminished reflexes for
days.
C
When appropriate, corticosteroids can be administered by
aerosol inhalation or intrasynovial injection to minimize systemic
availability. Corticosteriods use during pregnancy may cause an
increased risk for maternal gestation diabetes, hypertension, and
excessive weight gain.

FDA Pregnancy Categories


A studies in pregnant woman, no risk.
B animal studies no risk, but human not adequate
or animal toxicity but human studies no risk.
C animal studies show toxicity, human studies inadequate but benefit of use may exceed
risk.
D evidence of human risk, but benefit may outweigh.
X fetal abnormalities in humans, risk > benefit: contraindicate in pregnant women.
*Category with a subscript M (e.g., CM) refers to the risk factor that the manufacturer rated its product in its
professional literature.

References
Barbara GW, Joseph TD, Terry LS, Cynthia WH. Pharmacotherapy Handbook. 2nd ed.
Stamford (CT): Appleton & Lange; 2000.
Charles FL, Lora LA, Morton PG, Leonard LL. Drug Information Handbook. 8th ed.
Hudson (OH):
Lexi-Comp; 2000-2001.
Gerald GB, Roger KF, Sumner JY. Drugs in Pregnancy and Lactation. 5th ed. Baltimore (MD): Lippincott
Williams & Wilkins; 1998.
Philip OA, James EK. Handbook of Clinical Drug Data. 8th ed. Stamford (CT): Appleton & Lange; 19971998.
Robert JB. Effects of Certain Prenatal Drugs on the Fetus and Newborn. Pediatrics in Review 2002 Jan; 23(1):
17-23.

Anda mungkin juga menyukai