> Medications in pregnancy. Teratogenic effects

the Drugs in pregnancy, teratogenic effects, malformations of the fetus. drugs are responsible for only 2-3% of all the congenital malformations; most is due to genetic causes, environmental, or unknown.

    the

  • Introduction
  • the

  • anti-Microbial
  • the

  • Antacids, antimeteorici
  • the

  • Antiemetics
  • the

  • Antihistamines, cough and expectorant
  • the

  • Tranquilizers
  • the

  • Analgesia
  • the

  • anti-spasmodic
  • the

  • Anticoagulation
  • the

  • Anticonvulsants

Introduction

The effect of a drug on the product of conception is determined not only by the power of the assay, but also by gestational age. The substances administered to 20° day from the moment of conception may act according to the “law of all or nothing”, that is; or cause the death of the embryo or not the damage at all. The period between the 3rd and the 8th week, said of organogenesis, is critical to the teratogenic effects.

In this phase, the drugs that reach the embryo can result in:

    the

  • the abortion (very rarely)
  • the

  • An important anatomic defect
  • the

  • A defect of the permanent nature of the metabolic or functional può highlight in a later period.

The drugs administered after the 8th week are unlikely to have a teratogenic effect, but can alter the function of organs and fetal tissues normally formats. In the hours before the birth, that the drugs pass through the placenta should be administered with caution to avoid toxicityà in the newborn, which has a hepatic metabolism and renal immature. 90% of pregnant women use drugs.

we List below the più current:

Antimicrobici

Among the antimicrobials è recommended that you use the penicillin and its derivatives (ampicillin, amoxicillin) più or less associated with sulbactam. Also turns out to be harmless, the use of erythromycin, often used in pregnant women allergic to penicillins. The cephalosporins are often taken into consideration, but becauseé studies in man have failed to exclude the possibilityà of damage, these antibiotics should be used only when strictly necessary.

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The quinolone antibiotics (ciprofloxacin, norfloxacin) should be used with reserve, given the high staff affinitiesà for the bone and cartilage, can cause joint pain in the newborn.

Are to be avoided in pregnancy:

    the

  • Tetracyclines. These antibiotics cross the placenta and are deposited in the teeth, fetal; the più at risk goes from 20^ to 40^ week. The teeth may be permanently yellow, and the least resistant to decay and grow with difficultyà.
  • the

  • Streptomycin, gentamicin, Kanamycin. These antibiotics cross the placenta and can damage the labyrinth of the fetus.

The aztreonam instead è tolerable.

about the disinfectants of the urinary, in pregnancy is particularly harmless the fosfomycin, while nitrofurans are to be avoided at the end of pregnancy may cause the fetus in hemolytic anemia. the

sulfa drugs can cause, if used in close proximityà of childbirth, neonatal jaundice.  In the case of the use of any antibacterial, it is recommended to protect the intestinal flora (e.g. Symbiolact, 2 sachets dì for 30 days).

Antiacidi, antimeteorici

Can be used with safety all antacids without baking soda. Also can be used antimeteorici a base of dimethicone and antagonists for H2 receptors. Absolutely contraindicated are the anti-ulcer to base of misoprostol as prostaglandin può trigger miscarriage and preterm birth.

Antiemetici

Among the anti-emetics the più safe &is the vitamin B6 which is often associated with ginger.  Even if they are not been proven effects, embryotoxic, metoclopropamide should be used sparingly and only in the acute phase. Very effective proved to be the transmetilanti and glutathione.  Also phenothiazines have been used as antiemetics, with insignificant risk to the fetus.

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Antihistamines, cough and expectorant

antihistamines are often used for vomiting, “motion sicknessitching gravidorum. The meclizina is teratogena in rodents, , but this effect has been demonstrated in man. Having no certain data it is recommended to use antihistamines in the period of teratogenic only when strictly necessary.

In pregnancy can be used with tranquilityà cough such as dextromethorphan; vice versa, preparations containing opioids such as codeine can cause respiratory depression in the newborn, especially if used in proximityà the birth.

The colds , on the basis of acetylcysteine and ambroxol are very well tolerated.  For the decongestants nasal base, pseudoephedrine, nafazolina, imidazolina, etc, should be used with moderation and for short periods.

Tranquillanti

The diazepam and its derivatives are the anxiety and hypnotics più of the most frequently used. Recent data shows that there is an increased incidence of fetal abnormalities with the use of them. When these drugs are administered at the end of pregnancy, have been observed in infants depression, irritabilità, tremors, and hyperreflexia. There are no conclusive data on the association of tricyclic antidepressants and congenital malformations. (see antidepressants in pregnancy)

Analgesici

The salicylates can cause in the fetus, a jaundice of nuclear power. the aspirin and all FANS taken in doses massive and for long periods may delay the commencement of the travail, and the closure of the ductus; in the same way can lead to a bleeding diathesis in the mother during and after childbirth. For the foregoing reasons, NSAIDS should be used for very short periods of time. Paracetamol is the analgesic and antipyretic of choice in pregnancy. 

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Antispastici

inhibitors of the aceticolinesterasi can be adoperatoi with safety in pregnancy, but even for these drugs, if use is recommended in the acute phase and for short periods as they do not have side effects (constipation).

Anticoagulanti

heparin is the anticoagulant of choice during pregnancy. However the prolonged use può cause in the mother and osteoporosis , and thrombocytopenia. Even the recent low molecular weight heparins seem to be harmless to the fetus becauseé the passage through the placenta is minimum or zero. In contrast to heparin, dicumarol is teratogenic and toxic to the developing fetus.

Anticonvulsant

The anti if prescribed should be used, becauseé there can be some complications due to seizures.  The pregnant woman suffering from epilepsy must be treated by using the più low effective dose and controlling strictly.

Pregnancy low risk: the information contained in the video, così as the text of the song correspond to, and reflect recommendations taken from the guidelines of the schools of the Sanità international.

GRAVIDANZA:

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  • health pregnancy
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  • infectious Diseases in pregnancy
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  • Tests in pregnancy
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  • Nutrition in pregnancy
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  • childbirth

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Page last updated on June 5, 2013