Pharmacology and Teratogenic Effects

Study Notes

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.

Testosterone and danazol can cause masculinization of female external genitalia.
Hormonal contraception has shown no evidence of harm to the fetus, despite prior concerns.

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.

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.

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.

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.

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.

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.