Chapter-33 Principles of Drug Use in Pregnancy

BOOK TITLE: Essentials of Obstetrics

1. Arulkumaran Sabaratnam
2. Tamizian Onnig
Publishing Year
Author Affiliations
1. St. George’s Hospital Medical School London, St. George’s Hospital Medical School, London, St George’s Hospital Medical School, London, United Kingdom, St George’s Hospital Medical School, London, United Kingdom, e-mail: sarulkum@sghms.ac.uk, St George s University of London, London, UK, St George’s Hospital Medical School Cranmer Terrace, London SW17 0RE, United Kingdom, St George’s University of London, Cranmer Terrace, London, United Kingdom
2. Kings Mill Hospital, Nottingham, United Kingdom, Royal Derby Hospital, Derby, United Kingdom
Chapter keywords


A complete review of all medical treatments that may be used in pregnancy is beyond the scope of this chapter. A review of common medical treatments including vitamins and supplements such as: Folic acid, Vitamin K, Vitamin A, Vitamin B, Vitamin D and calcium, along with management options of common ailments and symptoms in pregnancy. Fetal safety is a major concern, so effective drugs that have been in use for many years are preferable to new alternatives, which, although may have theoretical advantages, often lack a long safety track record. In order to minimize fetal risk, drug doses at the lower end of the therapeutic range should be prescribed in pregnancy, accepting that due to altered pharmacokinetics in pregnancy, higher than normal adult doses may sometimes be required. For teratogenesis to be ascribed to a particular drug, certain patterns of defects should be seen when exposed to it at a particular gestation, the evidence being stronger if the defect caused has a biologically plausible mechanism of teratogenesis and/or is proven on animal models. Alongside the risk of teratogenesis, there is also the risk of misinformation about teratogenesis and the potential for unnecessary terminations or avoidance of much-needed therapy. Women and their unborn child need to be protected from both these risks. Most drug labels will have the warning ‘not to be used in pregnancy unless benefits outweigh risk’, putting heavy responsibility on the physician and reluctance by the woman to take the prescribed medication.

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