Scottish Neonatal and Paediatric Pharmacists Group

DRUGS IN PREGNANCY DRUGS IN PREGNANCY AND LACTATIONAND LACTATION

Scottish Neonatal and Paediatric Pharmacists Group

AIMSAIMS

• To update pharmacists on current opinion relating to the prescribing of drugs in pregnancy and breastfeeding.

Scottish Neonatal and Paediatric Pharmacists Group

OBJECTIVESOBJECTIVES• To be aware of the background and

relevance of this specialised area of prescribing

• To be able to find information regarding current drug use in pregnancy - and breast feeding

• To be able to interpret this in day to day cases encountered in working - practice.

Scottish Neonatal and Paediatric Pharmacists Group

INTRODUCTIONINTRODUCTION

• Thalidomide

• Foetal malformations occur in 2% of population

• 65% - 70% of malformations are of unknown cause

Scottish Neonatal and Paediatric Pharmacists Group

PRINCIPLES OF TERATO GENESISPRINCIPLES OF TERATO GENESIS • Placental barrier does not exist

• Teratogenicity is usually dose dependent

• Teratogenic agents may be synergistic.

• A teratogen may be harmless to the mother but

devastating to the embryo.

• Timing and exposure is critical

• Susceptibility to teratogenesis is genetically

determined.

Scottish Neonatal and Paediatric Pharmacists Group

PRINCIPLES OF PRESCRIBINGPRINCIPLES OF PRESCRIBING

• Evaluate every drug prescribed

• Use drugs which have been widely used in pregnancy

• Medico-legal

Scottish Neonatal and Paediatric Pharmacists Group

PROBLEMS ENCOUNTEREDPROBLEMS ENCOUNTERED

1. Anxious and emotional patients 2. Medico legal implications 3. Defensive Pharmaceutical Companies 4. Poor quality data 5. Media Scares

Scottish Neonatal and Paediatric Pharmacists Group

FACTORS TO TAKE INTO CONSIDERATIONFACTORS TO TAKE INTO CONSIDERATION

• Pregnant, planning pregnancy • Script needed• Consider period of gestation • Medicate only if benefits outweigh the

risks • Avoid new drugs • Use a single drug if possible • Use lowest effective dose • Involve and counsel patient

Scottish Neonatal and Paediatric Pharmacists Group

INADVERTENT DRUG EXPOSUREINADVERTENT DRUG EXPOSURE

• Identify medicines taken

• Go to the SPC

• Either contact the local medicines

information unit or

• Contact the National Teratology

Information Service at Newcastle