PREGNANCY AND LACTATION

Eka Kartika Untari

PHYSIOLOGIC AND PHARMACOKINETIC
FACTORS
PHYSIOLOGIC AND PHARMACOKINETIC
FACTORS
DRUG SELECTION DURING PREGNANCY
DRUG SELECTION DURING PREGNANCY
PRECONCEPTION PLANNING
PREGNANCY-INFLUENCED ISSUES:
GASTROINTESTINAL TRACT
PREGNANCY-INFLUENCED ISSUES:
GASTROINTESTINAL TRACT
PREGNANCY-INFLUENCED ISSUES:
GESTATIONAL DIABETES MELLITUS
PREGNANCY-INFLUENCED ISSUES:
HYPERTENSION
PREGNANCY-INFLUENCED ISSUES:
THYROID ABNORMALITIES
PREGNANCY-INFLUENCED ISSUES:
VENOUS THROMBOEMBOLISM
ACUTE CARE ISSUES IN PREGNANCY:
HEADACHE
ACUTE CARE ISSUES IN PREGNANCY:
URINARY TRACK INFECTION
ACUTE CARE ISSUES IN PREGNANCY:
SEXUALLY TRANSMITTED DISEASE
CHRONIC ILLNESS IN PREGNANCY:
ALLERGIC RHINITIS & ASTHMA
CHRONIC ILLNESS IN PREGNANCY:
ALLERGIC RHINITIS & ASTHMA
CHRONIC ILLNESS IN PREGNANCY:
DIABETES
CHRONIC ILLNESS IN PREGNANCY:
EPILEPSY
CHRONIC ILLNESS IN PREGNANCY:
HIV INFECTION
CHRONIC ILLNESS IN PREGNANCY:
HIV INFECTION
CHRONIC ILLNESS IN PREGNANCY:
HYPERTENSION
CHRONIC ILLNESS IN PREGNANCY:
HYPERTENSION
CHRONIC ILLNESS IN PREGNANCY:
DEPRESSION
CHRONIC ILLNESS IN PREGNANCY:
THYROID DISORDERS
LABOR DELIVERY
A. PRETERM LABOR
1. Tocolytic Therapy
 Beta agonist
 Mg sulfat
 NSAIDs
 CCB

2. Antenatal Glucocorticoids
LABOR DELIVERY
B. GROUP B STREPTOCOCCUS INFECTION
LABOR DELIVERY
C. CERVICAL RIPENING & LABOR INDUCTION
LABOR DELIVERY
D. LABOR ANALGESIA
LACTATION ISSUES
A. MASTITIS
 The highest incidence of mastitis occurs within 1 to 2 weeks of
beginning breast-feeding.
 The risk of developing mastitis may be higher in situations where the
feeding pattern has been altered, the number of feedings per day has
decreased, the first breast is not emptied before switching to the other
side, the infant is latching on poorly, the mother is overproducting milk,
or the child or mother is ill.
 Staphylococcus aureus is the most common organism associated with
mastitis. Antibiotics that are used for treatment of mastitis include
penicillinase-resistant penicillins (e.g., cloxacillin, dicloxacillin, and
oxacillin) and cephalosporins (e.g., cephalexin).
 Antibiotics are often given for 10 to 14 days.
 Anti-inflammatory agents, such as ibuprofen, also may be
considered for pain.
 Prevention of recurrence includes strategies to transfer milk
such as frequent feedings or pumping and reduction of breast
inflammation.
LACTATION ISSUES
B. POST PARTUM DEPRESSION
 Both nondrug and drug options exist for the treatment of
postpartum depression.
 Nondrug therapies include emotional support from family and
friends, education about the condition, and psychotherapy.
 Bright-light therapy (effective for seasonal affective disorder
and nonseasonal depression) also may provide benefit.
 Pharmacologic therapy may need to be initiated because
untreated depression may have negative effects on the
mother’s care of and relationship with the infant
Guidelines for postpartum antidepressant use include
(1)careful drug selection taking into account patient factors and available
literature related to potential adverse effects in breast-feeding infants
(2) continual monitoring of drug dosage needs as related to efficacy and
potential toxicity of the drug
(3) use of an agent that is known to result in limited infant exposure, (4)
use of a single agent whenever possible
(5) continual assessment of possible infant toxicity from a drug
(6) attention to pharmacokinetics of an agent as related to administration
of the agent in relation to breast-feeding as well as selection of an agent
with few or no active metabolites.
 The most common medications used to treat postpartum
major depression include selective serotonin reuptake
inhibitors and tricyclic antidepressants.
 The small number of case reports and studies published to
date suggest the relative safety of these agents for breast-
feeding infants
LACTATION ISSUES
C. RELACTATION
 Declining serum prolactin concentrations cause a decrease in or
cessation of lactation, and this can be problematic, as well as
distressing, for mothers who desire to breast-feed their infants.
 Relactation is the process of increasing the breast milk supply
for such women.
 Lactation also can be induced in women who have not recently
delivered a baby, such as adoptive mothers. The mainstay of
therapy for this condition involves nipple stimulation either by
the infant’s nursing or by pumping of the breast with a
mechanical pump or the hand
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