Pharmacology / Practical

Lab no. 9

Drug Therapy in Pregnancy

Introduction
‫ﺗﺤﺪﯾﺎ ﻛﺒﯿﺮا ﻟﻸطﺒﺎء‬
- Drug use during pregnancy presents a great challenge to clinicians because of the
potential adverse effect on the embryo, fetus, and newborn.

- The potential benefits of medication therapy must be weighed against the

possible risks to the fetus. .‫ﯾﺠﺐ ﻣﻮازﻧﺔ اﻟﻔﻮاﺋﺪ اﻟﻤﺤﺘﻤﻠﺔ ﻟﻠﻌﻼج اﻟﺪواﺋﻲ ﻣﻘﺎﺑﻞ اﻟﻤﺨﺎطﺮ اﻟﻤﺤﺘﻤﻠﺔ ﻋﻠﻰ اﻟﺠﻨﯿﻦ‬

- The limited availability of scientific data from randomized trials complicates the
decision to prescribe and recommend medications for pregnant women, even
when they are medically necessary. ‫ﯾﺆدي اﻟﺘﻮاﻓﺮ اﻟﻤﺤﺪود ﻟﻠﺒﯿﺎﻧﺎت اﻟﻌﻠﻤﯿﺔ ﻣﻦ اﻟﺘﺠﺎرب اﻟﻌﺸﻮاﺋﯿﺔ إﻟﻰ ﺗﻌﻘﯿﺪ ﻗﺮار‬
.‫ ﺣﺘﻰ ﻋﻨﺪﻣﺎ ﺗﻜﻮن ﺿﺮورﯾﺔ طﺒﯿﺎ‬،‫وﺻﻒ اﻷدوﯾﺔ واﻟﺘﻮﺻﯿﺔ ﺑﮭﺎ ﻟﻠﻨﺴﺎء اﻟﺤﻮاﻣﻞ‬

Teratogen
A teratogen is usually defined as any agent, physical force, or other factor (e.g.,
maternal disease) that can induce a congenital anomaly through alteration of normal
development during any stage of embryogenesis.

- Agents include drugs and other chemicals.

‫ﺗﻘﯿﯿﺪ ﺟﺴﺪي‬
- Physical forces include ionizing radiation and physical restraint (e.g., amniotic
banding)

Placental Transfer Of Drugs

- In general, what the mother consumes also is consumed by the fetus. Although the
placenta acts as a biologic membrane, it initially is composed of layers that
effectively separate two distinct individuals.
‫ إﻻ أﻧﮭﺎ ﺗﺘﻜﻮن ﻓﻲ‬،‫ ﻋﻠﻰ اﻟﺮﻏﻢ ﻣﻦ أن اﻟﻤﺸﯿﻤﺔ ﺗﻌﻤﻞ ﻛﻐﺸﺎء ﺑﯿﻮﻟﻮﺟﻲ‬.‫ ﻣﺎ ﺗﺴﺘﮭﻠﻜﮫ اﻷم أﯾﻀﺎ ﯾﺴﺘﮭﻠﻜﮫ اﻟﺠﻨﯿﻦ‬،‫ﺑﺸﻜﻞ ﻋﺎم‬
.‫اﻟﺒﺪاﯾﺔ ﻣﻦ طﺒﻘﺎت ﺗﻔﺼﻞ ﺑﺸﻜﻞ ﻓﻌﺎل ﺑﯿﻦ ﻓﺮدﯾﻦ ﻣﺘﻤﯿﺰﯾﻦ‬

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 Pharmacology / Practical
Lab no. 9

The Mechanisms Of Drugs And Nutrients Transporting

Through Placenta
- Simple diffusion (e.g., most drugs).
- Facilitated diffusion (e.g., glucose).
- Active transport (e.g., some vitamins, amino acids).

Factors Affect On Placental Transfer Of Drugs

Several factors influence the rate of drug transfer across the placenta, including:

- Molecular Weight (MW)

- Lipid solubility
- Ionization
- Protein binding
- Uterine and umbilical blood flow
- Maternal diseases.

Critical Periods of Exposure ‫ﻓﺘﺮات اﻟﺘﻌﺮض اﻟﺤﺮﺟﺔ‬

1. Preimplantation.
2. Embryonic development.
3. Fetal development.

Preimplantation
- The first week postconception (until the blastocyst attaches to the wall of the
uterus forming chorionic villi) was considered protected from drugs or medications
that may be in the maternal circulation because there is no formal biological
interface between the blastocyst and the mother. However, recent evidence
indicates that the preimplantation embryo may not be as protected as previously
thought. (e.g., mitomycin) ‫ ﺗﺸﯿﺮ اﻷدﻟﺔ اﻟﺤﺪﯾﺜﺔ إﻟﻰ أن ﺟﻨﯿﻦ ﻣﺎ ﻗﺒﻞ اﻟﺰرع ﻗﺪ ﻻ ﯾﻜﻮن ﻣﺤﻤﯿﺎ ﻛﻤﺎ ﻛﺎن‬،‫وﻣﻊ ذﻟﻚ‬
(‫ اﻟﻤﯿﺘﻮﻣﺎﯾﺴﯿﻦ‬،‫ )ﻋﻠﻰ ﺳﺒﯿﻞ اﻟﻤﺜﺎل‬.‫ﯾﻌﺘﻘﺪ ﺳﺎﺑﻘﺎ‬

Embryonic Development .‫اﻟﻤﺮﺣﻠﺔ اﻷﻛﺜﺮ أھﻤﯿﺔ ﻣﻦ اﻟﺘﻄﻮر ﻟﺘﺤﺮﯾﺾ اﻟﻌﯿﻮب اﻟﺨﻠﻘﯿﺔ ھﻲ ﻓﺘﺮة اﻟﺠﻨﯿﻦ‬

- The most critical stage of development for the induction of birth defects is the
period of the embryo. The period of the embryo extends the time of implantation
until 58–60 days postconception. The organs and tissues of the unborn baby are
being formed (i.e., organogenesis) during this period.

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Lab no. 9

‫ﺧﻄﺄ‬
- Mistakes which occur during the period of the embryo result in malformations
(congenital anomalies) and are called birth defects.
‫ﺗﺸﻮھﺎت ﻗﺎﺗﻠﺔ ﻟﻠﺠﻨﯿﻦ‬
- Malformations lethal to the embryo present as spontaneous abortion, sometimes
before pregnancy is recognized. Similarly, some substances that are directly toxic
to the embryo, e.g., methotrexate, also present as spontaneous abortions.

Fetal Development
- Most of the potential adverse effects during fetal development are
‫ﺑﺴﺒﺐ ﺗﻮﻗﻒ ھﺠﺮة اﻟﺨﻼﯾﺎ وﺗﺨﻠﻒ اﻟﻨﻤﻮ‬
maldevelopment due to interrupted cell migration and growth retardation, If blood
flow to an organ or structure is interrupted or obstructed, structures that were
normally formed during embryogenesis may be malformed during the fetal period
(e.g., vascular disruption and fetal cocaine or warfarin exposure)

Food And Drug Administration (FDA) Risk Factors

- the FDA established five letter risk categories - A, B, C, D or X - to indicate the
potential of a drug to cause birth defects if used during pregnancy.

- The widely cited FDA system for teratogenic potential is an attempt to quantify
teratogenic risk from A (safe) to X (definite human teratogenic risk).

Drugs Examples
Thalidomide disaster

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 Pharmacology / Practical
Lab no. 9

Categories Of Risk for Drugs During Pregnancy

‫اجانة اليوم بالفاينل‬