Medications in pregnancy

Question 1

Documented adverse, contraindicated

Answer 1

1. AECi Renal defects IUGR OligoH 2. Tetracycline Stains infant teeth, long bone 3. Retinoids CNS, craniofacial, cardiac, thymic 4. DES Vaginal adenosis AdenoCa Uterine malformations 5. Misoprostol Congenital facial paralysis w/wo limb defects, spontaneous abortion, preterm labour

Question 2

Documented adverse effects, weigh benefits

Answer 2

1. phenytoin Fetal hydantoin syndrome in 5-10% (IUGR, mental retardation, facial dysmorphogenesis, congenital anomalies) 2. valproate oNTD in 1% 3. carbamazepine oNTD in 1-2% 4. lithium Ebstein’s cardiac anomaly goitre hyponatremia 5. warfarin Increased incidence of spontaneous abortion, stillbirth, prematurity, IUGR, fetal warfarin syndrome (nasal hypoplasia, epiphyseal stippling, optic atrophy, mental retardation, intracranial hemorrhage) 6. erythromycin Maternal liver damage (acute fatty liver) 7. sulpha drugs Anti-folate properties, therefore theoretical risk in T1; risk of kernicterus in T3 8. chloramphenicol Grey baby syndrome (fetal circulatory collapse 2° to toxic accumulation)

Question 3

Drugs contraindicated in breastfeeding

Answer 3

BREAST Bromocriptine/Benzodiazepines Radioactive isotopes/Rizatriptan Ergotamine/Ethosuximide Amiodarone/Amphetamines Stimulant laxatives/Sex hormones Tetracycline/Tretinoin

Question 4

Drugs safe in breastfeeding

Answer 4

1. Analgesics->paracetamol, NSAIDs
2. Anticoagulants- heparin
3. Antidepressants
4. Antiepileptics
5. Antihistamines
6. Antimicrobials
7. Beta adrenergics
8. Insulin
9. Steroids
10. OCP