Medications in Pregnancy or Lactation

VickyRN, MSN, DNP, RN

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.

Medications in Pregnancy and Lactation

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.

Therapeutic Choices for the Discomforts of Labor

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.

Learning the essentials of epidural anesthesia

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.

How to Implement Complementary Therapies for Laboring Women

Gestational Diabetes Management

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.

Gestational Diabetes Management: Guidelines to a Healthy Pregnancy

Depression in Pregnancy

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.

Depression in Pregnancy: Drug Safety and Nursing Management

Herb Use in Pregnancy

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.

Herb Use in Pregnancy: What Nurses Should Know

HIV and Pregnancy

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.

HIV and Pregnancy: Considerations for Nursing Practice

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.

Preventing adverse drug events