Pregnancy and Lactation Flashcards
1.When analyzing information on the safety of a drug exposure during pregnancy, which one of these statements is true?
A. It is estimated that approximately 10% of congenital anomalies are caused by a medication exposure.
B. FDA categories should not be used to assess the safety of medication use during pregnancy.
C. Animal studies are of equal value with human data to inform on teratogenic risk of a drug.
D. Before a medication is put on the market, it is mandatory to have human pregnancy safety.
E. The fetogenesis period is the most at risk period for structural congenital anomalies following
a teratogenic exposure.
B
Option A: Incorrect. Medications are the cause of less than 1% of congenital anomalies.
Option B: Correct. The leading cause of congenital anomalies is genetic. Animal studies have
several limits to study human teratology. The organogenesis (or embryogenesis) is the most at-risk period for structural congenital anomalies.
2.Which of the following key points is appropriate when considering the use of lamotrigine during breast-feeding?
A. It is contraindicated to use lamotrigine during breast-feeding.
B. Lamotrigine blood concentration of a breast-fed infant can be up to 10% to 50% of simultaneous maternal blood concentration.
C. Several cases of severe rash have been reported in breast-fed infants whose mothers were taking lamotrigine.
D. When mothers who take lamotrigine breast-feed, the drug is usually undetectable in the infants’ serum.
E. There is scarcity of data on lamotrigine during breast-feeding.
B
- A 36-year-old woman wishes to become pregnant with her second child. She has been treated for type 2 diabetes for 3 years. She has a well balanced diet with plenty of vegetable and fruits. Based on this information, which of the following is the most appropriate folic acid recommendation for this patient to prevent congenital anomalies?
A. Folic acid 4 mg orally daily starting at 10 weeks’ gestation and throughout pregnancy.
B. Folic acid 0.4 mg with a multivitamin orally daily starting at least 1 month before pregnancy
and throughout the first trimester.
C. Folic acid 4 mg with a multivitamin orally daily starting 3 months before pregnancy and throughout the first trimester.
D. Multivitamin containing 0.4 to 0.8 mg of folic acid orally daily starting 1 month before
pregnancy and throughout the first trimester.
E. No folic acid supplement is required since folic acid is provided by her diet.
C
4.Which one of the following periods is considered the organogenesis (embryogenesis) period?
A. Days 1 to 14 postconception
B. Days 1 to 14 after last menses
C. Days 14 to 28 postconception
D. Days 14 to 77 after last menses
E. Days 1 to 56 postconception
D
Options A, B, and C: Incorrect. Organogenesis extends to day 77 (11 weeks) after last menses.
Option D: Correct. Days 28 to 77 after last menses represent the organogenesis (2–9 weeks after
conception). Do not confuse gestational age (calculated from the last menses) and
postconceptional age. Days 14 to 28 post conception correspond to the implantation and
predifferentiation period.
- Which of the following medications should never be used in pregnancy?
A. Warfarin
B. Naproxen
C. Norfloxacin
D. Methotrexate
E. Methimazole
D
- During the first trimester of pregnancy, each of the following screening tests should be performed except:
A. Hemoglobin and hematocrit
B. Group B Streptococcus vaginal-rectal culture
C. HIV
D. Urinalysis with Gram stain and culture
E. Chlamydia screening
B
Option B: Correct. Group B Streptococcus vaginal-rectal culture is recommended between 35
and 37 weeks of gestation and not during the first trimester.
Options A, C, and D: Incorrect. The other three tests should be completed during the first trimester.
7.Which of the following statements on bacterial vaginosis during pregnancy is true?
A. Bacterial vaginosis is associated with an increased risk of postpartum urinary tract infections.
B. Clindamycin, one vaginal ovule daily for 7 days, is a first-line treatment for bacterial
vaginosis during pregnancy.
C. Universal screening for bacterial vaginosis at 16 weeks of pregnancy is recommended.
D. Since bacterial vaginosis is associated with adverse pregnancy outcomes, sexual partners of
pregnant women who test positive for bacterial vaginosis should be treated.
E. Metronidazole 500 mg orally twice daily for 7 days is one of the best treatments for bacterial vaginosis during pregnancy.
E
8.A 22-year-old pregnant woman complains of pain following a severe ankle sprain. Ice and acetaminophen 650 mg orally every 6 hours are not relieving her pain. She rates her pain as 7 out of 10 on a visual analogue scale. She is 32 weeks pregnant. Which of the following is the best recommendation for her pain at this point?
A. Acetaminophen 2 g orally every 4 hours regularly
B. Acetaminophen 1 g orally every 6 hours as needed
C. Codeine 15 to 30 mg orally every 4 hours as needed
D. Glucosamine 500 mg orally three times daily for 5 days
E. Ibuprofen 400 mg four times daily as needed
C
9.Which one of the following is a first-line recommendation for the treatment bacterial mastitis in a breast-feeding woman with moderate symptoms?
A. Vancomycin 250 mg orally four times daily for 10 days
B. Fluconazole 200 mg orally once daily for 14 days
C. Cephalexin 500 mg orally four times daily for 10 to 14 days
D. Topical bacitracin ointment twice daily for 14 days
E. No antibiotic is usually recommended
C
- Which of the following maternal treatments has not been associated with a reduction of adverse pregnancy outcomes?
A. Ceftriaxone for gonorrhea
B. Metronidazole for trichomoniasis
C. Azithromycin for chlamydia
D. Penicillin G benzathine for syphilis
E. Oral acyclovir starting at 36 weeks gestation for herpes prevention
B
- Which of the following regimens is the most appropriate tocolytic at 30 weeks of
pregnancy?
A. Dexamethasone 2 mg IM every 24 hours for 48 hours
B. Nifedipine 10 mg orally every 20 minutes three times, then 10 mg every 6 hours for 48 hours
C. Magnesium sulphate 2 g IV, then 1 g/h for 48 hours
D. Amoxicillin 1 g orally once, then 250 mg every 8 hours for 24 hours
E. Indomethacin 25 mg orally every 6 hours for 5 days
B
12.Which of the following statements is true?
A. Antibiotics carry more risks than urinary tract infections during pregnancy.
B. Antihypertensive agents carry more risks of fetal malformations than hypertension.
C. Heparins carry more risks of fetal complications than warfarin.
D. Antiepileptic agents carry more risks of fetal malformation than epilepsy.
E. Propylthiouracil displays more risks of fetal malformations than hyperthyroidism.
D
13.Which of the following women should not be started on group B streptococcus antibiotic prophylaxis?
A. Preterm premature rupture of membranes, 30 weeks, first pregnancy, and GBS status unknown
B. Onset of labor, 34 weeks, second pregnancy, GBS status unknown, and negative status at previous delivery
C. Onset of labor, 38 weeks, third pregnancy, and second baby had GBS neonatal infection
D. Rupture of membranes, 39 weeks, first pregnancy, and negative GBS status at 36 weeks
E. Onset of labor, 40 weeks, first pregnancy, and positive urine culture for GBS
D
14.Chose the correct statement
A. Lithium is associated with an increased risk of cardiac malformations when used between the 6th and 10th weeks of pregnancy
B. Newer antipsychotics are not well studied and should be avoided during pregnancy
C. Valproic acid is the treatment of choice for rapid cycling bipolar disorders during pregnancy
D. Lithium has been associated with neonatal hypotonia (floppy infant syndrome) when used
during the first trimester of pregnancy
E. Lithium pharmacokinetics is changed during pregnancy which leads usually to doses reductions during the second and third trimesters.
A
15.MM gave birth this morning to a healthy 3.2 kg baby at 39 weeks gestation. She has been treated for a bipolar disease for several years. Her medication was not changed or adjusted during pregnancy. She would like to breast-feed. What would be the appropriate recommendation?
Medications: Lithium 900 mg orally at bedtime; citalopram 20 mg orally daily in the morning; lorazepam 1 mg orally at bedtime as needed (takes it twice weekly)
A. The baby should be admitted to the neonatal intensive care unit for close monitoring
B. Lithium should be changed for valproic acid which does not pass extensively into breast milk
C. Lithium can be used during breast-feeding in selected reliable women as long as close monitoring of the infant (including thyroid and renal functions, and lithium serum levels) can be ensured.
D. Citalopram can be used during breast-feeding as long as close monitoring of the infant (weight, renal and liver functions) can be ensured
E. Lorazepam should be switched to clonazepam which has a long half-life
C
- When analyzing information on the safety of a drug exposure during pregnancy, which one of
these statements is true?
A. Medication use during pregnancy is the leading cause of congenital anomalies.
B. There is a baseline risk of major malformations of about 3% at birth in the general population.
C. Animal studies are of more value than human data to inform on teratogenic risk of a drug.
D. The fetogenesis period is the most at risk period for structural congenital anomalies following a teratogenic exposure.
- Answer: B
Option A: Incorrect. Medications are the cause of less than 1% of congenital anomalies.
Option B: Correct. The leading cause of congenital anomalies is genetic. Animal studies have
several limits to study human teratology. The organogenesis (or embryogenesis) is the most
at-risk period for structural congenital anomalies.
- Which one of the following periods is considered the organogenesis (embryogenesis) period?
A. Days 1 to 14 post conception
B. Days 1 to 14 after last menses
C. Days 14 to 28 post conception
D. Days 28 to 77 after last menses
D
- Which of the following is the recommended daily dose of folic acid for a patient who is trying to conceive and does not have additional risk factors for fetal neural tube defects?
A. 0.1 mg
B. 0.4 mg
C. 1 mg
D. 4 mg
B
- Which of the following statements regarding thyroid disorders during pregnancy is true?
A. All pregnant patients should be screened for thyroid disorders in the first trimester
B. For prepregnancy hypothyroidism, empirically increase levothyroxine dose by 30% once
pregnant
C. Methimazole is the preferred agent for hyperthyroidism treatment in the first trimester
D. Levothyroxine should not be used during lactation
- Answer: B
Option A: Incorrect. Universal screening of thyroid disorders in pregnancy is no longer
recommended because identification and treatment of maternal subclinical hypothyroidism
has not been shown to result in improved pregnancy outcomes or neurocognitive
functioning in children.
Option B: Correct. The dose of levothyroxine should be increased by 30% from prepregnancy
dose once the patient is pregnant.
Option C: Incorrect. Methimazole is not used for treatment of hyperthyroidism in the first
trimester due to increased risk of congenital anomalies but is appropriate for use in the
second and third trimester.
Option D: Incorrect. Levothyroxine is considered safe to use in pregnancy and lactation.
- Which of the following statements regarding urinary tract infections during pregnancy is true?
A. During pregnancy, asymptomatic urinary tract infections do not require treatment
B. Screening for asymptomatic bacteriuria is completed in the 3rd trimester
C. Preferred treatment options for simple urinary tract infections during pregnancy are quinolones, nitrofurantoin, and fosfomycin
D. Trimethoprim-sulfamethoxazole should be avoided during organogenesis and near term
D
- When assessing a medication for use during lactation, which relative infant dose (RID) score
is considered acceptable?
A. Less than 10%
B. Less than 25%
C. Less than 50%
D. Less than 90%
A
- A patient has just delivered a baby boy at term and she needs treatment for postpartum hemorrhage secondary to uterine atony. She suffers from severe preeclampsia and is being treated with intravenous labetalol, oral nifedipine, and an IV perfusion of magnesium sulfate for
eclampsia prophylaxis. Which one of the following is not a treatment option in this case?
A. Tranexamic acid 1 g IV if not responsive to uterotonic agent
B. Methylergonovine 0.2 mg IM
C. Carboprost tromethamine 0.25 mg IM
D. Misoprostol 1000 mcg rectal
B
- A 40-year-old patient is at 8 weeks gestation with her first pregnancy. She was diagnosed with essential hypertension 3 years ago and well controlled since taking low-dose ramipril. Which statement is false?
A. She should stop her ACE immediately
B. On discharge postpartum, she should be instructed to monitor her blood pressure because she is still at risk of postpartum preeclampsia
C. Low-dose aspirin should be started after 20 weeks of pregnancy
D. Nifedipine (long acting) or labetalol are good options for her during pregnancy
C
- A 28-year-old patient is 12 weeks pregnant and presents to the emergency department with a new lower extremity deep vein thrombosis (DVT). Once stable, which of the following agents is
recommended for DVT treatment?
A. Dabigatran
B. Enoxaparin
C. Unfractionated heparin
D. Warfarin
B
