7. Pregnancy

Question 1

Facteurs de risques (autres que lifestyle)

Answer 1

Age
Chronic medical problems
Medications known to be teratogens
Reproductive history
Genetic conditions/family history
Infection and vaccinations
Social and mental health concerns

Question 2

lifestyle risk factors

Answer 2

Smoking cessation
Weight control (under or overweight)
Avoid alcohol/drugs
Avoid consumption of undercooked meats and unpasteurized foods (risk of toxoplasmosis, CMV, listeria)
Avoid mosquito (clothing, repellents)
Environmental hazards/toxins (occupational, heavy metals, pesticides, Zika)

Question 3

Medications to stop during pregnancy (8)

Answer 3

1) Stop retinoids / Vitamin A >10,000 units/day (risk of malformations in T1)

2) Stop ACE-i/ARB (risk of fetal kidney disease in T2/T3)
Change to methyldopa, labetalol, calcium channel blocker (Nifedipine XL)

3) Stop oral anti-hyperglycemic
Consider metformin or glyburide

4) Stop warfarin (risk of malformations in T1)
Consider heparin/LMWH

5) PSY drugs
lithium (very low risk of Ebstein anomaly and malformations in T1)
Avoid valproic acid/anticonvulsants (risk of malformations in T1)

6) Antibio:
- Sulpha drugs and Trimethoprim (anti-folate risk in T1, and kernicterus in T3)
- tetracycline (bone development, teeth staining)

7) NSAIDs (cardiac defects, spontaneous abortion)
Risks of untreated depression often outweigh risks of antidepressants

8) antidepressants
ok if outweights risks
paroxetine worst

Question 4

Stop ACE-i/ARB and change to what

Answer 4

Change to
methyldopa, labetalol, calcium channel blocker (Nifedipine XL)

Question 5

Recommend fwomen to take whatg and dose

Answer 5

Folic acid 0.4-1mg/d (high risk 5mg daily)