Drug Information Bulletin

an official publication of

Drug Information Center

Government College of Pharmacy, Amravati

Theme: Pregnancy and Maternal Health

Month: August- September 2023
Issue No.: 02

Patron: Dr. S. S. Khadabadi

Editors: Dr. Hrishikesh N. Gupta

Pratiksha P. Wanjari

Trupti P. Tathod
From Editor’s desk

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Drug of month:
Zurzuvae: Zuranolone capsules
FDA Approval: 04 Aug, 2023
Treatment for: Postpartum depression
Zurzuvae is a neuroactive steroid gamma-aminobutyric acid-A receptor positive modulator indicated for the
treatment of postpartum depression[5]. It selectively modulates the GABA-A receptors and rebalances the
dysregulated neuronal networks to reset the normal brain function. Zurzuvae is metabolised in liverby
CYP3A4 and eliminated in urine and faeces. It is given 50mg Once daily orally in the evening with fat-
containing food, for 14days. Pharmacokinetic profile shows that it has 62% bioavailability with the half-life
of 19.7-24.6hrs along with >99.5%. It has certain adverse effects such as somnolence, dizziness, diarrhoea,
fatigue, nasopharyngitis and UTI. It may cause serious side effects such as decreased ability to drive ordo
other vigorous activities, decreased awareness and alertness, increased risk of suicidal thoughts,etc.
Female patients with reproductive potential should use effective contraception during treatment and for
1week after final dose[6].

Answers: Intelligence corner

(See page no.04)
1. 2 hours (Pills are to be
taken at 0, 30, 60, 90, 120).
2. The baby in pregnant
Do you know? mother’s womb.
3. You have to pick only one
gummy from jar C. Suppose
the gummy is a mood
support gummy, then the
 Pregnant women have cravings for non-food items like jar C contains mood
chalk, paper, soap, soil,etc; this is known as “Pica support gummies only
disorder”. (because all the jars are
 Babies can be born with teeth, known as “Natal teeth”; mislabeled). Now, since jar
this tooth is removed by doctors to ensure no choking C has mood support
occurs as these teeth are often loose. gummies only, jar B can
contain multivitamin
 During pregnancy, mother’s heart actually grows both
gummies or mixture. But
emotionally and figuratively, beats faster and stronger, and
jar B can contain only the
the blood volume increases upto50%. mixture because its label
 In pregnancy, the males may experience pregnancy reads “mood support
symptoms like weight gain, nausea and swelling in tandem gummies” which is wrong.
with their pregnant partners; this is known as “Couvade Therefore, jar A contains
syndrome” or “Sympathetic pregnancy”. multivitamin gummies.

2

Herbal desk:
Saffron
Saffron is a spice derived from the Crocus Sativus
flower.It is commonly used in Indian cuisine and has
several essential nutrients that are important during
pregnancy named as crocin, picrocrocin, crocetin, and
saffranal. Kashmiri Mongrasaffron is the best in quality
[2]
. system. The motive of the portal is to modernize,
Nutritional benefits of saffron during pregnancy
 It is a good source of iron, which is crucial for the
production of red blood cells and prevents
anemia. Saffron is also rich in vitamin A, which is
vital for fetal development, and vitamin C, which
helps in the absorption of iron.
 Additionally, saffron contains several antioxidants
that help protect the body from oxidative stress
and free radicals, supporting a healthy pregnancy
 However, it is important to consume saffron in
moderation and after consulting with a doctor.
Psychological Benefits of Saffron during Pregnancy
 It contains natural antidepressants that promote
the production of mood-regulating
neurotransmitters.
 Saffron has calming effects, reducing anxiety and
stress levels in pregnant women.
 It is believed to improve memory and cognitive
function, which can be helpful during pregnancy
when women often experience brain fog.
 Adding saffron to the diet can help pregnant
women maintain a positive outlook and enjoy a
stress-free pregnancy.
 It is important to consume saffron in moderation
and after consulting with a doctor, especially if
taking antidepressant medication.
Medical Benefits of Saffron during Pregnancy
 Saffron has anti-inflammatory properties that can
reduce the risk of pregnancy-induced
hypertension, a condition that can lead to pre-
eclampsia and endanger the health of both the
mother and baby.
 Saffron is also believed to have anti-spasmodic
effects that can ease cramps and reduce the risk
of miscarriage.
 Saffron has been found to have a positive effect
on digestion, which can alleviate pregnancy-
related digestive issues such as constipation and
bloating.
 Saffron has been found to have a positive effect
on uterine contractions, making it beneficial
during labour[1].
Health-tech corner:
The U-Win Portal
The U-Win portal is basically an electronic registry of
Universal Immunization Programme and soon will be
introduced in healthcare practices.
The U-Win portal is based on the technology of Co-Win
portal, a successful COVID-19 vaccine management
streamline and up-to-date the Universal Immunization
Program (UIP) by digitizing immunization records and
increasing the individual tracking capabilities. The portal
is launched on Jan 11,2023 and is in its pilot trial phase
in every two districts of each state. In Maharashtra, the
trials are being done in RAIGAD and OSMANABAD
districts. The U-Win portal will register and vaccinate
every pregnant woman, record her delivery outcomes,
register birth of every child, administer birth doses and
all vaccinations thereafter.
How is the portal useful?
 Through U-Win portal, the citizens can identify
nearby routine immunization sessions, make
appointments and receive comprehensive
information about their vaccinations and the
portal updates the real-time vaccination status.
 The portal can provide tracking’s and
accessibility for citizens across India.
 The portal also provides awareness about
sessions, location and date, and individual
tracking among the beneficiaries.
 The platform can also generate
acknowledgement and immunization
certificates/cards linked to the Ayushman Bharat
Health Account (ABHA ID) for pregnant women
and children.
 It can avoid problems related with multiple
vaccinations and dosings which might have
caused difficulty in monitoring.
 It can avoid the problem of unregistered
immunizations taken at private healthcare
centres[3].
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 Intelligence Corner:

Diagnostic advances:
Electronic fetal monitoring:
Here are some fun riddles with
Electronic fetal monitoring is a continuous test that records
easy, medium and hard levels.
uterine contractions and baby’s heart rate, widely
recommended in pregnancies that are at a high risk of Try to solve and have fun!
complications.
There are two types of electronic fetal monitoring:
 External EFM: In this, the mother’s abdomen is secured
with two measuring devices by using elastic strips.
1.A doctor gives 5 pills to a pregnant
An ultrasound device placed over abdomen can
woman and tells to take one every half
measure fetal heart rate and the pressure gauge on the
an hour. How long will it take to finish
abdomen can measure frequency of the uterine
the pills if she follows the doctor’s
contractions.
order?
 Internal EFM: This is more invasive and can provide
results when getting a continuous heart rate is limited
by movement. A wire is insertedthrough vagina which
attaches to the baby’s head to track heart rate and a
catheter is inserted into uterus which measures uterine
contractions.
EFM is recommended to use in: -
 Maternal health conditions like preeclampsia, 2. In a bus, there is a toddler 3-year-old
Diabetes, Previous cesarean, or Bleeding during with her pregnant mom headed to a
pregnancy. city along with a security guard 37
 Small size of fetus or congenital abnormalities in years old, random woman-56 years old
baby. and the driver is 56 years old. Tell who
 Meconium staining during labor, which may is the youngest travelling by bus?
indicate fetal distress.
 Induced or assisted labour using medications.
 Trauma to mother’s belly after 20 weeks of
gestation.
 Detection of false labor
Risks of EFM:- 3. A pregnant women is advised to take
 EFM can lead to false alarms causing gummies by her doctor but the jars are
unnecessary stress. mislabelled. She is allowed to pick only
 Limit’s ability to move around which are one gummy at a time. Find the
beneficial in pregnancy. minimum picks required to correctly
 It may lead to a false concern for fetal distress label the jars.
which may result in cesarean section or
operative surgery using a vacuum device or
forceps. A Mix
B
 Internal EFM can cause injury to the baby’s
scalp, Maternal infection, Transmission of HIV or
genital herpes from mother to baby.
 In RARE cases, the catheter can get tangled with
the umbilical cord, punctures the uterus or tears
the placenta [8].
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Disease update:
Preeclampsia:
Preeclampsia is a serious medical condition unique to pregnancy characterized by high blood
pressure, high levels of protein in urine and/or other signs of organ damage. Its incidence varies
from 5% to 15% in India, and usually begins after 20 weeks of mother’s pregnancy.Preeclampsia,
which develop after baby’s delivery is known as “Postpartum preeclampsia”.
Signs and Symptoms of preeclampsia are:High Blood Pressure, Proteinuria, Thrombocytopenia,
Increased Liver enzymes, Severe headaches, Fluid accumulation in lungs causing shortness of
breath, Oedema, Nausea or Vomiting.
What causes preeclampsia?
The exact cause of preeclampsia is not well identified, but experts believe that the problem begins
with “The placenta”. In early pregnancy period, new blood vessels develop to supply oxygen and
nutrients to the placenta. When these vessels do not develop or work properly, leads to irregular
blood pressure in mother and may cause preeclampsia. This condition can also cause problems to
fetus.
Risk factors: can be listed as
Higher risk:
 Preeclampsia in previous pregnancy
 Chronic high BP
 Type1 or type 2 diabetes before pregnancy
 Kidney disease
 Autoimmune disorders
 Use of IVF (In-vitro fertilization)
Moderate risk:
 Family history with preeclampsia
 Maternal age of 35 and older
 Complications in previous pregnancy
 More than 10 years since previous pregnancy
Black woman and woman with low income are also at risk due to lack of knowledge and less access
to healthcare facilities.
What are the complications?
Preeclampsia can cause Foetal growth restriction, Preterm birth, Placental abruption, HELLP
Syndrome(Haemolysis, Elevated liver enzymes and Low platelet count), Eclampsia, Cardiovascular
diseases and other organ damage if not managed.
Prevention and Management: For reducing the risk of preeclampsia, a primary care provider
assesses the risk factors present in the mother. If one high risk factor or more than one moderate
risk factors are present, the provider recommends an aspirin tablet(81mg) daily after 12
weeks.Always consult with the primary care provider before taking any medications, vitamins or
supplements.To prevent the development of Eclampsia, patients are given with magnesium
intravenously during labour and following delivery. To reduce the risk, lose weight, control BP,
control blood sugar, get enough sleep, do exercise regularly and also eat healthy foods[4].

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Events corner:

“SUPOSHIT BHARAT, SAKSHAR BHARAT, SASHAKT BHARAT”: National nutrition

monthbeing celebrated at District General Hospital, Amravati.

Sept.2023, Amravati: National Nutrition Month (Poshan Maah 2023) has started from 1 st September in
NRC ward of District General Hospital, Amravati. The main objective of the “Poshan Maah” is to emphasize
the importance of nutrition, education, empowerment in building a healthier and stronger country and
reducing undernutrition levels among children below 6years of age, pregnant women & lactating mothers.
Various programs and competitions are being organized for celebration of the nutrition month 2023 in the
presence of Dr. Nitin Raut, Dr. Nirwane and the healthcare staff. The Indian Academy of Pediatrics,
Amravati is assisting in the programs. The whole campaign is scheduled to be evaluated in the month of
October and December. The theme for the “Poshan Maah” itself tells the significance of the campaign,
which is- “NUTRITION-RICH INDIA, EDUCATED INDIA, EMPOWERED INDIA”.

A pregnant women should always be aware about warning signs!

Following warning signs require immediate visit to the doctor/health facility:
 Fever >38.5°Cfor more than 24 hours.
 Headache, blurring of vision.
 Pain in abdomen.
 Generalized swelling of body and facial puffiness.
 Vaginal bleeding, watery discharge.
 Reduced fetal movements.
 Palpitations, easy fatigability and breathlessness at rest[9].

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Yoga poses for pregnancy:
1st trimester pose:
Standing forward bend (Uttanasana):
This is a brilliant pose to relieve stress from lower
back. It’s a simple Yoga pose where we have to
stand and bend forward to strengthen back.
Steps:
Stand on yoga mat with the feet wide apart.
Spread the legs hip- width apart and put hands on
your waist. Then slightly bend your knees and [Fig: Parsvasukhasana]
allow your head to drop forward towards the mat.
Keep the knees stay loose, leave both the hands
from waist and try to hold ankles. 3rd Trimester pose:
Butterfly pose (Baddhakonasana):
This Yoga asana is one of the best ways to relax
the whole spine, neck, and knees. It also opens up
pelvic muscles, thighs, and hips to improve
flexibility. It also helps in enduring pain during
labour.
Steps:
Sit in a lotus position or crossed legs on Yoga mat.
Then bring the soles of feet together in such a
way that they are touching each other. Try to pull
feet as much as by holding them in hands. Then,
[Fig: Uttanasana] Straighten the spine and relax the shoulders. Take
a deep breath in and out as folded knees go up
2nd trimester pose:
and down. Then, try to bring legs to the chest
Seated Side Bent (Parsvasukhasana): It is safe to
level. Then move them up and down as fast as
twist little bit in pregnancy. In this asana, pregnant
you can like a butterfly flaps its wings [7].
women should avoid the twists that can compress
body against knees.
Steps:
Sit down on the mat in a comfortable upright
position. Cross both the legs and fold hands in the
half-lotus pose. Then keep the right hand resting
comfortably on the floor and then stretch left arm
straight above the head and bend to the side.
After that, lower right forearm for support. Then,
Repeat the same exercise on other side of the
body.

[Fig: Baddhakonasana]

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Traditional practices

Garbh Sanskar: Benefits in Pregnancy

Garbh sanskar is the practice of simple activities that contributes in social, physical, spiritual,
mental well-being of both mother and child. Garbh means womb and sanskar means instilling
good values, so Garbh sanskar basically means educating an unborn child. It is proven that the
baby responds to external stimuli and thus if right external stimulation is given, his/ her mind and
senses will grow more efficiently as 80% of brain development happens in womb.
‘Garbh sanskar’ practices should be started three months before conception.

Garbh Sanskar activities for a pregnant woman:

 Relaxing with calming music
 Pregnancy meditation
 Pregnancy yoga
 A healthy pregnancy diet
 Creative pursuits and hobbies
 Communicating with the unborn child
 Be happy
 Set aside a dedicated time of the day
 Visualise the baby and actively send good vibes to the womb
 Recite or say aloud chants or texts from holy scriptures
 Consider yourself as third person while communicating with baby and talk aloud.

Benefits of Garbh Sanskar for the baby in their Adulthood:

 Better confidence and self-esteem.
 Long term strength of immune system.
 Good brain development.
 Significantly lowering chances of depression in later life.
 Making baby feel loved and wanted [10].

“God could not be everywhere, and therefore he made MOTHERS!”

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Clinical Case Analysis:
Case-study on post-natal care with eclampsia

A 26-year-old female patient was admitted in District General Hospital, Amravati on 18 July
2023 with chief complaints of seizures in 6 th -9th month of pregnancy, giddiness, restlessness,
breathlessness. On examining the past medical history, it was found that it is known case of
pre-eclampsia. Her past medication history was not significant. She was not taking
medications regularly. Further she was advised for CBC, LFT, ECG, EEG, BP monitoring every 2
hourly. After laboratory evaluation it was found that her Hb(hemoglobin) was low, platelets
count was high, her ECG was abnormal and hypertrophy in ventricles was found and
diagnosis was made of PNC with eclampsia. On day 1 she was seen by physician with general
condition poor and history of post C- section eclampsia, her BP was 170/110mmhg, pulse
rate was 138beats per min. Her other vitals were normal but CNS was conscious and
disoriented. She was treated with Inj. Taxim 1 gm IV BD,5gm IM every 4 hourly, Tab. Nicardia
20 mg BD, Inj. Mannitol 100 ml IV stat slowly, Inj. Taxim 1 gm IV BD, Inj. Metro 500 mg IV TDS,
Inj.Gentamicin 80 mg BD IM, Inj. Pan 40 mg OD, Inj. Tramadol 50 mg + 100 ml NS slowly stat.
On day 2 she was seen by gynecologist with her general condition moderate, all her vitals
were normal and history of PNC day 2, P3L3 with post C section with Eclampsia; her BP was
140/90 mmhg, she was given same treatment as that of day except inj. Lasix20 mg. On day 3
she was seen by gynecologist with no fresh complaints, her BP was 150/100mmhg; she was
treated same as day 1 and Tab. Labet 100mg BD was added. On day 4 she was seen by
gynecologist her general condition was moderate, all vitals were normal and BP was
130/90mmhg and she was treated same as day 3 and advised for liquid diet. On next day she
was discharged with discharge medications that are; Tab. Pan 40 mg OD, Tab.amoxyclav 625
mg BD, Tab. MVBC OD, Tab. Neurobion Fort OD, Tab. Amlo 2.5 mg OD daily for next 1 month
and monitor BP weekly (If BP raised visit to hospital). Patient was counseled regarding dose,
route of administration and frequency of dosage form [11].
Clinical Pharmacist’s remarks:
On examining the case study, it can be suggested that there should be gap of atleast 3-4hrs
between nifedipine and gentamicin as nifedipine will decrease the effect of gentamicin.
Labetalol and nicardia shows synergistic effects of antihypertension, so proper gap should be
maintained and blood pressure should be monitored. Sr. Potassium level should be
monitored as labetalol and gentamicin have effects on it.

9
References:

1. Kesar/Saffron During Pregnancy: Benefits and Risks.

2. Different Types/Grades of Kashmir Saffron.
3. Government to soon roll-out U-Win portal for maintaining electronic registry of routine
immunizations, Sept 04, 2023.
4. Preeclampsia- Symptoms and Causes, April 15,2022.
5. Zurzuvae FDA Approval History by Judith Stewart, Aug. 06, 2023.
6. FDA Approves Zurzuvae (Zuranolone) First Oral Treatment for Post-partum Depression, Aug.
04,2023.
7. 9 Prenatal Yoga Poses for Each Trimester of Pregnancy, Jul 12,2022.
8. Electronic Fetal Monitoring: Purpose, Procedure and Results, April 29, 2022.
9. High-Risk-Conditions-in-preg-modified -PMSMA, MOHFW.
10. Garbh Sanskar in Pregnancy: Benfits and Practices, by IMumz Expert Panel.
11. Case-study from ICU (Intensive Care Unit), District General Hospital, Amravati.

“Taking care of yourself is a part of taking care of your kids!”

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