DRUGS AND PREGNANCY

DRUGS AND PREGNANCY
Some drugs can cause damage to the baby when given during pregnancy. Some cause miscarriages or kill the babies. For example, tetracyclines may cause yellow or brown discolouration of deciduous teeth. Gestation is divided into three periods. (1) The ovum, from fertilization to implantation; (2) the embryonic period, from the 2nd through the 8th week; and (3) the fetal period, from after 8 completed weeks until term. The embryonic period is the most critical with regard to malformations since it encompasses organogenesis (period when the various parts or organs of the baby are formed). Drugs should not be given to pregnant women especially in the first three months of pregnancy except those recognized as safe during pregnancy.
Every care giver should find out from every woman in her reproductive age whether she is pregnant or not or when she had her last menstrual flow.
The following agents should be avoided during pregnancy.
 alcohol
 Cigarettes
 Phenytoin (drug used to treat epilepsy)
 Diethylstilbesterol
 Sports performance enhancing drugs like androgenic hormones
 Antibiotics like tetracyclines, ciprofloxacin, ofloxacin, chloramphenicol, ciproxin, septrin (co-trimoxazole), norfen, peflacin, Tarivid, streptomycin, rifampicin, laevofloxacin.
 Megavitamins that contain high doses of vitamin A, D, E and K.
No drug or medication should be taken during pregnancy unless clearly indicated and it is wise to advise the woman of the specific reasons for the use of such medications.

DRUGS THAT CAN BE USED DURING PREGNANCY

Drugs that can be used during pregnancy are in 4 categories.
Category A:
These are drugs for which controlled studies in humans have demonstrated no fetal risks. These include prenatal vitamins such as folic acid, multivites, B complex tablets, fersolate, vitamin C tablets.
Category B:
These are drugs for which animal or human studies have not demonstrated a significant risk. There are, however, no controlled human studies. These include the penicillins such as:
 Ampicillin
 Ampiclox
 Cloxacillin
 Procaine Penicilline
 Crystalline Penicilline
 Amoxycillin
Other category B drugs include
 Cephelosporins like Ceftriaxone (Rocephine, Oframax)
 Metronidazole (Flagyl)
 Erythromycin
 Nitrofurantoin
 Nystatin
 Chloroquine
Others are
 Digoxin (used to treat heart failure)
 Insulin (used to control diabetes mellitus)
 Antihistamines like Avomine, chlorpheniramine (piriton)
 Acetaminophen (Paracetamol)
 Alpha methyl Dopa (aldomet)
Category C
These are drugs for which there are no adequate studies either animal or human or drugs in which there are adverse fetal effects in animal studies but no available human data.
Such drugs can only be used by doctors when they feel the patient needs them to stay alive. They should not be used by other categories of health workers.
They include:
 Corticosteroids such as prednisolone
 Adrenaline
 Ephedrine
 Furosemide (lasix)
 Carbamazepine (Tegretol) used to treat epilepsy
 Chlorpromazine (largactil)
 Aspirin
 Phenothiazines (used to treat psychiatric patients)
Category D
Drugs for which there is evidence of fetal risks but benefits are thought to outweigh these risks. Such drugs should only be used by medical practitioners when they think it is absolutely necessary to do so.
Many anti cancer drugs are in this category including
 Methotrexate
 Vincristine
 Melphalan
 Cyclophosphamide
 Chlorambucil
 Cis platin
Other drugs in this category include:
 Phenytoin (used to treat epilepsy)
 Progestins
 Tetracyclines
 Amitriptyline (used to treat depression)
 Diazepam
 Imipramine (used to treat depression)