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 Pregnancy & Motherhood

 
Drug Check for Gonna Be Mammas
Dr P Lakshmi Reddy
 
She’s pregnant! She has quit smoking, settled for mocktails, given up the pill – cleansed herself of all potential deterrents that might affect the one (perhaps two, or more, you never know) who’ll join her around soon.

But she has these mild aches and pains on and off and after an aspirin or two, she feels a lot better. For those who don’t sniff a problem in this scenario, this read would help clear the cobwebs.

Different bodies respond differently to the drug, hence drug treatment during pregnancy is unique – a drug beneficial for the mother may not necessarily suit the foetus. The effects either show up immediately or at times, years after childbirth. In the 1950s, for example, thalidomide was prescribed for vomitings in early pregnancy. The newborns to these women, were with missing limbs and forearms. Likewise, during the 1970s, DES (diethylstilbestrol) was prescribed to women with history of recurrent miscarriages, which resulted in structural abnormalities of the genital tract, virilisation of the female foetus, vaginal adenosis and clear cell adenocarcinoma of the vagina in adolescent girls. In DES exposed male foetuses, it is nonneoplastic abnormalities of the genital tract cryptoorchidism.

Mostly, in the first week after conception and before implantation, the potentially harmful drug takes its toll. The embryo either dies or the damaged cells get replaced by undifferentiated cells which, however, have the potential to develop normally. During organogenesis, harmful drugs can lead to congenital malformations and severe damage may even result in abortion. During the second and third trimesters, drugs can affect the growth and functional development of the foetus. The effect of the drug, however, depends on a number of factors like the chemical composition of the drug, dosage and duration, and time of administration.

Drugs which cause untoward effects on the foetus during pregnancy

Drug Use Foetal effects
Anticonvulsants To control seizures in people with epilepsy Almost all anticonvulsant drugs like Carbamazepine, Sodium Valproic acid and Phenytoin may lead to craniofacial abnormalities, neural tubedefects such as spina bifida and anencephalus and cardiac defects.
Antimigraine Headaches Ergotamine and methysergide increase the risk of premature labour.
Antibiotics Infections Tetracyclines cause teeth discolouration, inhibition of bone growth and softening of bones. Sulphonamides produce neonatal jaundice, while Streptomycin might trigger deafness.
Antipsychotic drugs Mood-stabilising Lithium (given in early pregnancy) can lead to cardiovascular defects like Ebstein anomaly.
Anticoagulants Deep vein thrombosis Warfarin diphenadione group of drugs cause nasal hypoplasia, bleeding problems in pregnant woman and fetus, limb and eye abnormalities, abnormal growth of the head and mental retardation.
Antidiabetic Treatment of diabetes Chlorpromide can cause severe and prolonged neonatal hypoglycemia.
Vitamin A Analogues Treatment of acne Etretinate and isotrtinoinin is shown to produce abnormalities such as small low set ears, heart defects, hydrocephalus (water in the brain), facial dysmorphia and even miscarriage.
Diagnostic radiology X-rays X-rays taken during early pregnancy augment the risk of childhood leukemia.
Oral contraceptives Birth-control Pills during pregnancy may lead to a series of birth defects called VACTERL syndrome that includes vertebral, anal, cardiovascular tracheo, esophageal, renal and limb anomalies.

You may grudgingly conclude that almost no drug is really safe for pregnant women. The teratogenic potential of drugs rarely used during pregnancies, or those newly brought out in the market, cannot be completely comprehended. Hence all physicians, while prescribing medicines to women in their child bearing age, should first do a pregnancy check. No drug should be administered to the pregnant woman unless it benefits her more than it risks the foetus. The smallest effective dose for the shortest duration can be a solution. A woman on medication of a nature not advisable during pregnancy can wait for the treatment to be over before going for a baby. A careful note of drugs prescribed to pregnant women should be maintained in order to correlate with any congenital defects detected later. Wish all moms in the making of a happy and safe pregnancy!
Dr P Lakshmi Reddy is Consultant Obstetrician and Gynaecologist, Apollo Health City, Hyderabad.

  
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