PRINICIPLES OF USING DRUGS DURING PREGNANCY

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Drug use during pregnancy and lactation
 • requires special consideration because both the mother and the child are affected. Few drugs are considered safe, and drug
 • use is generally contraindicated. Many pregnant or lactating women take 
• drugs for acute or chronic disorders or habitual use of alcohol and tobacco.
 Drugs taken by a pregnant woman reach the fetus primarily by crossing the placenta, the same route taken by oxygen and nutrients, which are needed for the fetus's growth and development. Drugs that a pregnant woman takes during pregnancy can affect the fetus in several ways

  Principles of Therapy: Pregnancy 

 • Give medications only when clearly indicated, weighing benefits to the mother against the risks to the fetus. 
• Any drugs used during pregnancy should be given in the lowest effective doses and for the shortest effective time.
 • The choice of drug should be based on the stage of pregnancy and drug information. Principles of Therapy: Pregnancy (Cont,d)
 • During the first trimester, an older safe drug is preferred over a newer drug of unknown teratogenicity
. • Counsel pregnant women about the use of immunizations during pregnancy. Principles of Therapy: Pregnancy (Cont,d)
 • Live virus vaccines (measles, mumps, polio, rubella) should be avoided because of possible harmful effects to the fetus
. • Inactive virus vaccines (influenza, rabies, hepatitis B) and toxoids (diphtheria, tetanus) are considered safe for use.
 • Hyperimmune globulins can be given to pregnant women who are exposed to hepatitis B, rabies, tetanus, or varicella. Principles of Therapy: Pregnancy (Cont,d)
 • Hyperimmune immunoglobulin are IGIVs with high titers of antibodies against viruses or toxins.
 • Hyperimmune IGIVs are available for hepatitis B virus, rabies, tetanus, and digoxin overdose. 
• Intravenous administration of the hyperimmune globulins reduces risk or severity of infection. Principles of Therapy: Lactation
 • Most systemic drugs taken by the mother reach the infant in breast milk
. • For some, the amount of drug is too small for others effects are unknown or potentially adverse.
 • Give medications only when clearly indicated. 
• For contraindicated drugs, the mother should stop the drug or stop breast feeding. Principles of Therapy: Lactation (Cont,d) 
• Any drugs used during lactation should be given in the lowest effective dose for the shortest effective time. 
• Stopping breast feeding during maternal drug therapy is not recommend unless necessary.
 • In some instances, mothers may pump and discard breast milk while receiving therapeutic drugs, to maintain lactation. 
• Women with HIV infection should not breast-feed. The virus can be transmitted to the nursing infant.

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