PREGNANCY AND PRESCRIBING Flashcards
2 Questions to consider when a woman on medication wants to become pregnant
is the drug safe?
is the drug necessary?
is there any safer alternative
what is the effect of the drug on pregnancy
what is the effect of pregnancy on the drug
is any extra monitoring needed? for mum or the baby
What pre-pregnancy counseling points can you give?
what evidence base practice resources do you have for women wanting to become pregant?
toxbase
uktis
Bnf
Bumps
why is nicotine a no in pregnancy?
causes growth restriction and can cause a stillbirth
why is alcohol a no in pregnancy?
can cause fetal alcohol syndrome causing low ears, low IQ and neurodevelopmental issues
why is cocaine a no in pregnancy?
It can cause blood clots in the placenta so the womb seperates
define preconception
before pregnancy
define 1st trimester
1- 13 weeks
define 2nd trimester
13-28 weeks
define 3rd trimester
after 28 weeks
define postpartum
after birth
what physiological changes happen during the 1st trimester
- increase blood volume by 40%
- faster kidney clearance
- gut motility decreases
- increase in sex binding hormone in the blood
- placenta grows
- transfer of drugs from mothers blood flow to fetus blood flow
why is methotrexate a no?
it is highly teratogenic
why is active iodine a no?
it is highly toxic to the fetus
why is warfarin a no and what is the alternative
it can give the baby birth abnormalities
instead give heparin
mother can continue on warfarin but has to consent to the risk
why is spironolactone a no?
cause androgenicity of female fetus
why is folic acid good for a fetus?
- vitamin b9
- it prevents fetus neural defects and spinal Bifida
- it helps babies brain development
what is a teratogenic agent?
an agent that can disturb the development of the embryo or fetus
- it can alter organ growth due to the placenta transfer
is paracetamol safe in pregnancy?
yes
when should you avoid NSAIDs in pregnancy
in the third trimester
Are opiates safe in pregnancy?
no, they carry the risk of neonatal withdrawal if taken for long periods of time
can women stay on SSRIs?
yes if the risk outweighs the benefits
gives the fetus withdrawal effects so needed to give the fetus doses for 48h postpartum
what does the placenta do to diabetic patients?
- it produces lots of hormones which are anti-insulin so the blood sugar levels rise
which diabetic drugs are not safe to use in pregnancy?
GLP2
which diabetic drugs are safe to use in pregnancy?
Insulin and metformin