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DRUGS CONTRAINDICATED IN PREGNANCY

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  • most drugs cross the placenta to some extent
  • use any drug with caution and only if necessary

ANTIBIOTICS

  • safest = ampicillin, cephalosporins
  1. Erythromycin


    • maternal liver damage (acute fatty liver)
    • used only if contraindication to penicillin use 


  2. Tetracyclines : staining of child's teeth 
  3. sulpha drugs


    • antifolates therefore theoretical risk in first trimester
    • risk of kernicterus in third trimester 


  4. metronidazole


    • antimetabolite therefore theoretical risk in first trimester 


  5. chloramphenicol


    • grey baby syndrome (fetal circulatory collapse secondary to ccumulation since fetus cannot metabolize this drug)
OTHER DRUGS

  1. Alcohol


    • increased incidence of abortion and stillbirth, congenital anomalies, fetal alcohol syndrome (growth retardation, CNS involvement and facial anomalies)


  2. Cigarettes


    • decreased birth weight, placenta previa/abruption, increased spontaneous abortion, preterm labour and stillbirth


  3. Anticoagulants


    • warfarin crosses placenta, heparin does not
    • fetal warfarin syndrome: nasal hypoplasia, epiphyseal stippling, optic atrophy, MR, intracranial hemorrhage
    • also spontaneous abortion, stillbirth, prematurity, IUGR


  4. ACE inhibitors
  5. Anticonvulsants


    • facial dysmorphogenesis, IUGR, mild MR, NTD's, congenital anomalies


  6. Lithium : Ebstein's cardiac anomaly, goitre, hyponatremia
  7. Cocaine : microcephaly, growth retardation, prematurity, MR
  8. DES-Diethylstilbestrol (and other estrogenic or androgenic compounds)


    • vaginal adenosis, adenocarcinoma, uterine malformation in daughters exposed to DES in utero


  9. Retinoids (e.g. Accutane)
IMMUNIZATIONS 

  1. administration is dependent on the risk of infection vs. risk of  immunization complications 
  2. safe : tetanus toxoid, typhoid fever (killed bacterial), diphtheria, influenza, hepatitis B
  3. avoid live vaccines (polio and mumps  )-----> risk of placental and fetal infection
  4. contraindicated : rubella

BREASTFEEDING AND DRUGS

Safe
  1. penicillins, aminoglycosides, cephalosporins
  2. oral contraceptive use (low dose) is now believed to be safe

Avoid
  1. chloramphenicol (bone marrow suppression)
  2. metronidazole (mutagenic in vitro)
  3. sulphonamides (hemolysis with G6PD deficiency)
  4. nitrofurantoin (hemolysis with G6PD deficiency)
  5. tetracycline (stains teeth and bones)
  6. lithium
  7. antineoplastics and immunosuppressants
  8. psychotropic drugs (relative)
DRUGS CONTRAINDICATED IN PREGNANCY DRUGS CONTRAINDICATED IN PREGNANCY Reviewed by Radiology Madeeasy on September 08, 2010 Rating: 5
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