Drugs in pregnancy

Drugs in pregnancy can be either pharmaceutical or recreational and can have temporary or permanent effects on the fetus. Any drug used in pregnancy that acts during embryonic or prenatal development to produce a permanent alteration of form or function is known as a teratogen.

Pharmaceutical drugs

The apprehension is not necessarily data driven and is a cautionary response to the lack of clinical studies in pregnant women. The indication is a trade-off between the adverse effects of the drug, the risks associated with intercurrent diseases and pregnancy complications, and the efficiency of the drug to prevent or ameliorate such risks. In some cases, the use of drugs in pregnancy carries benefits that outweigh the risks. For example, high fever is harmful for the fetus in the early months, thus the use of paracetamol (acetaminophen) is generally associated with lower risk than the fever itself. Similarly, diabetes mellitus during pregnancy may need intensive therapy with insulin to prevent complications to mother and baby. Pain management for the mother is another important area where an evaluation of the benefits and risks is needed. NSAIDs such as Ibuprofen and Naproxen are probably safe for use for a short period of time, 48–72 hours, once the mother has reached the second trimester.[1] If taking aspirin for pain management the mother should never take a dose higher than 100 mg.[1]

Pregnancy categories

U.S. Code of Federal Regulations requires that certain drugs and biological products must be labelled very specifically with respect to their effects on pregnant populations, including a definition of a "pregnancy category." These rules are enforced by the Food and Drug Administration (FDA).[2][3] The FDA does not regulate labelling for all hazardous and non-hazardous substances and some potentially hazardous substances are not assigned a pregnancy category.

Australia’s categorisations system takes into account the birth defects, the effects around the birth or when the mother gives birth, and problems that will arise later in the child's life caused from the drug taken. The system places them into a category of their severity that the drug could cause to the infant when it crosses the placenta(Australian Government, 2014).[4]

Anticonvulsants

Valproic acid, and its derivatives such as sodium valproate and divalproex sodium, causes cognitive deficit in the child, with an increased dose causing decreased intelligence quotient.[5] On the other hand, evidence is conflicting for carbamazepine regarding any increased risk of congenital physical anomalies or neurodevelopmental disorders by intrauterine exposure.[5] Similarly, children exposed lamotrigine or phenytoin in the womb do not seem to differ in their skills compared to those who were exposed to carbamazepine.[5]

Recreational drugs

Alcohol

Medical organizations strongly discourage drinking alcohol during pregnancy.[6][7][8] Alcohol passes easily from the mother's bloodstream through the placenta and into the bloodstream of the fetus,[9] which interferes with brain and organ development.[10] Alcohol can affect the fetus at any stage during pregnancy, but the level of risk depends on the amount and frequency of alcohol consumed.[10] Regular heavy drinking and binge drinking (four or more drinks on any one occasion) pose the greatest risk for harm, but lesser amounts can cause problems as well.[10] There is no known safe amount or safe time to drink during pregnancy.[11] Every year about 12,000 babies are born with FAS in the US. Around 60,000 are born with some kind of alcohol-related abnormalities and developmental issues.[12] Despite this 1 in 10 pregnant women report drinking alcohol, 1 in 33 binge drink.[13]

Prenatal alcohol exposure can lead to fetal alcohol spectrum disorders (FASDs). The most severe form of FASD is fetal alcohol syndrome (FAS).[11] Problems associated with FASD include facial anomalies, low birth weight, stunted growth, small head size, delayed or uncoordinated motor skills, hearing or vision problems, learning disabilities, behavior problems, and inappropriate social skills compared to same-age peers.[14][15] Those affected are more likely to have trouble in school, legal problems, participate in high-risk behaviors, and develop substance use disorders themselves.[14] It's also been shown that alcohol impairs global motion perception if consumed during the prenatal development period. It was also shown that with an increasing amount of alcohol exposure there is a correlation with an increase in the impairment of global motion perception.[16]

Cannabis

Cannabis in pregnancy there are multiple studies on cannabis affects on pregnancy. A recent study on the Birth outcomes associated with before use and during pregnancy(2011), seems to suggest that Cannabis will increase the chances of negative birth outcome. The possible outcomes of cannabis use during pregnancy include a low birth weight, pre term birth, and the infant being small at gestational age. The study examined cannabis use independent of confounding factors and concluded that the result remained statistically significant when accounting for confounding factors. [17]

Recreational drug; cannabis. Plant having a significant effect on prenatal birth.

Tobacco

A number of studies have shown that tobacco use is a significant factor in miscarriages among pregnant smokers, and that it contributes to a number of other threats to the health of the fetus.[18][19] Smoking and pregnancy, combined, cause twice the risk of premature rupture of membranes, placental abruption and placenta previa.[20] Also, it causes 30% higher odds of the baby being born prematurely.[21]

Cocaine

Prenatal cocaine exposure is associated with, for example, premature birth, birth defects and attention deficit disorder.

A recent study on cocaine in Prenatal Drug Exposure(2008)[22] explores how the differences between children who were exposed to drugs prenatal and those with non-drug prenatal exposure differ at the age of five.

Many of the side effects from the children who were exposed to the recreational drug being cocaine had side effects including the following; lack in school readiness, slower impulse control and lack in visual attention.

Others

  • Prenatal methamphetamine exposure can cause premature birth and congenital abnormalities.[23] Other investigations have revealed short-term neonatal outcomes to include small deficits in infant neurobehavioral function and growth restriction when compared to control infants.[24] Also, prenatal methamphetamine use is believed to have long-term effects in terms of brain development, which may last for many years.[23]
  • Marijuana can cause low birth weight, tremors, poor eyesight, late start of breathing, and a hole in the heart. In the first six months of life babies who have been exposed to marijuana have a higher chance of having breathing problems such as asthma, chest infections, and wheezing. By the age of three or four the child might be fearful, reckless, inattentive, restless, irresponsible, and may have poor memory, verbal, and reasoning ability; at age ten these problems can continue along with depression, anxiety, reading and spelling problems.[25]
  • Opioid abuse is the main cause of neonatal abstinence syndrome and reduced autonomic nervous system control which causes vomiting, fever, diarrhea, blotchy skin, over-sensitivity to stimulation such as touch, sound or visual stimulation and rapid breathing.

By pregnancy stage

Pregnancy and fetal development progress through various changes. The period of one week from fertilisation to implantation of the fertilized egg is called the preimplantation period. This is an 'all or none' period, .i.e. an insult can either cause death or complete recovery can occur. The period from the eighth day to the end of eighth week is the period of organogenesis during which the organs are formed in the fetus. This is the most crucial time with regards to 'structural malformations' and concern over teratogenicity of drugs. From the third month to the end of nine months is the period of fetal maturation. Intake of drugs during this period may modify the 'function' of the fetal organs rather than causing gross structural malformations in the fetus; for example, aminoglycosides can affect the functioning of the kidneys as well as the hearing mechanism. Another example is when cocaine crosses through the placenta, this directly influences the fetus and its chances to fully develop are slim because it has a negative effect on the brain.[22]

References

  1. 1 2 Kim, Joong; Segal, Neil (2015). Pharmacological Treatment of Musculoskeletal Conditions During Pregnancy and Lactation. Springer International Publishing. pp. 227–242. ISBN 978-3-319-14318-7.
  2. ↑ FDA (1 April 2015), CFR – Code of Federal Regulations Title 21, 4, Food and Drug Administration
  3. ↑ FDA (3 December 2014), Pregnancy and Lactation Labeling (Drugs) Final Rule, Food and Drug Administration
  4. ↑ "Australian categorisation system for prescription medicines in pregnancy". Australian Government. 2014. Retrieved 2016-05-18.
  5. 1 2 3 Bromley, Rebecca; Weston, Jennifer; Adab, Naghme; Greenhalgh, Janette; Sanniti, Anna; McKay, Andrew J; Tudur Smith, Catrin; Marson, Anthony G; Bromley, Rebecca (2014). "Treatment for epilepsy in pregnancy: Neurodevelopmental outcomes in the child". Cochrane Database of Systematic Reviews. doi:10.1002/14651858.CD010236.pub2.
  6. ↑ Vice Admiral Richard H. Carmona (2005). "A 2005 Message to Women from the U.S. Surgeon General" (PDF). Retrieved 12 June 2015.
  7. ↑ Kathleen Stratton; Cynthia Howe; Frederick C. Battaglia, eds. (1995). Fetal alcohol syndrome : diagnosis, epidemiology, prevention, and treatment. Washington, D.C.: Committee to Study Fetal Alcohol Syndrome, Division of Biobehavioral Sciences and Mental Disorders, Institute of Medicine National Academy Press. ISBN 0-309-05292-0.
  8. ↑ "Australian Government National Health and Medical Research Council". Retrieved 4 November 2012.
  9. ↑ Nathanson, Vivienne; Nicky Jayesinghe; George Roycroft (27 October 2007). "Is it all right for women to drink small amounts of alcohol in pregnancy? No". BMJ. 335 (7625): 857. doi:10.1136/bmj.39356.489340.AD. PMC 2043444. PMID 17962287.
  10. 1 2 3 "Fetal Alcohol Exposure". April 2015. Retrieved 10 June 2015.
  11. 1 2 "Facts about FASDs". 16 April 2015. Retrieved 10 June 2015.
  12. ↑ "What You Should Know About Fetal Alcohol Syndrome". 9 February 2017. Retrieved 22 February 2017.
  13. ↑ "FASDs. Key Findings: Alcohol use and binge drinking among women of childbearing age – United States, 2011-2013". 24 September 2015. Retrieved 22 February 2017.
  14. 1 2 Coriale; et al. (2013). "Fetal Alcohol Spectrum Disorder (FASD): neurobehavioral profile, indications for diagnosis and treatment". Rivista di psichiatria. 48 (5): 359–69. doi:10.1708/1356.15062. PMID 24326748.
  15. ↑ Chudley; et al. (2005), "Fetal alcohol spectrum disorder: Canadian guidelines for diagnosis", CMAJ, 172 (5 Suppl): S1–S21, doi:10.1503/cmaj.1040302, PMC 557121, PMID 15738468, retrieved 16 April 2016
  16. ↑ Chakraborty, Arijit; Anstice, Nicola (19 November 2015). "Prenatal exposure to recreational drugs affects global motion perception in preschool children". Nature Research. doi:10.1038/srep16921.
  17. ↑ Hayabakhsh, Mohammad R.; Flenady, Vicki J.; Gibbons, Kristen S.; Kingsbury, Ann M.; Hurrion, Elizabeth; Mamun, Abdullah A.; Najman, Jake M. (Dec 21, 2011). "Birth outcomes associated with cannabis before and during pregnancy". Pediatric Research. 71: 217. doi:10.1038/pr.2011.25.
  18. ↑ Ness RB, Grisso JA, Hirschinger N, et al. (February 1999). "Cocaine and tobacco use and the risk of spontaneous abortion". N. Engl. J. Med. 340 (5): 333–9. doi:10.1056/NEJM199902043400501. PMID 9929522.
  19. ↑ Oncken C, Kranzler H, O'Malley P, Gendreau P, Campbell WA (May 2002). "The effect of cigarette smoking on fetal heart rate characteristics". Obstet Gynecol. 99 (5 Pt 1): 751–5. doi:10.1016/S0029-7844(02)01948-8. PMID 11978283.
  20. ↑ "Preventing Smoking and Exposure to Secondhand Smoke Before, During, and After Pregnancy" (PDF). Centers for Disease Control and Prevention. 2007.
  21. ↑ "Tobacco Use and Pregnancy: Home". Centers for Disease Control and Prevention. 2009.
  22. 1 2 Pulsifer, Margaret B.; Butz, Arlene M.; Foran, Megan O'Reilly; Belcher, Harolyn M. E. (2008-01-01). "Prenatal Drug Exposure: Effects on Cognitive Functioning at 5 Years of Age". Clinical Pediatrics. 47 (1): 58–65. doi:10.1177/0009922807305872. ISSN 0009-9228. PMC 2269702. PMID 17766581.
  23. 1 2 "New Mother Fact Sheet: Methamphetamine Use During Pregnancy" (PDF). North Dakota Department of Health. Archived (PDF) from the original on 15 March 2013. Retrieved 4 February 2014.
  24. ↑ Grotta, S.; LaGasse, L.; Arria, A.; Derauf, C.; Grant, P.; Smith, L.M.; et al. (30 June 2009). "Patterns of Methamphetamine Use During Pregnancy: Results from the IDEAL Study". Matern Child Health J. 14 (4): 519–527. doi:10.1007/s10995-009-0491-0. PMC 2895902. PMID 19565330.
  25. ↑ "Marijuana Reproduction and Pregnancy". University of Washington Alcohol & Drug Abuse Institute. Retrieved 2011. Check date values in: |accessdate= (help)
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