Drug therapy during pregnancy

Fetal dysmorphic syndromes have been described with exposure to most commonly used anticonvulsants, most recently carbamazepine (Tegretol, Ciba-Geigy, Basel, Switzerland). Fetal genetic susceptibility may determine which infants are affected. Long-term use of heparin in pregnancy may cause significant osteoporosis, which appears to be reversible. Pharmacokinetic studies of ritodrine have resulted in recommendations for more appropriate infusion regimens, including a role for intramuscular therapy for patients undergoing maternal transport. Nifedipine shows promise as a tocolytic with fewer side effects than ritodrine but equivalent efficacy. Indomethacin is also an effective tocolytic, and clinically significant side effects have not been seen with 48 hours or less of treatment. Indomethacin has also been used successfully for treatment of polyhydramnios.