most drugs cross the placenta to some extent use any drug with caution and only if necessary ANTIBIOTICS safest = ampicillin, ceph...
- most drugs cross the placenta to some extent
- use any drug with caution and only if necessary
ANTIBIOTICS
- safest = ampicillin, cephalosporins
- Erythromycin
- maternal liver damage (acute fatty liver)
- used only if contraindication to penicillin use
- Tetracyclines : staining of child's teeth
- sulpha drugs
- antifolates therefore theoretical risk in first trimester
- risk of kernicterus in third trimester
- metronidazole
- antimetabolite therefore theoretical risk in first trimester
- chloramphenicol
- grey baby syndrome (fetal circulatory collapse secondary to ccumulation since fetus cannot metabolize this drug)
- Alcohol
- increased incidence of abortion and stillbirth, congenital anomalies, fetal alcohol syndrome (growth retardation, CNS involvement and facial anomalies)
- Cigarettes
- decreased birth weight, placenta previa/abruption, increased spontaneous abortion, preterm labour and stillbirth
- Anticoagulants
- warfarin crosses placenta, heparin does not
- fetal warfarin syndrome: nasal hypoplasia, epiphyseal stippling, optic atrophy, MR, intracranial hemorrhage
- also spontaneous abortion, stillbirth, prematurity, IUGR
- ACE inhibitors
- Anticonvulsants
- facial dysmorphogenesis, IUGR, mild MR, NTD's, congenital anomalies
- Lithium : Ebstein's cardiac anomaly, goitre, hyponatremia
- Cocaine : microcephaly, growth retardation, prematurity, MR
- DES-Diethylstilbestrol (and other estrogenic or androgenic compounds)
- vaginal adenosis, adenocarcinoma, uterine malformation in daughters exposed to DES in utero
- Retinoids (e.g. Accutane)
- administration is dependent on the risk of infection vs. risk of immunization complications
- safe : tetanus toxoid, typhoid fever (killed bacterial), diphtheria, influenza, hepatitis B
- avoid live vaccines (polio and mumps )-----> risk of placental and fetal infection
- contraindicated : rubella
BREASTFEEDING AND DRUGS
Safe
- penicillins, aminoglycosides, cephalosporins
- oral contraceptive use (low dose) is now believed to be safe
Avoid
- chloramphenicol (bone marrow suppression)
- metronidazole (mutagenic in vitro)
- sulphonamides (hemolysis with G6PD deficiency)
- nitrofurantoin (hemolysis with G6PD deficiency)
- tetracycline (stains teeth and bones)
- lithium
- antineoplastics and immunosuppressants
- psychotropic drugs (relative)
