Pregnancy And Breastfeeding

Question 1

Folic acid

Answer 1

Develops baby spine and decreased neural rube defects (spina bifidia)
400 mcg before conceiving and up to 12 weeks of pregnancy
If high risk given 5 mg e.g DM, epilepsy, hx
Sickle cell and thalassaemia to take throughout pregnancy as 5 mg

Question 2

Vitamin D

Answer 2

Regulate calcium and phosphorus in the body
Provide vitamin D to the baby first few months of life
10 mcg daily
Supplementation dietary intake e.g fatty fish, fortified food

Question 3

Iron

Answer 3

Help prevent anaemia and tiredness
Green leafy vegetables, lean red meat and dried food
Supplements advised by GP and midqife

Question 4

Vitamin C

Answer 4

Protect cells and aids iron absorption
Citrus fruits, broccoli and tomatoes

Question 5

Calcium

Answer 5

For the development of baby bone and teeth
Diary products, dried fruits, green leafy vegetables

Question 6

What happens to medication clearance during pregnancy ?

Answer 6

Medication clearance increases
Due to increased cardiac output, hence renal elimination and rate of metabolism
Medication doses need to be higher in 2nd and 3rd trimester

Question 7

What vaccines are recommended?

Answer 7

Inactivated vaccines
Not live vaccines
Need flu and whooping cough

Question 8

Cytotoxic drugs and pregnancy

Answer 8

Teratogenic
ESP in 1st trimester avoid
Use effective contraception before during and after
Exclude pregnancy before treatment

Question 9

Drugs during trimesters

Answer 9

1st trimester - congenital abnormalities
2nd and 3rd will affect growth and development
Term / labour - obstetric complications that can affect on baby

Question 10

Asthma and pregnancy

Answer 10

SABA, LAMA, ICS and oral IV theophylline can be used as normal
Use steroids as normal
LRA is needed for adequate control dont withhold its use
Encourage smoking cessation
Use during lactation

Question 11

Depression and pregnancy

Answer 11

Mo liecensed antidepressant
Risk vs benefit - specialist use
MHRA/CHM - SSRI/SNRI - small increase risk postpartum haemorrhage when used in the month before delivery

Question 12

Depression and breast feeding

Answer 12

Highest level with citalopram and fluoxetine
Lowest with sertraline

Question 13

Hypertension in breast feeding and pregnancy?

Answer 13

Avoid ACEi, ARB and diuretics - when pregnant
Lobetalol, Methyldopa and nifedipine MR (unliecensed)
Avoid amlodopine, diuretics, ARBS, ACEi during breastfeeding use Methyldopa and labetolol

Question 14

Diabetes in pregnancy and breastfeeding

Answer 14

Pre existing type II DM - continue metformin, Glibenclamide and insulin if prescribe; stop others may be switched to insulin
Gestational diabetic - diet and exercise (2 week trial), metformin +/- Glibenclamide +/- insulin stop medication after birth
Breastfeeding ; insulin increase risk of hypoglycaemia post natal especially if breast feeding (meal, snack before during feeds = prevent hypo)

Question 15

Epilepsy and pregnancy

Answer 15

Risk vs benefit - no drug is 100% safe
Monotherapy has a lowest risk
Minimise potential risk factors for seizures, sleep deprivation and stress adherence
Valproate not used unless no alternative and PPI in place
Lamotrigine safest

Question 16

Oral retinoids and pregnancy

Answer 16

E.g Isotretinoin can cause birth defects
indicated for acne and CI in pregnancy
Highly lipophilic and can readily pass into breast milk so avoid

Question 17

Infections and pregnancy

Answer 17

Harmful - chicken pox, group B strep, Hep B+C, herpes, HIV rubella, STI, slapped cheek syndrome
Take specimens to inform treatment
Nitrofurantoin should be avoided in term
Trimethoprim is unlikely to cause problems unless or dietry folate - antagonist avoid 1st trimester esp

Avoid; tetracyclines, aminoglycosides, quinolones, azithromycin, clarithromycin, high dose metronidazole

Question 18

Pre eclampsia

Answer 18

High risk ; give aspirin from 12 weeks onwards if one risk factor
Type I or II, chronic HTN, CKD, autoimmune disease, increase BP pregnancy

Moderate risk give aspirin from 12 weeks if they have 2 or more risk factors
1st preg, over 40, Fam hx, multiple preg, preg interval over 10 years, bmi 35

Aspirin 75 to 150 mg daily

Question 19

Smoking cessation support pregnancy

Answer 19

NRT preferable and not to smoke
Patches useful if patient experiences nausea and vomiting remove before bed
Avoid liquorice flavour
Intermittent therapy is preferable to patches

Question 20

What drugs to avoid handling

Answer 20

Methotrexate
Finasteride
Cyclophosphamide

Question 21

Paternal exposure

Answer 21

Sperm cells can take around 3 months to fully develop
Some meds taken by the father in the previous 3 months pre concentration may cause genetic faults or changes to the genetic code in sperm

Question 22

Breastfeeding drugs found in High concentrations

Answer 22

Fluvastatin - high amount in milk
Phenobarbital - inhibits sucking reflex
Bromocrphine - inhibits lactation
Ethosuximide and lamotrigine - high in milk

Question 23

Common teratogenic drugs

Answer 23

Chloramphenicol - grey baby syndrome
Topiramate - cleft palate
Finasteride - feminisation of male foetus
Quinolones - arthropathy
Aspirin/ NSAIDs - early closure ductus arterios
Methotrexate, trimethoprim - anti-folate
Aminoglucosides - auditory and vestibular damage in 2/3rd trimester