Chapter 24

Mosby items and derived items © 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Chapter 24Chapter 24

Pregnancy and Breast-FeedingPregnancy and Breast-Feeding



TeratogenesisTeratogenesis From the Greek (producing a monster)From the Greek (producing a monster) Difficult to identify drugs that are teratogenicDifficult to identify drugs that are teratogenic Teratogenic effects may not be evident for Teratogenic effects may not be evident for

many years after birthmany years after birth Timing and exposure varies from drug to drugTiming and exposure varies from drug to drug

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Pregnancy TrimestersPregnancy Trimesters During the first trimester of pregnancy the fetus’ organs During the first trimester of pregnancy the fetus’ organs

are forming.are forming. This is the most critical time for teratogenicity.This is the most critical time for teratogenicity. Oftentimes, the woman does not know she is pregnant Oftentimes, the woman does not know she is pregnant

during the first six weeks of the first trimester.during the first six weeks of the first trimester. The second trimester is the ideal time for dental The second trimester is the ideal time for dental

prophylaxis. She is usually most comfortable during this prophylaxis. She is usually most comfortable during this time.time.

During the third trimester the woman is usually During the third trimester the woman is usually beginning to feel uncomfortable and it is difficult for to be beginning to feel uncomfortable and it is difficult for to be in the prone position.in the prone position.

Drugs that could effect the newborn child should not be Drugs that could effect the newborn child should not be given at this time.given at this time.

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FDA Pregnancy Categories FDA Pregnancy Categories for Medication Use for Medication Use

Category ACategory A Adequate studies have failed to demonstrate a Adequate studies have failed to demonstrate a

risk to fetus (in first trimester) and no evidence risk to fetus (in first trimester) and no evidence of risk in later trimesters; possibility of fetal of risk in later trimesters; possibility of fetal harm appears remote.harm appears remote.

Thyroid supplements (levothyroxine), vitamins Thyroid supplements (levothyroxine), vitamins (folic acid, riboflavin; vitamins A, D, and C)(folic acid, riboflavin; vitamins A, D, and C)

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FDA Pregnancy Categories FDA Pregnancy Categories for Medication Usefor Medication Use

Category BCategory B Animal studies have failed to demonstrate a Animal studies have failed to demonstrate a

risk to the fetus, and there are no adequate risk to the fetus, and there are no adequate studies in pregnant women; studies in pregnant women; oror animal studies animal studies show an adverse effect on the fetus but well-show an adverse effect on the fetus but well-controlled studies in pregnant women have controlled studies in pregnant women have failed to demonstrate a risk to the fetus.failed to demonstrate a risk to the fetus.

Acetaminophen, opioids, penicillins, Acetaminophen, opioids, penicillins, cephalosporins, erythromycin, prednisone, cephalosporins, erythromycin, prednisone, caffeine, sulfonamides, cimetidine, fluoxetine, caffeine, sulfonamides, cimetidine, fluoxetine, insulin, NSAIDsinsulin, NSAIDs

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Category CCategory C Animal studies have shown an adverse effect Animal studies have shown an adverse effect

on the fetus and there are no adequate studies on the fetus and there are no adequate studies in humans, in humans, oror no studies are available in either no studies are available in either animals or women. Potential benefits may animals or women. Potential benefits may warrant its use.warrant its use.

Epinephrine, phenylpropanolamine, Epinephrine, phenylpropanolamine, trimethobenzamide, aspirin, atropine, trimethobenzamide, aspirin, atropine, promethazine, theophylline, lisinopril, promethazine, theophylline, lisinopril, potassium chloride, disulfiram, acyclovir, potassium chloride, disulfiram, acyclovir, propranololpropranolol

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Category DCategory D Positive evidence of human fetal risk based on Positive evidence of human fetal risk based on

adverse reaction data, but potential benefits in adverse reaction data, but potential benefits in serious situations may warrant its use.serious situations may warrant its use.

Warfarin, tetracycline, phenytoin, diazepam, Warfarin, tetracycline, phenytoin, diazepam, trimethadione, lorazepam, amitriptylinetrimethadione, lorazepam, amitriptyline

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Category XCategory X Studies in animals or humans have Studies in animals or humans have

demonstrated fetal abnormalities and/or there demonstrated fetal abnormalities and/or there is positive evidence of human fetal risk, and is positive evidence of human fetal risk, and the risks clearly outweigh any potential the risks clearly outweigh any potential benefits.benefits.

Isotretinoin, diethylstilbestrol, phencyclidine Isotretinoin, diethylstilbestrol, phencyclidine (PCP), triazolam, X-rays, chemotherapy(PCP), triazolam, X-rays, chemotherapy

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Managing Pregnant Managing Pregnant Dental PatientsDental Patients

Avoid elective dental treatment except in the second trimester.Avoid elective dental treatment except in the second trimester. Avoid any unnecessary drugs, especially during the first trimester.Avoid any unnecessary drugs, especially during the first trimester. If drugs are needed, check the FDA categories to choose the If drugs are needed, check the FDA categories to choose the

safest.safest. Minimize periodontal problems, perform oral prophylaxis before Minimize periodontal problems, perform oral prophylaxis before

pregnancy or during second trimester; monitor for periodontal pregnancy or during second trimester; monitor for periodontal conditions.conditions.

Avoid radiographs unless absolutely necessary; use lead apron.Avoid radiographs unless absolutely necessary; use lead apron. Pay particular attention to periodontal disease because it has been Pay particular attention to periodontal disease because it has been

associated with low-birth-weight newborns.associated with low-birth-weight newborns. Position patient in recumbent position in last trimester with right hip Position patient in recumbent position in last trimester with right hip

elevated (not Trendelenburg).elevated (not Trendelenburg). If morning sickness is a problem, schedule an afternoon If morning sickness is a problem, schedule an afternoon

appointment.appointment. Give frequent breaks for urination, especially during the first Give frequent breaks for urination, especially during the first

trimester.trimester.

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Nursing Safety Options to Consider for Nursing Safety Options to Consider for Breast-Feeding PatientsBreast-Feeding Patients

Take the medicine just prior to nursing.Take the medicine just prior to nursing. Pump and store breast milk prior to Pump and store breast milk prior to

starting medicine.starting medicine. Pump and dump breast milk until therapy Pump and dump breast milk until therapy

is completed.is completed. Stop nursing.Stop nursing. Follow the FDA pregnancy categories to Follow the FDA pregnancy categories to

determine whether or not the drug can be determine whether or not the drug can be given to a nursing mother.given to a nursing mother.

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Chapter 24