February - Medications contraindicated in pregnancy

Medications contraindicated in pregnancy

 

What’s Teratogenic?

Teratogenic effect refers to the toxic effect that can act on the pregnant mother, interfere with the normal development of the embryo, and cause congenital malformations. Causes include genetics, chemical factors (drugs), endocrine disorders, etc.

 

 

 

Table 1: Medications contraindicated in pregnancy

 

Classes of drugs

Drugs names

Drug effects

Vitamin A

and

its derivatives

Vitamin A

Spontaneous abortion, microtia or anotia, retinal or optic nerve anomalies, and central nervous system malformations, and risk of many significant anomalies

Isotretinein

Etretinate

Accutane

ACE inhibitors

Enalapril

May cause kidney damage in the fetus when used in II and III trimester, decrease in the amount of amniotic fluid and deformities of face, limbs and lungs

Captopril

Anticoagulants

Warfarin

Ÿ   Use during I trimester produces defects like nasal hypoplasia and a depressed nasal bridge

Ÿ   Use during II and III trimesters is associated with increased risk of fetal malformations

Heparin

Ÿ   Safe

Ÿ   if taken for long time osteoporosis and decrease in number of platelets in pregnant women occurs

Sex hormone

Estrogen and Androgens

Genital tract malformations

Thyroid preparations

Methimazole

Overactive and enlarged Thyroid gland

Carbimazole

Radioactive iodine

Underactive Thyroid gland in fetus

Propylthiouracil

Safe

Anticonvulsants

Carbamazepine

Risk of birth defects

Phenytoin

Ÿ   Risk of birth defects,

Ÿ   Bleeding problem in the newborn which can be prevented if pregnant woman takes Vit. K by mouth every day for a month before delivery

Ÿ   Or if the newborn baby is given an injection of Vit. K soon after birth.

Phenobarbitone

Trimethadione

Increased risk of miscarriage in the women

Sodium valproate

Increased risk of birth defects in fetus; including a cleft palate and abnormalities of the heart, face, skull, hands or abdominal organs

Antidepressants

Lithium

Birth defects (mainly of the heart), lethargy, decreased muscle tone, underactivity of Thyroid gland and nephrogenic diabetes insipidus in the new born. Ebstein’s anomaly (tricuspid valve malformation)

NSAIDs

Aspirin

and

other Salicylates

Delay in start of labor, premature closing of ductus arteriosus, jaundice, brain damage in the fetus and bleeding problems in the woman during and after delivery and in the newborn

Antibiotics

Tetracycline

Slowed bone growth, permanent yellowing of the teeth and increased susceptibility to cavities in the body

Chloramphenicol

Gray Baby Syndrome

Ciprofloxacin

Possibility of joint abnormalities (seen in animals)

Kanamycin Streptomycin

Damage to fetus’s ear resulting in deafness (risk of ototoxicity)

Sulfonamides

Jaundice and brain damage in newborn

Antineoplastic agents

Busulfan

Birth defects such as less than expected growth before birth

Chlorambucil

Underdevelopment of lower jaw, cleft palate, abnormal development of

Cyclophosphamide, Methotrexate

skull bones, spinal defects, ear defects and club foot

Oral Hypoglycemic drugs

Chlorpropamide

A very low level of sugar in the blood of newborn. Inadequate control of diabetes in the pregnant woman

Tolbutamide

Anticonvulsant

Phenobarbital

Heart, palate, urogenital system, extremities, dysmorphic facial features

Primidone

 

 

 

Table 2: Medications can be use in pregnancy(Common drugs)

 

Classes of drugs

Drugs names

Drug effects

Antihistamines

Doxylamine

Treating the nausea in pregnancy

Acid-Suppressing Drugs

Cimetidine

Treatment for reflux esophagitis

Omeprazole

Ranitidine

Analgesics

Acetaminophen

(paracetamol)

Ÿ   First choice drug

Ÿ   Mild pain reliever and antipyretic

Codeine

Ÿ   Can cause addiction and newborn withdrawal symptoms if used to excess perinatally.

Antiasthmastics

Theophylline

Ÿ   Safe

Ÿ   For the treatment of asthma in pregnancy

Aminophylline

Terbutaline

Preferred for asthma in the pregnant patient

Corticosteroids

Safe, but have a five-fold increased risk for cleft lip with or without cleft palate in the infant has been reported after exposure to steroids in the first trimester

Cardiovascular

and

antihypertensive agents

Digoxin

Cardiovascular

Methyldopa

Antihypertensive agents

Metoprolol

Hypertension

Antibiotic

Penicillins,

Cephalosporins, Erythromycin,

Azithromycin, Clarithromycin, Roxithromycin,

Spiramycin,

Fosfomycin

Antibiotic treatment

Nystatin

Clotrimazole

Miconazole

Amphotericin B

Treatment for mycosis

Constipation

Bulking agents,

 Lactulose,

Macrogol,

 Bisacodyl

Treatment for constipation

Diabetes mellitus

Human insulin

Metformin

Treatment for Diabetes

Vitamins

Vitamins B,C,D,E

Essential nutrients during pregnancy

Folic acid

Folic Acid

Prevent fetal neural tube development malformations, congenital heart disease, etc.

Vitamin B6

pyridoxine

Treating the nausea and vomiting of pregnancy

Oral iron

iron

Anemia

Oral zinc

zinc

Prevent stunted growth

Oral calcium

calcium

Promote the development of fetal bones and teeth

 

 

Reference:

1.         Sachdeva, P., Patel, B. G., & Patel, B. K. (2009). Drug use in pregnancy; a point to ponder!. Indian journal of pharmaceutical sciences, 71(1), 1–7. https://doi.org/10.4103/0250-474X.51941

2.         van Gelder, M. M., van Rooij, I. A., Miller, R. K., Zielhuis, G. A., de Jong-van den Berg, L. T., & Roeleveld, N. (2010). Teratogenic mechanisms of medical drugs. Human reproduction update, 16(4), 378–394. https://doi.org/10.1093/humupd/dmp052

3.         Niebyl, J, Simpson, J, Glob. libr. women's med., Teratology and Drugs in Pregnancy ,(ISSN: 1756-2228) 2008; DOI 10.3843/GLOWM.10096

4.         Dathe, K., & Schaefer, C. (2019). The Use of Medication in Pregnancy. Deutsches Arzteblatt international, 116(46), 783–790. https://doi.org/10.3238/arztebl.2019.0783

5.         Brown, B., & Wright, C. (2020). Safety and efficacy of supplements in pregnancy. Nutrition reviews, 78(10), 813–826. https://doi.org/10.1093/nutrit/nuz101