In this lecture, I talked about almost everything concerning the usage of medicine in pregnancy .

1. DRUGS IN…
PREGNANCY
Presented by
Jaber Al-Manasia
5th year medical student

2. ALCOHOL
•
It causes mental and physical defects
represented in distinctive abnormal stigmata.
The effects are known as fetal alcohol
syndrome
(1)characteristic facial anomalies .
(2)growth retardation
(3)CNS involvement
•

3. • a. Small palpebral fissures
• b. Thin vermilion border
• c. Smooth philtrum

4. CNS
• Structural : microcephaly, agenesis of corpus callosum,
cerebellar hypoplasia, hipocampus…
• Neuological : epilepsy, impaired fine motor skills, hearing loss,
poor gait, clumsiness…
• Functional : communication, learing, behavior…

5. TOBACCO
 Newborns of smoking mothers are 200 g less than
those of nonsmokers’ baby.
 Smoking also may cause
increase incidence of subfertility, spontaneous
abortion, placenta previa, placental abruption ,
preterm delivery.
 Many studies found association between maternal
smoking and hydrocephaly,microcephaly,
omphalocele, gastroschisis,cleft lip and palate &
hand abnormalities.

6. ANAL SIC
GE
• Aspirin: not increase risk of anomalies
• Acetaminophen: not increase risk of anomalies
• NSAIDs
• indomethacin
• Early closure of fetal ductus arteriosus and
subsequent pulmonary hypertension
• decrease fetal urine output and reduce amnionic
fluid
• reversible if discontinued before 34 weeks

7. ANTI-THYROID DRUGS
•
(carbimazole, neomercazole, thiouracil);
Anti -thyroid
thyroid hormone in the fetal thyroid gland causing
compensatory over action of the pituitary leading
to fetal goiter which may cause neonatal respiratory
obstruction

9. ANTI-THYROID DRUGS
• Lack of thyroid hormone will cause fetal
cretinism& mental retardation.
• If anti-thyroid drugs are used, they should
be combined with L-Thyroxin
• Radio –Active Iodine ;shouldn’t be used
in pregnancy, because the fetal thyroid
gland will be destroyed if Iodine 131 is
ingested by the mother.

10. :HYPOTENSIVE DRUGS
• Beta-Blockers;
(e.g. propanol, atenalol, tenormin).
placental insufficiency… hypotonia,
hypoglycemia IUGR + increase in P.N.M.

11. :Hypotensive Drugs

12. :Hypotensive Drugs
• ACE inhibitors ...
•
•
•
•
C/I in pregnancy;
Skull defects.
Oligohydraminos 2ry to renal impairment in the foetus.
Affects fetal blood pressure control.
• Angiotensin II receptor inhibitor
(Losartan, Valsartan)  should be avoided(evidence of
fetal risk).
risk
• Methyldopa, hydralazine, calcium channel blocker:
No reports of congenital defect.[C ]

13. RESPIRATORY SYSTEM
• Asthma drug : Bronchodilators
Salbutamol, Aminophylline & Theophylline  safe.
• steroids:
If administered by inhalation (safe)  no adrenal
suppression.
Systemic steroids : facial clefts.

14. ANTIBIOTIC DRUGS
• Tetracycline; after 4th month of pregnancy it
enters the fetal circulation, chelates with Ca &
deposits in teeth, bones, nails.
• When the teeth erupt in the infant ,they are
at 1st light yellow & fluoresce in ultraviolet
light & later the color fades gradually to a non
florescent brown, in addition to hypoplasia of
teeth leading to dental carries
• Ampicillin& penicillin :safe

15. • Chloramphenicol : B.M. depression in
the mother & very dangerous to
premature neonate. No congenital
anomalies.
– Gray baby syndrome
• Aminoglycosides : Although both
nephrotoxicity and ototoxicity have
been reported in preterm newborns
and adults treated with gentamicin or
streptomycin, congenital defects
resulting from prenatal exposure
have not been confirmed.

16. :ANTI- CONVULSANT DRUGS
• Phenobarbitone, Phenytoin, Primidone ;
• Retrospective study suggested that cleft lip & palate
may occur in the fetus, but prospective study of 16
neonates of mother on anti-convulsant drugs showed
that 7 neonates had severe coagulation defects
similar to vitamin K deficiency.
• Prophylactic RX of the mother with vit. K may
prevent this risk.

17. DRUGS CAUSING KERNICTERUS&
.JAUNDICE
• They cause dissociation of the bilirubin from its
protective binding to serum albumin in the fetus….. The
free bilirubin diffuse readily into the CNS producing
Kernicterus :
e.g. the following;
• Sulphonamide (sulphamethoxazole + trimethoprim)
• Salicylates, Phenylbutazone
• Phenothiazides.

18. Thank you