medications and pregnancy (safe/unsafe)

Question 1

NSAIDs

Answer 1

ibuprofen
naproxen
block prostaglandins- which are important to maintain the ducts ateriosus in fetes and neonate. PGE softens the cervix and stimulates uterine contraction

*avoid in pregnancy unless necessary (RA) particularly in third trimester.

Question 2

beta blockers

Answer 2

e.g labetalol
HTN, cardiac problems, migraine

labetalol is used in pregnancy, first line for pre-eclampsia

*Fetal growth restriction
Hypoglycaemia in the neonate
Bradycardia in the neonate

Question 3

ACE inhibitors

Answer 3

medications that block the RAAS can cross the placent and enter the fetes, effecting kidneys and urine output (and therefore amniotic fluid)

hypocalvaria (incomplete formation of skull bones)
Oligohydramnios (reduced amniotic fluid)
Miscarriage or fetal death
Renal failure in the neonate
Hypotension in the neonate

Question 4

opitates

Answer 4

withdrawal symptoms
neonatal abstinence syndrome
presents 3-72 hours after birth
irritability, tachypnoea (Fast breathing), high temp and poor feeding

Question 5

warfarin

Answer 5

VTE, AF, metallic mechanical valve
can cross the placenta and is teratogenic in pregnancy

• fetal loss
• congenital malformations
• bleeding during pregnancy, post partum haemorrhage, fetal haemorrhage, intracranial bleeding

Question 6

sodium valproate

Answer 6

can cause neural tube defect and developmental delay

strict rules in avoiding sodium valproate unless they are on suitable alternatives to ensure they do not get pregnancy

‘prevent’ is the specific programme ‘valoprate pregnancy prevention pogramme’

Question 7

lithium

Answer 7

mood stabiliser (bipolar, mania, recurrent depression)

avoid in prengnacy unless antipsychotics have failed

avoid in 1st trimester (congenital cardiac abnormalities) ‘Ebstein’s anomaly’

if used, monitor closely (Every four weeks). also enters breast milk so avoid breastfeeding

Question 8

SSRI

Answer 8

antidepressant
can cross placenta
risk / benefit

First-trimester use has a link with congenital heart defects

First-trimester use of paroxetine has a stronger link with congenital malformations

Third-trimester use has a link with persistent pulmonary hypertension in the neonate

Neonates can experience withdrawal symptoms, usually only mild and not requiring medical management

Question 9

Isoretinoid (roaccutane)

Answer 9

vitamin A
used in severe acne
prescribe and monitor by specialist dermatologist

highly teratogenic
causes miscarriage and congenital defect

women need reliable contraception before, during and one month after taking isotretinoin

Question 10

hypothyroidism in pregnancy (pre-existing)

Answer 10

untreated or under-treated hypothyroidism can lead to several adverse pregnancy outcomes (miscarriage, anaemia, small gestational age, pre-eclampsia)

treatment:
levothyroxine (T4)
levothyroxine dose must be increased during pregnancy by 25-50mcg (30-50%)
titrate based on TSH

Question 11

existing hypertension

Answer 11

stop ACEi, ARDS, thiazide diuretic

meds not known to be harmful

• beta blocker (labetalol0
• ca2+ blocker (nifedipine_)
• alpha blocker (doxazosin)

Question 12

epilepsy (pre-existing)

Answer 12

*take folic acid 5mg before conception to reduce risk of neural tube defects

pregnancy may worsen seizure control

control with a single anti-epileptic drug before becoming pregnant

SAFE MEDS:
levetiracetam
lamotrigine
carbamazpein

NOT SAFE:
sodium valporate
phenytoin (cleft lip and palate)

Question 13

rheumatoid arthritis

Answer 13

DMARDs
ideally RA should be well controlled at least 3 months before pregnancy.

NOT SAFE / contraindicated:
methotrexate (miscarriage, congenital abnormalities)

SAFE
hydroxychloroquine (first line)
sulfasalazine
corticosteroid (flare ups)