DRUGS IN

PREGNANCY
 A. Nutritional supplement:
1. Iron supplement

2. Folic acid

B. Management of gastric acidity

• Causes of gastric acidity
TA B L E O F • Antacids
CONTENTS • Histamine antagonist

• Chelates and complexes

C. Constipation in pregnancy and childbirth

1. Laxatives

• Oral

• suppositories
O V I E RV I E W
• Pregnancy introduces unique considerations for the use of medications, as the
developing fetus may be susceptible to the effects of drugs. The safety of a
drug during pregnancy depends on various factors, including the specific
medication, the trimester of pregnancy, the dosage, and the individual health
circumstances of the pregnant woman.
• The essence of prescribing in pregnancy is to weigh between the benefit to
the mother of giving or continuing a pre-med in pregnancy and the risk to her
baby.
NUTRITIONAL SUPPLEMENT

The aim of nutrition in pregnancy is to maximize the

health of the mother and enhance the development of a
healthy infant.
• It is important to note that the overuse of
micronutrients may also prove hazardous. For
example, vitamin A in daily doses > 10000 iu was
shown to increase the incidence of malformations.
 Expansion of blood volume and red blood cell
formation.
• Establishment of fetal iron stores for first few
months of life.
1. IRON • Inadequate iron intake results in maternal effects
(such as anemia, cardiac arrest especially during
labor and delivery) and fetal effects ( such as
decreased availability of oxygen thus affecting
fetal growth)
ANEMIA IN PREGNANCY
• Iron deficiency anemia – most common nutritional
disorder during pregnancy.
• Side effects: Stomach problem, heart burn, cramps,
nausea, diarrhea, constipation
 60 mg/day-
30 mg/day- women who
requirement for have low level
normal of hemoglobin
pregnancy prior to
pregnancy
REQUIREMEN
T I N TA K E 120mg/day- Additional 85
women who have mg/day of
true anemia( iron vitamin C to
deficiency) before enhance iron
pregnancy. absorption.
 • Formation of red blood cells and
prevention of anemia.
2. FOLIC • Play an important role in
ACID
prevention of neural tube defects
(spinal bifida, Anencephaly),
abortion, abruptio placenta.
400 mcg/day- for normal pregnancies, representing a more than 2 times the
daily requirements before pregnancy
• 4mg/day- for women who posses risk of developing neural tube defects in
their unborn child.
NEURAL TUBE DEFECTS
Are serious birth defects that occur in the development of the brain and spinal
cord of some babies. The most common neural tube defects are Spina bifida
and anencephaly.
Spina bifida( abnormal development of part of the spine and spinal cord)
• Anencephaly ( severely abnormal development of the brain)
 TYPES OF NEURAL TUBE
DEFECTS (NTB’S)
ANENCEPHALY SPINA BIFIDA
BENEFITS OF FOLIC ACID

Folic acid will avoid the development of neural tube defects in

fetus

When taken before and during pregnancy, folic acid may also
protect the fetus against premature birth, low birth weight,
miscarriage, poor growth in womb.
• Folic acid has also been suggested to reduce your risk
pregnancy complications.
GASTRIC ACIDITY

Gastric acid, gastric juice, or stomach acid is a digestive fluid

formed within the stomach lining.
• Acidity in pregnancy is commonly due to hormonal changes
and the growing baby pressing against the stomach
 1. 2.
Hormone Esophageal
levels sphincter
CAUSES OF changing: relaxing
GASTRIC
ACIDITY
3. Uterus 4. Multiple
enlarging pregnancy
MANAGEMENT OF GASTRIC
ACIDITY
 TYPES OF
M E D I C AT I O
• Antacids
N T H AT A R E
SAFE FOR A • Histamine antagonist
WOMAN TO
• Chelates and complexes
TA K E
DURING
PREGNANCY
 • Antacids neutralize stomach
acid, making it less acidic
• Common examples of over-the-
counter antacids include Tums,
A N TA C I D S Mylanta, and Rolaids.
• Most antacids contain at least
one of these ingredients:
calcium carbonate, magnesium
hydroxide, aluminum hydroxide,
or sodium bicarbonate.
S I D E E F F E C T S O F A N TA C I D S

Brands with magnesium may cause diarrhea

Brands with calcium or aluminum may cause constipation

Rarely brands with calcium may cause kydney stones

• If you take large amounts of antacids that contain
aluminum, you may be at risk for calcium loss, which
can lead to weak bones.
U S E S O F A N TA C I D
It bring down the percentage of Acidity in our Stomach and
prevent mucus lining in the stomach.

It prevent from HEART BURN (acid from stomach rising into

esophagus) that can to our stomach lining.
• It also prevent from the ULCER(damage to lining of
stomach wall, resulting in loss of tissues and inflammation).
 H I S TA M I N E A N TA G O N I S T

• Histamine antagonist are another type of acid reflux medication

• Are medications that stop the cells in the stomach from

producing too much acid.
• These drugs are well absorbed orally.

• Examples of H2 antagonist: Cimetidine, Famotidine, Ranitidine,

nizatidine.
T Y P E S O F H 2 A N TA G O N I S T
S I D E E F F E C T S O F H I S TA M I N E A N TA G O N I S T

Famotidine- the most common side effects is headache.

Cimetidine – side effects are rare but dizziness , rashes,

headaches may occur

Ranitidine- the most common side effect is headaches

• Nizatidine- side effects are rare.
C H E L AT E S A N D C O M P L E X E S A G E N T S

 These bind to the base of the ulcer in the lining of the

gastrointestinal tract and provide physical protection.
 Example: Sucralfate –used to treat and prevent ulcers in
the intestines.
 Route: oral

Side effects : constipation, diarrhea; · nausea, vomiting,

gas, indigestion; · itching, rash; · dizziness, drowsiness;
 C O N S T I PAT I O N D U R I N G
PREGNANCY AND CHILDBIRTH

Constipation during pregnancy is due to the increase

in progesterone hormones that relax the intestinal
muscle causing food and waste to move slower
through your system.
 Constipation is very common in pregnancy. It
means that your bowel motions are very hard and
may be painful to pass.
 1. Fiber: taking fiber supplements or eating fibrous
foods can increase the number of stools and
facilitate their passage through the intestines.
2. Fluid: drinking enough water Is important to keep
MANAGEMEN stool soft and easy to pass.

T AND 3. Activity: helps stool move through the intestines.

T R E AT M E N T 4. Probiotics: millions of healthy bacteria live in the
gut and help repopulate the gut bacteria with
healthy strains that encourage normal and regular
bowel movement.
5. Bulk forming agent
 A laxatives is an agent that
facilitates evacuation of the
bowel.
LAXATIVES
• Laxatives may be
administered orally, as
enemas or suppositories
O R A L L A X AT I V E S
Stool Softeners (e.g., Docusate Sodium): Generally considered safe but should be used
under medical supervision. They work by adding water to the stool, making it softer and
easier to pass.
 Bulk-Forming Laxatives (e.g., Psyllium): Can help increase fiber in the diet, aiding
bowel movements.

S U P P O S I TO R I E S L A X AT I V E S
 Bisacodyl Suppositories: Stimulate bowel movements by irritating the intestines. Use
under medical guidance as excessive stimulation can lead to contractions, which
might be a concern in pregnancy.
EFFECTS DURING PREGNANCY
Discomfort: Constipation can cause discomfort and abdominal pain,
adding to the physical challenges of pregnancy.

Hemorrhoids: Straining during bowel movements can contribute to the

development or worsening of hemorrhoids.

Increased Pressure: The growing uterus, combined with constipation,

may increase pressure on pelvic organs, exacerbating discomfort.
• Iron Absorption: Some pregnant individuals take iron supplements,
which can contribute to constipation, affecting iron absorption.
 POTENTIAL EFFECTS DURING
CHILDBIRTH:

Discomfort: Constipation can persist during labor, adding to

overall discomfort.

Impact on Pushing: Straining during bowel movements might

affect the pushing phase of labor, potentially prolonging it.
• Postpartum Discomfort: Constipation can continue postpartum,
impacting recovery and adding discomfort during an already
challenging time.