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Key Clinical Questions

  • image What key questions should the practitioner ask to ensure safe use of medication during pregnancy?

  • image What are the limitations of the Federal Drug Administration drug classification?

  • image How should the physiologic changes in pregnancy that affect pharmacokinetics influence prescribing of medication?

Until the middle of the last century there was a widespread belief among both clinicians and patients that the human fetus grew in a protected environment that minimized any potential effects of substances ingested by the mother. This misperception ended dramatically when the effects of thalidomide became widely known in the late 1960s. Ever since this tragedy, a primary driver for both patients and providers of the approach the use of medications in pregnancy is fear of causing adverse fetal effects. Despite this, use of medications during pregnancy remains widespread throughout the world. Therefore, it seems that a dichotomy exists: a widely perceived fear regarding the ingestion of medication during pregnancy juxtaposed against the practical reality that medications are necessary and continue to be used during the course of gestation.

This chapter aims to provide a helpful evidence-based approach to guide hospitalists who may be asked to consult on or care for pregnant women. Table 219-1 lists some references that discuss the safety of particular agents in pregnancy. Table 219-2 makes some clinically based recommendations about which medications are preferred for specific indications during pregnancy. The remainder of this chapter will provide a general approach to prescribing in pregnancy that should guide the reader in the informed use of the information contained in both the listed references and the provided summary table.

TABLE 219-1Resources for Helping to Determine which Medication to Use when Treating Medical Illness in Pregnancy

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