Common Problems in Pregnancy
During pregnancy, drugs have to be prescribed with great caution as some drugs can harm the developing foetus while others can affect the course of pregnancy. Some of the common problems women can face during pregnancy and the guidelines for managing these situations are listed below:
Nausea and vomiting
Nausea and vomiting are the most frequent symptoms in pregnancy and can be quite distressing though these symptoms usually disappear by the fourth month. Women should be reassured and advised to take smaller, more frequent meals and to avoid large volume drinks. Nausea in the first three months of pregnancy does not normally require drug therapy. On some occasions when the symptoms are severe or prolonged, antiemetics such as doxylamine or prornethazine can be given.
For heartburn, antacids are widely prescribed in all trimesters. There is no evidence of foetal abnormalities.
The inclusion of more fibre and fluids in the diet may be sufficient to relieve constipation. Laxatives should only be used when dietary changes prove ineffective. Bulk forming laxatives should be first tried such as Ispaghula. Stimulant laxatives such as senna are best avoided. Bisacodyl, Lactulose and docusate are all thought to be safe during pregnancy.
The drug treatment of Asthma is essentially unchanged by pregnancy. There is no evidence that the commonly used drugs by asthmatics harm the foetus and women. Inhaled medication should be preferred. There is no evidence that the inhaled corticosteroids are harmful to the foetus. Short courses of systemic steroids may also be given.
For vaginal discharge, topical agents are to be preferred over oral medications. Discharge due to candida can be treated with clotrimazole. Topical clindamycin is effective in bacterial vaginosis and may be considered for women in the first trimester. Oral metronidazole can be given if required during second and third trimester if trichomonas infection is confirmed. However, it should not be administered during first three months. Oral antifungal drugs such as fluconazole and itraconazole should be avoided.
Promethazine and chlorpheniramine are the antihistamines of choice in pregnant women with allergic rhinitis and urticaria. Non- sedating compounds such as cetirizine are best avoided because of lack of experience in pregnancy. Use of loratidine is contraindicated during pregnancy.
Urinary tract infections are the most common reason for prescribing antibiotics during pregnancy, although they are frequently needed for many other infections.
|Class of Antibiotic||Commonly used Drugs||Safety in Pregnancy|
|Penicillins||Ampicillin, Amoxycillin, Cloxacillin, Penicillin||No evidence of problems.|
|Cephalosporins||Cephalexin||No evidence of problems.|
|Macrolides||Erythromycin||No evidence of problems.|
|Aminoglycosides||Gentamycin, Netilmicin||Avoid- Risk of Foetal toxicity|
|Tetracycline||Oxytetracycline, Tetracycline, Minocycline||Avoid- exposure at or after 12 weeks of gestation can affect developing teeth and bones.|
|Quinolones||Ciprofloxacin, Norfloxacin, Ofloxacin||Avoid – Insufficient evidence of safety|
|Other Antibiotics||Nitrofurantoin||No evidence of problem|
|Metronidazole||No evidence of increased foetal risk. However to be used with care in the first trimenster.|
|Trimethoprim||Avoid in the first trimester. However no evidence of increased foetal risk.|
For pain, paracetamol is the analgesic of choice. Aspirin is not recommended as it can cause bleeding in late pregnancy. At present there is insufficient evidence of safety to recommend the use of ibuprofen in pregnancy. NSAID painkillers are best avoided in late pregnancy as they can cause premature closure of ductus arteriosus (foetal heart opening).
Hypertension is fairly common during pregnancy. Severe hypertension in the mother carries a risk of cerebrovascular accident and cardiac problems. It can lead, to eclampsia (convulsions) during pregnancy.
If a pregnant woman’s blood pressure is sustained greater than 160 mm Hg systolic and/or 110 mm Hg diastolic at any time, lowering the blood pressure quickly with rapid-acting agents is indicated for maternal safety.
Most of the antihypertensive drugs are excreted into human breast milk, but most are excreted to a negligible degree. All antihypertensive medications are believed to be compatible with breastfeeding, but using medications with a well-established record is reasonable. Atenolol, as well as the other beta-blocking agent’s nadolol and metoprolol, appear to be concentrated in breast milk. Labetalol and propranolol do not share this property and are preferred agents if a beta-blocker is indicated.
ACE inhibitors should be avoided during pregnancy, as they are associated with fetal renal dysgenesis or death when used in the second and third trimesters, as well as with increased risk of cardiovascular and central nervous system malformations when used in the first trimester.
Diuretics do not cause fetal malformations but are generally avoided in pregnancy, as they prevent the physiologic volume expansion seen in normal pregnancy. They may be used in states of volume-dependent hypertension, such as renal or cardiac disease.