+ Prescribing in pregnancy often causes

uncertainty and anxiety for the clinician and may lead to the omission of necessary treatment + Teratogenicity refers to the potential for a drug to cause fetal malformations and affects the embryo 3-8 weeks after conception. structural. Eg : thalidomide + Fetotoxicity refers to the functional changes that can occur to the fetus as a result of medication in the second and third trimesters. functional. eg : NSAID

+ The aim when prescribing in pregnancy (or

in anticipation of pregnancy) is to balance the risks of the potential adverse effects of the drug (usually to the fetus) with the benefit (usually to the mother) of treating the disease.

+ Cardiovascular disease Hindari ACE Inhibitor! Methyldopa dan labetolol aman. Hidralazine dapat digunakan iv. + Asthma Steroid dan salbutamol (ventolin) inhaler aman. Aminofilin kemungkinan aman.

+ Epilepsy
Review indication for medication. For example, if childhood epilepsy and seizure-free for many years, may be appropriate to consider dose reduction or withdrawal. BUT remember that withdrawal or changing antiepilepticmedication necessitates stopping driving. All anti-epileptic drugs (AEDs) are known to increase the risk of congenital malformations. But the majority of women taking AEDs give birth to healthy babies. Start 5 mg folic acid at least 6 weeks before conception and continue for at least the first trimester. Monotherapy is less teratogenic than polytherapy. Sodium valproate is considered particularly teratogenic Poorly controlled epilepsy is potentially dangerous for the mother and fetus.

+ Depression Mild-moderate depression: psychological therapy alone if possible. When medication is deemed necessary, consider a tricyclic antidepressant (amitriptyline) + Thyroid disease Hypothyroidism: most women will require an increase in their thyroxine dose to maintain adequate thyroxine levels and mimic the pregnancy. Adequate intake of iodine is also important. Hyperthyroidism: avoid radioisotopes. If antithyroid medication is required, propylthiouracil (PTU) is preferred to carbimazole.

+ Diabetes mellitus Establish tight glycaemic control before conception Weight loss before conception for overweight women with type 2 diabetes or previous gestational diabetes Start folic acid 5 mg daily before conception. Insulin requirement increases during pregnancy. + Rheumatic disease Analgesia : paracetamol is safe. Avoid NSAIDs, especially in third trimester. Prednisolone is safe, although caution is needed at high doses where it has been implicated in occurrence of premature rupture of membranes. Methotrexate and cyclophosphamide are contraindicated in pregnancy because of their teratogenic potential.

+ Antibiotics The full adult dose and length of treatment should be given. Serious infections should be treated aggressively. Penicillins and cephalosporins are considered safe. Use higher-dose regimens as they are cleared more quickly because of the increase in GFR in pregnancy. Avoid aminoglycosides (eg, gentamicin) for minor infections because of theoretical risk of neonatal ototoxicity seen with streptomycin. Avoid tetracyclines, they cause discolouration and dysplasia of bones and teeth. Chloramphenicol is safe topically but avoid other routes of administration as associated with grey baby syndrome.

< British National Formulary < UK Teratology Information Serviced http://www.uktis.org < Organisation of Teratology Information Specialists (OTIS) http://www.otispregnancy.org < Food and Drug Administration http://www.fda.gov < Weiner C, Buhimschi C. Drugs for Pregnant and Lactating Women. Saunders, 2009 (second edition) < Hale TW. Drug Therapy and Breast Feeding: From Theory To Clinical Practice. Parthenon Publishing Group, 2002. < Thomas Hale s website http://neonatal.ama.ttuhsc.edu/lact/