pre-conception counselling and drugs in pregnancy (W1) Flashcards
pre-pregnancy counselling advice?
take folic acid
stop smoking, drinking, drugs
healthy weight
vaccines?
vitamin D
disease optimization
screen for sickle cell and thalassaemia
disease optimization examples?
shouldn’t get pregnant if you have poorly managed diabetes - will harm the baby and mother
shouldn’t get pregnant if you have very high blood pressure
folic acid is required for what?
purine and pyrimidine synthesis amino acid conversions
what is folic acid important for during foetal development? what else is a risk factor for this?
closing the neural tube
family history
what should pregnant women start taking as soon as they are aware that they are pregnant
folic acid
what does significant exposure to alcohol during pregnancy result in
foetal alcohol syndrome
alcohol screening questions?
tolerance - how many to get drunk
annoyed by people asking you to cut down
ever felt the need to cut down?
eye-opener-drink first thing in the morn
what is the leading preventable cause of birth defects
alcohol
what is common in foetal alcohol spectrum disorder
facial dysmorphism - low nasal bridge, thin upper lip, smooth philtrum, small palpebral fissures
dihydrofolate reductase action?
converts dihydrofolate to tetrahydrofolate (involved in purine and pyrimidine synthesis)
what drug commonly used to treat RA is a competitive inhibitor of dihydrofolate reductase?
methotrexate
methotrexate effect?
reduces cell division
reduced amino acid synthesis
antagonises action of folic acid
what can methotrexate cause
congenital defects, eg:
cranial face anomalies
congenital heart disease
limb defects
how long should you be off methotrexate before conception
3 months
safe drugs for RA during pregnancy?
hydroxychloroquine
sulfasalazine
(both types of DMARDs)
epilepsy treatment relevant to pregnancy?
sodium valproate
what is a seizure?
sudden change in behaviour caused by electrical hyper synchronization of neuronal networks in the cerebral cortex
what is epilepsy
recurrent seizures
with sodium valproate, what percentage of foetuses get neural tube defects?
1-2% (20x risk of general population)
what is sodium valproate associated with?
mainly neural tube like defects
also cardiac, oral, urogenital malformations
should sodium valproate be used in those of child bearing age? what is an exception to this?
NO!!!!!!!!!!!!!!!!!!!!!
can be used if they are in a pregnancy prevention programme
what is a pregnancy prevention programme
given counselling and information leaflet
ensure highly effective contraception (often 2 forms)
commonly used drug for hypertension, heart failure, renal disease?
angiotensin converting enzyme inhibitors (ACEi)
angiotensin receptor blockers (ARBs) have similar uses
what do angiotensin converting enzymes do
convert angiotensin 1 into angiotensin 2
ACEi/ARB in second and third trimester
oligohydramnios (reduced amniotic fluid)
renal failure
high blood pressure
pulmonary hypoplasia
respiratory distress syndrome
foetal circulation features
low pressure system
ACEi/ARB in first trimester?
uncertain, there is a risk
when during pregnancy should you avoid NSAIDs
3rd trimester
what in the foetal circulation enables oxygenated blood to pass from the pulmonary artery to the aorta (bypassing the lung)
ductus arteriosus
what keeps the ductus arteriosus open during pregnancy
prostaglandin E (PGE)
what is prostaglandin E produced by
placenta
what allows the ductus arteriosus to close
drop in prostaglandin E levels
NSAIDs mechanism of action? what does this result in?
inhibits cyclooxygenase
results in inhibition of prostaglandin production
what can occur when you take NSAIDs during pregnancy? (especially during the 3rd trimester)
premature closure of ductus arteriosus
what does premature closure of ductus arteriosus cause
pulmonary hypertension leading to cardiac failure (high output cardiac failure as pumping blood through wrong part of body)
leads to foetal hydrops (fluid accumulation in tissues and organs)
