Questions and Answers
What organization did Mary contact for advice regarding breastfeeding and medications?
How is the drug Mary is concerned about characterized in relation to breastfeeding?
What symptoms was Mary advised to monitor her baby Michael for?
What was suggested to help Michael with his latching issues during breastfeeding?
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What effect did nipple stimulation have on Mary's milk supply?
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What emotional benefit did Mary associate with breastfeeding her baby?
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During what time period did Mary start feeling more confident as a mother?
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Why did Mary want to continue breastfeeding while preparing to return to work?
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What did the other mother at the support group inform Mary about Michael's feeding difficulties?
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What physical symptom of Michael did the mother suggest needed attention during breastfeeding?
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Study Notes
Isotretinoin and Teratogenic Risks
- Isotretinoin is highly teratogenic and poses significant risks to fetal development.
- ACE inhibitors and Angiotensin II receptor blockers can cause renal damage, relevant in pregnancy.
- Teratogenic effects of certain drugs, including:
- Fluconazole and other azole antifungals: Avoid in HIV positive mothers during the first trimester.
- Alkylating agents like methotrexate and lithium, with potential for cardiovascular defects.
- Paroxetine implicated in ventricular septal defects.
- Statins should be stopped during pregnancy, limited effect on long-term lipid control.
- Warfarin can lead to nasal hypoplasia, stippled epiphyses, CNS, and eye defects, particularly in the first trimester.
Drugs Influencing Fetal Development
- Testosterone and danazol can cause masculinization of female external genitalia.
- Hormonal contraception has shown no evidence of harm to the fetus, despite prior concerns.
Therapeutic Drug Uses in Pregnancy
- Steroids before preterm birth assist in fetal lung maturation.
- Folic acid is critical for reducing neural tube defects.
- Antiretrovirals are effective in preventing mother-to-child transmission (PMTCT) of HIV.
Updated Guidelines for Dolutegravir
- Government advice has evolved, supporting the use of dolutegravir in pregnancy based on new study results indicating only negligible risks.
- Guidelines are regularly updated, influencing the management of pregnant women on antiretroviral therapy.
Management of Nausea and Vomiting in Pregnancy
- Mild nausea often alleviated through reassurance and dietary adjustments.
- For moderate nausea, Doxylamine is a safe antihistamine; ondansetron may be used after 12 weeks if necessary.
- Hyperemesis gravidarum requires hospitalization, IV hydration, and antiemetics.
Behavioral Teratogens
- CNS teratogens, such as alcohol, can cause behavioral abnormalities, impacting fetal development beyond physical malformations.
- The foetus remains at risk for behavioral toxicity due to ongoing CNS development throughout pregnancy.
FDA Pregnancy Categories
- Category A: No risk to fetus (e.g., levothyroxine).
- Category B: No risk shown in animal studies (e.g., paracetamol).
- Category C: Risks cannot be ruled out.
- Category D: Evidence of risk, yet benefits may justify use (e.g., phenytoin).
- Category X: Risks outweigh benefits.
Breastfeeding Considerations
- Sulpiride has been used for mood elevation and milk supply but is not generally recommended for breastfeeding mothers.
- When considering medications like senna for postpartum constipation, minimal doses should be used, as it is excreted in breast milk.
- Monitoring is crucial for any adverse effects on infants from maternal medications.
Parenting Support and Challenges
- Mary connects with other mothers for support regarding breastfeeding challenges.
- Suggestions included using a mucus extractor to help with infant nasal congestion for easier feeding.
- The experience of motherhood strengthens the bond between Mary and her baby.
Returning to Work
- As Mary anticipates returning to work, she appreciates breastfeeding's role in nurturing her relationship with her baby and the ease of reconnection.
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Description
This quiz explores the teratogenic effects of various medications, such as isotretinoin, ACE inhibitors, and antineoplastic agents during pregnancy. It also covers the implications of specific drugs like fluconazole, lithium, and statins on fetal development. Test your knowledge on how these medications can lead to cardiovascular defects and other complications in the first trimester.
