Class 11- pregnancy Flashcards
FETAL AGE
- Calculated from the day of fertilization, difficult to determine
- Used in research
GESTATIONAL AGE
- Date of the first day of the last menstruation period (LMP)
- Used in clinical practice
Implementation and pre-differentiation
(weeks 1-2)
• Fertilization and implantation
• Teratogen drugs do not cause malformations at this stage
• If impact = spontaneous abortion
Embryonic period
(weeks 3-9)
• Organogenesis, organ formation at different times
• Maximum sensitivity to teratogenic drugs, critical period for structural abnormalities
Fetal period
(weeks 10-40)
• Functional growth and maturation of organs and systems
TERATOGENIC EXPOSURE
- Exposure that has the ability to alter normal embryonic or fetal development
- Infectious agents, drugs, chemicals, agents found in the environment (e.g. lead), physical agents (e.g. radiation), trauma.
Congenital abnormalities
Metabolic, morphological or functional abnormality present at birth that is fatal or causes physical or mental disability
MAJOR ABNORMALITIES
- Seriously interfere with sustainability, quality of life, physical wellbeing or social acceptability
- 1 to 3% in the general population
MINOR ABNORMALITIES
- No significant medical or cosmetic consequences
* 10-15% of children
ABSORPTION
GASTROINTESTINAL
• increase Gastrointestinal motility
•increase gastric pH
• Nausea and vomiting
• Decrease in the absorption of certain drugs
• Dehydration can affect serum levels of certain medications (e.g.
lithium)
ABSORPTION
CUTANEOUS
- increase skin hydration
- increase perfusion
- These parameters increase the skin absorption of drugs
DISTRIBUTION VOLUME
- increase total body water
- increase plasma volume, amniotic fluid, placenta, fetus
- increase fat mass
- increase distribution of water-soluble and fat-soluble drugs
DISTRIBUTION PLASMA PROTEIN-BINDING
- decrease plasma proteins (albumin and alpha-glycoprotein)
- decrease ability of drugs to bind
- increase free fraction of certain drugs
LIVER METABOLISM
- Changes in the activity of certain liver enzymes
* increase or decreasce serum concentration of drugs
RENAL ELIMINATION
- increase glomerular filtration rate
* increase elimination of certain drugs
Schizophrenia and pregnancy
- 59 % : deterioration of symptoms
- 29 % : improvement of symptoms
- Cessation of medication increase the risk of relapse of 65 % in this population
- Higher risk of post partum psychosis
HALOPERIDOL and pregnancy
- First-intention antipsychotic for acute episodes of agitation or psychosis
- Less hypotension, sedation and anticholinergic effects than other first-generation antipsychotics
- Risk of extrapyramidal reactions (increased with long-acting formulations)
Atypical antipsychotics and pregnancy
No teratogenic risk demonstrated
OLANZAPINE
• Best-documented molecule
OTHERS
• Quetiapine, risperidone and paliperidone could also be
considered
• Clozapine reserved for refractory conditions
• Little data for aripiprazole and ziprasidone
Antipsychotics – Follow-up
MOTHER ASSESSMENT
• Increased risk of gestational diabetes : early detection by orally induced hyperglycemia
NEONATAL ASSESSMENT
• CBC if maternal exposure to clozapine : day 3, week 2, week 4
Depression in pregnancy
RISKS OF NOT TREATING
• Mother’s decompensation (risk of impulsivity or judgment disorder)
• Obstruction to prenatal follow-up and infant arrival preparation
• Non-compliance with medical treatments
• Changes in physiological functions (risk of premature labour)
• Breaking the social network
• “Direct” effects on the fetus: switching to transplacental
cortisol levels, risk of suicide and infanticide, risk of exposure to tobacco, alcohol and drugs
Treatment of depression in pregnancy
PHARMACOLOGICAL TREATMENT
• Recommended if moderate to severe depression or a history of severe or recurrent depression
• Prioritize monotherapy
OTHER TREATMENT OPTIONS
• Psychotherapy if mild to moderate depression
• Electroconvulsive therapy (effective and safe during pregnancy)
Antidepressants in pregnancy
SSRIs
• Citalopram, fluoxetine and sertraline have been the subject of the largest number of studies : data do not demonstrate a teratogenic risk
• Paroxetine associated with an increased risk of cardiovascular malformation, so it is best to focus on other drugs SNRI
• Reassuring data with venlafaxine (better documented than others)
BUPROPION
• Reassuring data
MIRTAZAPINE
• Insufficient data
TRICYCLIC ANTIDEPRESSANTS
• Data are not in favour of a teratogenic risk
• Caution for drug interactions and possible side effects
MONOAMINE OXIDASE INHIBITORS (MAOI)
• Not recommended
• Lack of information
• Risk of exacerbation of hypertension and hypoperfusion
Antidepressants
AT THE END OF THE PREGNANCY
- Symptoms of withdrawal are possible for the baby (agitation, lack of tone), but generally transient and mild
- Reduce the dose or stop a little before giving birth
SSRI AND RISK OF AUTISM
• Observed risk increases are often insignificant after adjustment of confounding variables, including maternal condition
Compare the risks and benefits of using an SSRI, but also the major risks of not treating the maternal condition