DRUGS USED IN

PREGNANCY

Dwi Indria Anggraini

Dept. Pharmacology And Therapy
Faculty Of Medicine, Lampung University

Pregnant woman should use drug or drugs

The factors contribute to

congenital anomalies
Drugstadium
Teratogenic
The
General
dosage
condition
of
and
pregnancy
the
of the
ability
mother.
to cross the placenta

Stadia of growth and development

I.

Pregnancy is a physiological process

Alters the function of organs
Changing in pharmacokinetics
and pharmacodynamics
Plasma
concentration
Pass into placental barrier
Fetus

Absorption:

Alteration in pharmacokinetic during

pregnancy

Gastric emptying and intestinal motility decrease

Nausea and vomiting
Distribution :
Total body water increases
Dilution of drug (C max.of hydrophilic drug)
binding

Steroids & placental hormones compete with some drug in prot

Some drugs should monitored

Metabolism :
Cyt P-450 could be induced by estrogen & progesteron (incr.
metabolic rate)
Other enzymes are inhibited competitively by estradiole or
progesterone cause
disturbance in elimination
Estrogen is a cholestatic agent

Elimination :
Renal blood flow and GFR
increase
Steady state only slight
declines but the dosage
does not need increase
Drug could damage the fetus :
1. Directly
2. Indirectly

Diagram of factors influencing the availability of a drug to the fetus

Administration of drug to mother
Within mother

(Oral,IV,IM)
Bound drug

Metabolite

hepatic metabolism
Uterine Blood Flow
PLACENTA

Free drug

Within placenta :
Placental determinants

Within the fetus

Metabolite

Renal excretion

Hepatic metabolism

Receptor

Amniotic Fluid
Free drug

Free Drug

Protein bound drug

Types of teratogenesis

Examples
Anticonvulsants : fetal hydantoin
syndrome
Anticoagulants
: warfarin syndrome
Alcohol
: fetal alcohol
syndrome
Antithyroid drugs : ablatio thyroid
Mefenamic acid
: embryotoxic
Aminoglycosides : N. VIII, ototoxic,
nephrotoxic
DES
: late abnormality

Drugs often used during

pregnancy
Analgesicantipyretics
Antibiotics
Anti emeticantihistaminic
Anti hypertensives
Anti malarial drugs
Antidiabetics

Tuberculostatics
Anti thyroid drugs
Hypnoticsedativespsychotropics
Corticosteroidal
drugs
Drugs used in
asthma

Other factor s contibute congenital anomaly beside

drugs consumed by mother

General principles of drug used in

pregnancy
Absolute
Correct
Contribute
Appropiate
Avoid
Do
Effect
notthe
on
take
benefits
reasons
the
combination
the
self
fetus
changes
medication
(no
arealternatives)
not
ofindrugs
always as same as on the mother

Giving drugs during pregnancy must be

considered to these factors:
Stadium of pregnancy

The Classification of Drugs Used in pregnancy

(Relating to Their Effects) :
(Australian Drug Evaluation Committee)
A. Drugs used by most pregnant women and the
women
in reproductive age no direct or indirect
enhancing in
malformation
etc.)

(Paracetamol, penicilline, isoniazide, folic acid

B. Limited drugs used by pregnant women no

direct or

C. The pharmacologic effects of the drug affect the fetus

Thank you
May ALLAH Bless you all