…DRUGS IN PREGNANCYPresented by

Jaber Al-Manasia5th year medical student

ALCOHOL

• It causes mental and physical defects represented in distinctive abnormal stigmata.

• The effects are known as fetal alcohol syndrome

(1)characteristic facial anomalies .(2)growth retardation(3)CNS involvement

• a. Small palpebral fissures

• b. Thin vermilion border

• c. Smooth philtrum

CNS

• Structural : microcephaly, agenesis of corpus callosum, cerebellar hypoplasia, hipocampus…

• Neuological : epilepsy, impaired fine motor skills, hearing loss, poor gait, clumsiness…

• Functional : communication, learing, behavior…

TOBACCO Newborns of smoking mothers are 200 g

less than those of nonsmokers’ baby.

Smoking also may cause

increase incidence of subfertility, spontaneous abortion, placenta previa, placental abruption , preterm delivery.

Many studies found association between maternal smoking and hydrocephaly,microcephaly, omphalocele, gastroschisis,cleft lip and palate & hand abnormalities.

ANALGESIC

• Aspirin: not increase risk of anomalies • Acetaminophen: not increase risk of

anomalies• NSAIDs

• indomethacin

• Early closure of fetal ductus arteriosus and subsequent pulmonary hypertension

• decrease fetal urine output and reduce amnionic fluid

• reversible if discontinued before 34 weeks

ANTI-THYROID DRUGS• (carbimazole, neomercazole, thiouracil);

Anti -thyroid

thyroid hormone in the fetal thyroid gland causing compensatory over action of the pituitary leading to fetal goiter which may cause neonatal respiratory obstruction

• Lack of thyroid hormone will cause fetal cretinism& mental retardation.

• If anti-thyroid drugs are used, they should be combined with L-Thyroxin

• Radio –Active Iodine ;shouldn’t be used in pregnancy, because the fetal thyroid gland will be destroyed if Iodine 131 is ingested by the mother.

ANTI-THYROID DRUGS

HYPOTENSIVE DRUGS:

• Beta-Blockers; (e.g. propanol, atenalol, tenormin).

placental insufficiency… hypotonia, hypoglycemia IUGR + increase in P.N.M.

Hypotensive Drugs:

• ACE inhibitors ... ACE inhibitors ... • C/I in pregnancy;• Skull defects.• Oligohydraminos 2ry to renal impairment in the foetus.• Affects fetal blood pressure control.

• Angiotensin II receptor inhibitor Angiotensin II receptor inhibitor (Losartan, Valsartan) should be avoided(evidence evidence

of fetal riskof fetal risk).

• Methyldopa, hydralazine, calcium channel blocker:

No reports of congenital defect.[C ]

Hypotensive Drugs:

RESPIRATORY SYSTEM

• Asthma drug : Bronchodilators

Salbutamol, Aminophylline & Theophylline safe.

• steroids:If administered by inhalation (safe) no adrenal

suppression.Systemic steroids : facial clefts.

ANTIBIOTIC DRUGS

• Tetracycline; after 4th month of pregnancy it enters the fetal circulation, chelates with Ca & deposits in teeth, bones, nails.

• When the teeth erupt in the infant ,they are at 1st light yellow & fluoresce in ultraviolet light & later the color fades gradually to a non florescent brown, in addition to hypoplasia of teeth leading to dental carries

• Ampicillin& penicillin :safe

•Chloramphenicol : B.M. depression in the mother & very dangerous to premature neonate. No congenital anomalies.

– Gray baby syndrome

•Aminoglycosides : Although both nephrotoxicity and ototoxicity have been reported in preterm newborns and adults treated with gentamicin or streptomycin, congenital defects resulting from prenatal exposure have not been confirmed.

ANTI- CONVULSANT DRUGS:

• Phenobarbitone, Phenytoin, Primidone ;

• Retrospective study suggested that cleft lip & palate may occur in the fetus, but prospective study of 16 neonates of mother on anti-convulsant drugs showed that 7 neonates had severe coagulation defects similar to vitamin K deficiency.

• Prophylactic RX of the mother with vit. K may prevent this risk.

DRUGS CAUSING KERNICTERUS& JAUNDICE.

• They cause dissociation of the bilirubin from its protective binding to serum albumin in the fetus….. The free bilirubin diffuse readily into the CNS producing Kernicterus :

e.g. the following;

• Sulphonamide (sulphamethoxazole + trimethoprim)

• Salicylates, Phenylbutazone

• Phenothiazides.

Thank you