Medications in Pregnancy or Lactation

  1. medications in pregnancy and lactation

    the issue of medication use during pregnancy is of concern because the physiology of pregnancy affects the pharmokinetics of medications used, and certain medications can reach the fetus and cause harm. studying medication safety in pregnancy and lactation is challenging; thus, the u.s. food and drug administration (fda) categories of medication risk in pregnancy are limited, especially for the lactating mother. a better understanding of the role of physiologic changes in pregnancy, placental function, effects of medication on the fetus, and the mechanisms of drug transfer into breast milk can help nurses teach their patients both preconceptionally and during pregnancy and lactation. this article provides a review of current literature so nurses can become more aware of the basic principles involved in medication use for pregnant and lactating women.

    therapeutic choices for the discomforts of labor

    health care providers including nurses and childbirth educators are crucial resources for childbearing families for accurate and current information regarding nonpharmacologic and pharmacologic interventions available for pain management in labor. all medications that are administered to laboring women have maternal and fetal effects. in order to assist women in the decision for relief of labor discomforts, health care professionals must be knowledgeable of the chemical actions and adverse effects of all medications offered to women in labor. this article discusses various types of therapeutic options used for pain management for the relief of labor discomfort.

    learning the essentials of epidural anesthesia

    find out how this technique manages pain and make sure you know your patient-care responsibilities before and after catheter insertion.

    how to implement complementary therapies for laboring women

    complementary therapies have been a part of nursing practice for centuries and are supported today as a part of nursing practice by many state boards of nursing. some of these modalities can be used by nurses as a part of their comprehensive plan of labor support for women during the childbirth experience. this article describes five complementary therapies (aromatherapy, massage, use of birth balls, music therapy, and hydrotherapy), and how one large midwestern hospital system implemented an educational program for nurses that helped them integrate complementary therapies into their nursing care for laboring women.

    gestational diabetes management: guidelines to a healthy pregnancy

    gestational diabetes mellitus is not uncommon, affecting 7% of pregnant women annually (200,000 cases are diagnosed each year). gestational diabetes is defined as any degree of glucose intolerance with onset or initial recognition during pregnancy. it can have negative effects on the development and health of the fetus, including metabolic abnormalities, such as hypoglycemia, and injuries during birth, such as damage to the shoulders caused by macrosomia (abnormally large body).

    there are noticeable long-term effects of the intrauterine environment in the offspring of women with gestational diabetes. while insulin has been the accepted treatment for gestational diabetes when diet and exercise are not effective at controlling blood glucose, attention is now being given to the safety and effectiveness of oral agents. there are various treatments available for the mother and modalities for the prevention of type 2 diabetes in children born to mothers with gestational diabetes.

    depression in pregnancy: drug safety and nursing management

    women who are already predisposed to depression are at increased risks during pregnancy because of endocrine changes; untreated depression in pregnant women might lead to adverse effects for both mothers and infants. this article examines outcomes associated with the use of antidepressants during pregnancy and identifies how nurses can help depressed pregnant women.

    herb use in pregnancy: what nurses should know

    during the last decade, there has been a dramatic rise in the availability and use of medicinal herbal preparations. childbearing women are among those who are asking nurses about herbal use, and therefore nurses need to learn more about this topic. one of the most important points to understand is that in the united states herbs are classified as dietary supplements (not drugs), and manufacturers are therefore not required to provide proof of efficacy or safety before selling these substances. few studies about effects of herbs have been conducted in the general population, and fewer still have been published about pregnancy use. because the perinatal nurse has two patients to consider when caring for a pregnant woman, he or she has two equally important mandates: to help the mother without harming the fetus. this article provides an overview of key concepts underlying herbal use in general and also safety in pregnancy. common herbs that can be safely be used in pregnancy are presented in detail to enable the nurse to better care for the pregnant woman who is considering herbal use.

    hiv and pregnancy: considerations for nursing practice

    this article describes current nursing practice for pregnant women with hiv. in the united states, the number of new cases of hiv continues to rise in women of childbearing age. women often learn of their hiv status when a pregnancy involves them in the healthcare delivery system. since the manifestation of the disease in 1981, there have been significant advances in treatment, and now, among pregnant women testing positive for hiv, the risk of perinatal transmission can be decreased to 1% with pharmacologic intervention. yet, hiv disease poses many new challenges to the woman testing positive who is considering pregnancy or who is already pregnant. the progression of the symptoms of aids is similar to the common symptoms of pregnancy; the hiv medications may also cause these symptoms. adherence to the hiv medication regime is necessary for ongoing viral suppression, for missed doses can initiate drug resistance and the whole categories of antiretroviral drugs may become ineffective. additionally, the hiv stigma continues to impact those infected and interferes with the access to healthcare. hiv poses a major challenge for the nurse caring for the childbearing woman.

    preventing adverse drug events

    simply put, an adverse drug event (ade) is an injury or other undesirable response to a drug administered for a therapeutic effect. this includes not only adverse drug reactions but also adverse outcomes associated with omissions in therapy, such as the failure to administer a drug as ordered. medication errors are a common cause of ades, but allergic or immunologic responses and other adverse reactions, including toxicity and drug interactions, are also considered ades, even when not related to an error.
    although some ades are little more than minor annoyances, others are life-threatening. the cost of ades in patient suffering and added health care expense is enormous. according to one estimate, ades increase the cost of hospitalization by $2,200 to $3,200 per stay and prolong hospital stays by 2 days on average.

    as part of its 100,000 lives initiative, the institute for healthcare improvement is campaigning to prevent ades and save lives through medication reconciliation. for details on this initiative, see “best-practice interventions: how medication reconciliation saves lives” on page 63. in this article, i'll discuss why various types of ades occur and how you can help promote a culture of medication safety in your facility.

    Last edit by VickyRN on Dec 27, '06
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  2. 11 Comments

  3. by   VickyRN
    new breastfeeding & medications resource - lactmed

    drugs and lactation database (lactmed) - a peer-reviewed and fully referenced database of drugs to which breastfeeding mothers may be exposed. among the data included are maternal and infant levels of drugs, possible effects on breastfed infants and on lactation, and alternate drugs to consider.

    quote:
    the national library of medicine just released a new database, lactmed, on drugs and breastfeeding. it is part of toxnet and can be searched together with all the toxnet database or separately. it is a web-based collection of resources covering toxicology, chemical safety, and environmental health. geared to the healthcare practitioner and nursing mother, lactmed contains over 450 drug records. it includes information such as maternal levels in breast milk, infant levels in blood, potential effects in breastfeeding infants and on lactation itself, the american academy of pediatrics category indicating the level of compatibility of the drug with breastfeeding, and alternate drugs to consider.
    lactmed search
  4. by   VickyRN
    abundant information concerning intrapartal medications/ analgesia/ anesthesia:

    nursing management during labor and birth

    http://connection.lww.com/products/r...icci.ch.14.pdf

    especially note pp 353-357.
  5. by   VickyRN
    [font='times new roman']drug use during pregnancy and lactation
  6. by   gwenith
    Vicky - thank- you so, so much!! I work in an ICU?CCU that also has a very high throughput maternal patients - complicated maternity patients, Graves disease, myocarditis, AF, HELLP, and you name it. We are always looking for good resources to help us as we need this information often enough to want to know more but not often enough to be completely familiar with it.
  7. by   VickyRN
    Glad to be of assistance
  8. by   VickyRN
    paxil

    glaxosmithkline has issued a “dear healthcare professional” letter as a follow-up to a september 2005 letter that alerted providers to an increase in congenital malformations in infants born to women who were taking antidepressants, including the antidepressant paroxetine (paxil), during the first trimester of pregnancy. as a result of further studies, the pregnancy risk category (prc) has been changed from c to d, and warnings about the use of the drug during pregnancy have been added to the “warnings” section of the label. though a clear causal relationship hasn’t been identified, they report a twofold increase in the incidence of cardiac defects, including ventricular and atrial septal defects, in infants exposed to the drug in the first trimester. the company suggests informing women who become pregnant while taking the drug of the risk, stopping the drug in women who want to become pregnant, and stressing the use of contraceptive measures to women of childbearing age who start taking paroxetine.

    ndhnow.com - drug updates - paroxetine
    medwatch - 2005 safety information alerts
    http://www.fda.gov/medwatch/safety/2...hcp_letter.pdf
    Last edit by VickyRN on Dec 27, '06
  9. by   VickyRN
    the food and drug administration has approved changes to the prescribing information for sertraline (zoloft) a selective serotonin reuptake inhibitor (ssri) used to treat depression, following post-marketing studies about the use of ssris during pregnancy. the additions to the "precautions" section of the information states that infants exposed to ssris in late pregnancy have an increased risk for persistent pulmonary hypertension of the newborn. health care providers caring for women in the third trimester of pregnancy should carefully weigh these risks and the risks of a relapse of a major depression if the drug is stopped.

    infants exposed to ssris in late pregnancy may have an increased risk for persistent pulmonary hypertension of the newborn (pphn). pphn occurs in 1-2 per 1,000 live births in the general population and is associated with substantial neonatal morbidity and mortality. in a retrospective case-control study of 377 women whose infants were born with pphn and 836 women whose infants were born healthy, the risk for developing pphn was approximately sixfold higher for infants exposed to ssris after the 20th week of gestation compared to infants who had not been exposed to antidepressants during pregnancy. there is currently no corroborative evidence regarding the risk for pphn following exposure to ssris in pregnancy; this is the first study that has investigated the potential risk. the study did not include enough cases with exposure to individual ssris to determine if all ssris posed similar levels of pphn risk.
    ndhnow.com - drug updates - sertraline hydrochloride
    http://www.fda.gov/medwatch/safety/2.../zoloft_pi.pdf
  10. by   Dabuggy
    Hello VickyRN and the others who have posted such useful information as this thread. I want to send a special thank you. My next classes in the RN program are Pharm II and Mental Health II. There is a ton of information that you have provided for us. Just wanted to say thank you.

    Dabuggy
  11. by   mitchsmom
    Thanks for all the resources

    A huge mainstay resource for lactational pharmacology is the work of Dr. Thomas Hale/his books(Medications & Mother's Milk and others/his website:
    Breastfeeding Pharmacology
    Lactational pharmacology questions can be answered on his forum:
    Medications Forums

    Lactmed (as posted above) is also considered a good source of drug information in lactation circles. I was on a review panel for Lactmed before it came out

    An recent study on epidurals with fentanyl & their effect on breastfeeding (also quotes other studies with similar findings):
    International Breastfeeding Journal | Full text | Intrapartum epidural analgesia and breastfeeding: a prospective cohort study
  12. by   GLORIAmunchkin72
    Could you tell me why a pregrant woman should not handle the inhaler Spiriva? Just curious.
  13. by   ccrnmomnb
    Is there a resource for postpartum pain control. A map or something to help guide you in what to give (perc vs norco, etc)?

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