What key questions should the practitioner ask to ensure safe use of medication during pregnancy?
What are the limitations of the Federal Drug Administration drug classification?
How should the physiologic changes in pregnancy that affect medication clearance 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 to clinicians and the general public in the late 1960s. Ever since this tragedy, there has been a tendency for both patients and clinicians to approach the use of medications in pregnancy with great anxiety because of fears 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 through this challenging terrain. Table 221-1 lists some references that discuss the safety of particular agents in pregnancy. Table 221-2 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 221-1 Resources for Helping to Determine Which Medication to Use When Treating Medical Illness in Pregnancy |Favorite Table|Download (.pdf)
Table 221-1 Resources for Helping to Determine Which Medication to Use When Treating Medical Illness in Pregnancy
|Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk||Briggs GS, Freeman RK, Yaffe SY.||Lippincott Williams & Wilkins; 8th ed., 2008||Hardcover 2144 pages|
|Teratogenic Effects of Drugs: A Resource for Clinicians (TERIS).||Friedman JM, Polifka JE.||John Hopkins University Press, 2nd ed., 2000||Hardcover 793 pages|
|Medication Safety in Pregnancy and Breastfeeding: The Evidence-Based, A to Z Clinician's Pocket Guide||Koren G||McGraw-Hill Professional, 1st ed., 2006||Paperback 312 pages|
|Medication Safety in Pregnancy and Breastfeeding||Koren G||McGraw-Hill Professional, 1st ed., 2007||Hardcover 623 pages|
|Drugs for Pregnant and Lactating Women||Weiner CP, Buhimschi C||Churchill Livingstone, 1st ed., 2004||Hardcover 1101 pages|
|Drugs During Pregnancy and Lactation||Schaefer C, Peters PWJ, Miller RK||Academic Press, 2nd ed., 2007||Hardcover 904 pages|
|Prescribing in Pregnancy||Rubin PC, Ramsey M||BMJ Books, 4th ed., 2008||Paperback 256 pages|
|Catalog of Teratogenic Agents||Shepard TH, Lemire RJ||John Hopkins University Press, 12th ed., 2007||Hardcover 656 pages...|