Drugs In Pregnancy

• Drug administered to the mother may cross the placenta.

• Numbers of drug prescribed during pregnancy should be restricted to a minimum with lowest dose for shortest time.

• The time period between 35-55 days from LMP is most crucial is may result in missed abortion or has bad effect on the growing baby.

• USFDA has categorized drugs in categories ABCDX for use in pregnancy.

Maternal drug intake and breast feeding

• Maternal drug intake may have deleterious effect not only on lactation but also on the baby through the ingested breast milk
• Any drug ingested by lactating mother may be present in her breast milk but the amount – concentration are usually low compared to blood
• Most drugs are compatible with breast feeding . The physician must therefore consider the benefit of mother and possible danger the baby may face each time drug is prescribed during nursing period.

Maternal medication during pregnancy and fetal hazards

• Maternal foetal drug transfer, prior to implantation , ie during embryogenesis drug reach the conceptus through the tubal and uterine section by diffusion effect is usually death in case of survival congenital anomaly exist during organogenesis.
• During pregnancy mother and baby represent nonsepratable single unit.
• It is important to treat the mother whenever needed while protecting the unborn baby to the greatest possible extent.
• During antenatal care what we are give is only nutritional supplements and vaccines.
• Women may required treatment for illness during pregnancy for example upper respiratory tract infection, urinary tract infection, malaria, epilepsy, TB, diabetes, blood pressure , preterm labour pain etc.

DRUGS AND CHEMICAL PROVEN TO BE TERATOGENIC
ALCHOHOL : Foetal alcohol syndrome , during pregnancy alleviate fears in mild or occasional drinkers who may terminate pregnancy based on unrealistic perception of risk . Women consuming 2gm/Kg/day during the 1st trimester has 1 to 3 fold high risk for congenital malformation. Alchohol is freely distributed in the milk. She should not breast feed her baby atleast 2 hour after consumption of alchohol

NICOTIN: Do not smoke during lactation it can cause infant colic, decresed milk flow and erlier weaning

STRET DRUGS: It must be avoided such as marijuhana, cocain etc.

Many mothers are required to use drugs during breastfeeding. Almost all drugs transfer into breast milk and this may carry a risk to a breastfed infant. Factors such as the dose received via breast milk, and the pharmacokinetics and effect of the drug in the infant need to be taken into consideration. Problems should not be overstated however, as many drugs are considered ‘safe’ during breastfeeding.

Transfer of drugs into breast milk is influenced by protein binding, lipid solubility and ionisation

Nearly all drugs transfer into breast milk to some extent. Notable exceptions are heparin and insulin which are too large to cross biological membranes. The infant almost invariably receives no benefit from this form of exposure and is considered to be an ‘innocent bystander’. Drug transfer from maternal plasma to milk is, with rare exceptions, by passive diffusion across biological membranes. Transfer is greatest in the presence of low maternal plasma protein binding and high lipid solubility. In addition, milk is slightly more acidic than plasma (pH of milk is approximately 7.2 and plasma is 7.4) allowing weakly basic drugs to transfer more readily into breast milk and become trapped secondary to ionisation. Milk composition varies within and between feeds and this may also affect transfer of drugs into breast milk. For example, milk at the end of a feed (hindmilk) contains considerably more fat than foremilk and may concentrate fat-soluble drugs.

Transfer of drugs into breast milk is most commonly described quantitatively using the milk to plasma (M/P) concentration ratio. The accuracy of this value is improved if it is based on the area under the concentration-time curves (AUC) of the drug in maternal milk and plasma (M/PAUC).

Calculation of infant exposure to drugs can be used to help guide safe use
The infant’s dose (Dinfant) received via milk can be calculated using the maternal plasma concentration (Cmaternal), M/PAUC ratio and the volume of milk ingested by the infant (Vinfant):

Dinfant (mg/kg/day) = Cmaternal (mg/L) x M/PAUC x Vinfant (L/kg/day)
The volume of milk ingested by infants is commonly estimated as 0.15L/kg/day. The infant dose (mg/kg) can then be expressed as a percentage of the maternal dose (mg/kg). An arbitrary cut-off of 10% has been selected as a guide to the safe use of drugs during lactation. Drugs such as lithium (infant dose as high as 80% of the weight-adjusted maternal dose) and amiodarone (infant dose up to 50%) should be avoided due to high infant exposure and potential for significant toxicity. For drugs with greater inherent toxicity such as cytotoxic agents, ergotamine, gold salts, immunosuppressives and isotretinoin, the cut-off of 10% is too high and breastfeeding is contraindicated.

As a general rule, maternal use of topical preparations such as creams, nasal sprays or inhalers would be expected to carry less risk to a breastfed infant than systemically administered drugs. This is due to lower maternal concentrations and therefore lower transfer into breast milk. However, the risk to the infant must be considered in relation to the toxicity of the drug used, the dosage regimen and the area of application. For example, use of corticosteroids nasal sprays or inhalers in standard doses would be considered compatible with breastfeeding.

Other factors to consider in conjunction with the infant’s dose include the pharmacokinetics of the drug in the infant. Generally, drugs that are poorly absorbed or have high first-pass metabolism are less likely to be problematical during breastfeeding. For example, gentamicin is highly hydrophilic and is very poorly absorbed when administered orally. Should any gentamicin be ingested via breast milk, it is unlikely to be absorbed.

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Vaidehi Women's & Children Hospital in Ahmedabad is fully equipped with modern medical machines and exclusive services for Gynecology-Maternity, Fertility & IVF, Vaccination Clinic, NICU, Pathology, Sonography, 24 Hours Pharmacy, Exclusive Health Checkup, Round The Clock Emergency Service. Our doctors and staff are always committed to listen to your complaints and answering your each and every question to your utmost satisfaction. We give all kind of preventive as well as curative treatment. Our services for women and children are set in with trained and seasoned nurse who ensure that you and your baby are well taken care of. Vaidehi Women's & Children Hospital is staffed with experienced consultants to offer professional care in Obstetrics, Gynaecology, Neonatology, Pediatrics and other specialities and subspecialties for you and your baby.

• 24-hr consultant-led emergency and specialty services including perinatal services

• All pediatric and allied services for children

• Sophisticated maternal care

• State-of-the-art labour rooms

• Committed team of professionals 24x7

 

VAIDEHI WOMEN'S & CHILDREN HOSPITAL

Dr. Nirav Patel (M.S. Gynec)

Dr. Manisha Patel (M.B.B.S., D.C.H.)

Dr. Chintan Patel (M.D., DNB Medicine)

105 to 112, 1^st Floor, Shashwat Mahadev-1 Complex, RTO Road,

Opp. Suryam Greens, Vastral, Ahmedabad - 382418.

Call for Appointment: +91 76230 40999

Source :  by VAIDEHI WOMEN'S & CHILDREN HOSPITAL, Vastral, Ahmedabad.

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