Pregnancy in Practice - Drug Use

Question 1

Explain the pre-embryonic stage.

Answer 1

• 17 days after conception
• Blastocysts involvement
• Damage caused can lead to failed implantation and miscarriage.
• Damaged cells can be replaced by extra division of the remaining cells.
• Drug induced damage i.e. long-half life, after pre-embryonic stage.

Question 2

Explain how the foetus receives blood supply.

Answer 2

• The foetus receives blood supply, nutrients and oxygen from the umbilical cord.
• Wastes and CO2 also delivered to the baby

Question 3

What pregnancy changes are expected in the mother?

Answer 3

Increase in:
* Total Body Water = Potential Swelling
* Liver Metabolism
* Renal Blood Flow
* Plasma Protein Concentration

Question 4

Define teratogens.

Answer 4

• Drugs that cause structural or functional abnormalities to the foetus or child after birth.

Question 5

Give examples of teratogens.

Answer 5

• Sodium Valproate

Question 6

What factors affect how much drug reaches the foetus?

Answer 6

• Maternal Plasma levels
• Half-life
• Molecular weight
• Transfer of similar agents
• Presence or absence of placental metabolising
  enzymes

Question 7

What questions do you need to consider whether the drug has a teratogenic risk?

Answer 7

• Does the drug cause toxicity in animals at lower doses?
• Does the drug cross the human placenta?
• Is their human pregnancy experience of exposure to
  similar agents?
• Is their human pregnancy experience of exposure to the drug itself?

Question 8

What problems do most pregnant women face regarding medications?

Answer 8

Pregnant women are excluded from clinical trials.

Question 9

Explain the considerations for prescribing in pregnancy.

Answer 9

• Only prescribe medication if benefit outweighs risk
• Avoid during the first trimester where possible
  – Use drugs with extensive use in pregnancy in preference to new/untried drugs.
  – Lowest effective dose
  – Absence of information does not imply that the
  medication is safe

Question 10

What does MHRA/CHM state about effective contraception?

Answer 10

Refer to this website for further details: https://assets.publishing.service.gov.uk/media/5c936a4840f0b633f5bfd895/pregnancy_testing_and_contraception_table_for_medicines_with_teratogenic_potential_final.pdf

Question 11

What is the are you ready campaign?

Answer 11

Consists a tool designed for pregnancy planning.

For more details, go to this website:
https://www.tommys.org/pregnancy-information/planning-a-pregnancy

Question 12

What is preconception health?

Answer 12

The health of women and men during their reproductive years which are the years they can have a child.

Question 13

What are the 2 main concepts of good preconception health?

Answer 13

1. Planning pregnancy:
   - Enabling women & their partners to choose if and when to start or grow their families.
2. Fit for pregnancy:
   - Recognising pre-pregnancy health behaviours and non-modifiable/ modifiable risk factors.

Question 14

Explain the process of preparing for pregnancy.

Answer 14

• Healthy eating
• Ideal Weight
• Supplements
  – Folic Acid
• Smoking cessation
• Alcohol consumption
• Drug misuse
• Existing medical conditions
• Vaccinations
• Cervical and STI Screening

Question 15

What does healthy eating benefit for pregnancy?

Answer 15

• Your diet prior to pregnancy can affect your baby’s development.
• Healthy diet and moderate exercise are advised to maintain/obtain an IBW
• Eat high fibre foods, fruit and vegetables,
  avoid saturated fats and sugary foods and
  drinks