DRUG THERAPY

DURING PREGNANCY
Developed By
D. Ann Currie , R.N.,M.S.N.

PHYSIOLOGICAL CHANGES DURING

PREGNANCY AND THEIR IMPACT
ON DRUG THERAPY
EVERY SYSTEM IN THE BODY IS
EFFECTED BY PREGNANCY
PHARMACOKENETICS OF DRUGS IS
EFFECTED BY PREGNANCY

PHARMACOKENETICS
OF DRUGS DURING
PREGNANCY

ABSORPTION- DECREASED GI MOTILITY

CAUSES INCREASED DRUG
ABSORPTION.
DISTURBUTION- PROTIEN BINDING IS
DECREASED CAUSES INCREASED FREE
DRUG TO BE AVAILABLE.
METABOLISM-INCREASED HEPATIC
METABOLISM OCCURS FOR SOME
DRUGS

PHARMACOKENETICS

EXCRETION- IN THE 3RD

TRIMESTER INCREASED RENAL
BLOOD FLOW & GFR CAUSES
SOME DRUGS TO CLEAR THE
BODY FASTER.

DRUG THERAPY IN THE

CHILDBEARING CLIENT

REQUIRES SPECIAL
CONSIDERATIONS
IS CHALLENGING
TO PROVIDE
EFFECTIVE TX
WHILE AVOIDING
HARM TO
EMBRYO,FETUS OR
NEONATE

CENTERED ON
RISK/BENEFIT
RATIO
EFFECTS OF
DRUGS NOT
ALWAYS KNOWN

ANY DRUG TAKEN BY

EFFECTS OF DRUGS ON
THE EMBRYO, FETUS,
OR NEONATE

MAY VARY--NO EFFECT.

LITTLE
SERIOUS- FETAL TOXICITY
SPONTANEOUS ABORTION
DEATH
FETAL MALFUNCTION
FETAL MALFORMATIONS.

DRUG THERAPY
DURING PREGNACY

CENTERED ON RISK/BENEFIT RATIO

EFFECTS OF SOME MEDICATION ARE
KNOWN
UNKNOWN- NEW MEDICATIONS,
DIFFERENT COMBINATIONS,
DEFICIENCY IN MATERNAL
METABOLISM
NO DRUG IS ABSOLUTELY SAFE.

RECENT STUDIES

75% OF PREGNANT CLIENTS USE

3-10 DIFFERENT
DRUGS(PRESCRIPTION OR OTCS)
OTHER THAN VITAMINS/MINERAL
SUPPLEMENTS DURING THEIR
PREGNANCY.
OTCS WERE USED 4 TIMES THAT
OF PRESCRIPTION DRUGS.

TYPES OF DRUGS USED

IN THE STUDY BY
PREGNANT
CLIENTS
DIETARY
ANALGESICS

SUPPLEMENTS
ANTIEMETICS
ANTACIDS
TRANQUILIZERS
HYPNOTICS
ANTIBIOBIOTICS
ANTIHISTAMINES

DIURETICS
ETOH
CNS
DEPRESSANTS
CNS STIMULANTS

DRUG LEVELS IN THE

FETUS REACHED 50100% OF THE
MATERNAL BLOOD

SELF TREATMENT WITH

DRUGS DURING
PREGNANCY

SELF TX OF MINOR ILLNESSES OR

DISCOMFORTS SHOULD BE
DISCOURAGED
*SELFTREATMENT OF ANY ILLNESSES
SHOULD BE DISCOURAGED
WOMEN SHOULD BE INSTRUCTED TO
KEEP A COMPLETE RECORD OF ALL
MEDICATIONS TAKEN .

THE CHALLENGE OF
PROVIDING EFFECTIVE
CARE/TX FOR THE
AVOID HARM TO EMBRYO, FETUS,
CHILDBEARING CLIENT

NEONATE.
DILEMMA UNFORTUNATELY THE
RISK OF MOST DRUGS HAVE NOT
BEEN ESTABLISHED.
DESPITE NOT KNOWING DRUG
THERAPY DURING PREGNANCY

CANNOT OR SHOULD NOT BE

AVOIDED BECAUSE THE HEALTH OF
THE FETUS DEPENDS ON THE
HEALTH OF THE MOTHER.
FOR EXAMPLE: SEIZURES ,DM, MG,
SLE,OR INFECTIONS.

BIRTH DEFECTS

INCIDENCE OF MAJOR
STRUCTURAL
DEFECTS(ABNORMALITIES) IS
ABOUT 6% OF ALL PREGNANCIES.
3% ARE CAUSED BY DRUGS OR
ENVIRONMENTAL
FACTORS/EXPOSURE
3% HAVE A UNKNOWN CAUSES

BIRTH DEFECTS

1/2 OF THE BIRTH DEFECTS ARE

OBVIOUS AT BIRTH.
1/2 OF THE BIRTH DEFECTS ARENT
DISCOVERED UNTIL LATER IN LIFE
OR DISCOVERED DURING AN
AUTOPSY
INCIDENCE OF MINOR STRUCTURAL
ABNORMALIES IS NOT KNOWN.

BIRTH DEFECTS

INCIDENCE OF FUNCTIONAL
ABNORMALITIES IS NOT KNOWNGROWTH RESTRICTIONS, MENTAL
RETARDATION, AND LEARNING
DISABLITIES
SOME ABNORMALITIES HAVE
MULTIPLE CAUSES-GENETIC FACTORS,
ENVIRONMENTAL FACTORS,
CHEMICALS OR DRUGS.

TERATOGENIC
TERATOGENESIS

TERAS-MONSTER
GENSIS-PRODUCING
BIRTH DEFECTS/DISTORTION OF
GROSS ANATOMY.
EXAMPLES- CLEFT LIP/PALATE,
CLUBFOOT, NEURAL TUBAL
DEFECTS, MISSING OR MALFORMED
LIMBS/FINGERS.

TERATOGENIC

ALSO-BEHAVORIAL AND/ OR
BIOCHEMICAL ABNORMALITIES.
TERATOGENESIS MAYBE DIRECT-IEMALFORMATIONS OF STRUCTURES
OR INDIRECT-SUCH AS
INTERFERING WITH O2 OR
NUTRIENTS.

TERATOGENIC

EXAMPLE OF KNOWN TERATOGENIC

AGENTS:
ONE TIME EXPOSURE IS
THALIDOMIDE-CAUSES MISSING
LIMBS.
CONT. OR PROLONG EXPOSURE IS
ETOH-CAUSES FAS.
SEE HANDOUT FOR OTHER AGENTS.

FETAL EFFECTS FROM

DRUGS DEPEND ON
SEVERAL FACTORS

TIME- WHEN DRUG IS TAKEN IN

PREGNANCY.
PREIMPLANTATION/PRESOMITE
PERIOD-CONCEPTION TO 2 WEEK
HIGH DOSE- MAYBE
LETHAL/DEATH/ABORTIONS.
LOW DOSE-MAYBE NOTHING.

EMBRYONIC PERIOD-3-8 WEEKS

*FIRST TRIMESTER*
GROSS MALFORMATIONS
FETAL PERIOD-9-40 WEEKS(TERM)
FUNCTION PROBLEMS RATHER THAN
GROSS ANATOMY*LEARNING DEFICITS &/OR
BEHAVORIAL ABNORMALIES

WHY IS
IDENTIFICATION OF
TERATOGENIC AGENTS
SOMETIMES DIFFICULT
TO IDENTIFY?

INCIDENCE OF CONGENITAL ANOMALIES IS

GENERALLY LOW.
ANIMAL TESTS MAY NOT BE RELIABLE
PROLONGED OR INCREASED EXPOSURE MAYBE
REQUIRED.
EFFECTS MAYBE DELAYED OR NOT RECONIZED.
BEHAVIORAL EFFECTS ARE DIFFICULT TO
DOCUMENT.
CONTOLLED EXPERIMENTS CANNOT BE DONE
ON HUMANS.

DOCUMENTATION IS INCOMPLETE
ONLY IN A LIMITED NUMBER OF DRUGS IS
THE TERATOGENIC EFFECTS KNOWN OR
PROVEN.
LACK OF PROOF OF TERATOGENICITY
DOES NOT MEAN A DRUG IS SAFE IN
PREGNANCY
MAY MEAN THERE IS A LACK OF
RESEARCH OR INFORMATION.

PROVING A DRUG IS A
TERATOGEN

3 CITERIA MUST BR MET:

1. DRUG MUST CAUSE A
CHARACTERISTIC SET OF
MALFORMATIONS.
2. IT MUST ACT ONLY DURNIG A
SPECIFIC WINDOW OF
VULNERABILITY-3-8 WEEKS OF
GESTATION

3.THE INCIDENCE OF
MALFORMATIONS SHOULD
INCREASE WITH INCREASED
DOSAGE & DURATION OF
EXPOSURE.

PLACENTAL DRUG
TRANSFER

THE PLACENTA IS NOT A COMPLETE

BARRIER.
SOME DRUGS ARE STOPPED.
SOME DRUGS(IN FACT MOST) ARE
NOT.
WAYS DRUGS ARE TRANSFER
ACROSS- SIMPLE DIFFUSION-ACTIVE
TRANSPORT.

TRANSFER DEPENDS
ON SEVERAL FACTORS

CHEMICAL PROPERTY OF THE DRUG

MOLECULAR WEIGHT.
PROTEIN BINDING CAPABILITIES.
CHEMICAL CONFIQURATION.
LIPID SOLUBILITY.*
PERIOD OF TIME DRUG REMAINS IN
MATERNAL BLOODSTREAM
HALFLIFE OF THE DRUG.

TRANSFER DEPENDS
ON SEVERAL FACTORS

CONT.
AMOUNT OF THE DRUG.
PATHOLOGICAL PROCESSES OF THE
PLACENTA.
WHEN IN THE PREGNANCYINCREASED BLOOD FLOW TO THE
PLACENTA IN LAST PART OF
PREGNANCY.

MOST DRUGS
TRANSFER AND ARE
AT 50-100% THAT OF
THE MATERNAL
LEVELS * SOME DRUG
LEVELS ARE MORE
THAN THE MATERNAL
LEVELS

DRUGS THAT TRANSFER EASILY

ARE LIPID SOLUBLE.
DRUGS THAT ARE DIFFICULT/HARD
TO TRANSFER ARE IONIZED
DRUGS-HIGHLY POLAR-OR PROTEIN
BOUND.

HOW IS DATA
COLLECTED ON DRUGS
NO HUMAN EXPERIMENTATION
WHICH
CAUSE
SYSTEMATIC COLLECTION AND
PROBLEMS
INON DRUGS
ANALYZING
OF DATA
TAKEN
BY PREGNANT CLIENTS.
PREGNANCIES?

REPORTING OF INFORMATION BY
HEALTH PROFESSIONALS.
SEE FORM.

THE NURSES ROLE

AND RESPONSIBILITY
IN DRUG THERAPY IN
KNOWLEDGE (CURRENT
THE
CHILDBEARING
&ACCURATE INFORMATION)CLIENT
PREGNANCY

MEDICAL CONDITIONS
MEDICAL TREATMENTS
DRUGS AND CLIENT

EDUCATION OF
PREGNANT/PREPREGN
ANT CLIENTS

PROVIDE ACCURATE INFORMATION

WITH RATIONALES
INFORMATION SOULD BE CURRENT
AND BASED ON EVIDENCE.
* ESTABLISH ENVIRONMENT
CONDUCIVE TO EXCHANCE OF
INFORMATION*- TRUST.
POTENTIAL HARM/RISKS.

EDUCATION

BENEFITS
COMMON SUBSTANCES & OTC
DRUGS TO AVOID IN PREGNANCYASA,ETOH,INCREASED DOSES OF
MULTVITAMINS,CAFFIENE,CIGARET
TE SMOKING,ETC.
AVOID SELF TX-OTCS, DRUGS
FORM MEXICO.

ADVOCATE FOR CLIENTS AND

GENERAL PUBLIC.
* SUPPORT*
ASSIST WITH COPING IF CLIENT
HAS TAKEN A TERATOGENIC
AGENT..WITH GUILT OR FEAR
ASSOCIATED WITH DRUGS TAKEN IN
PREGNANCY.

PREGNANT CLIENTS
BILL OF RIGHTS
RIGHT TO KNOW

For individual drugs

see handout.