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Drug therapy during pregnancy and lactation
1Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
Emergency Medicine Clinics of North America
|February 1, 1994
Summary
This review covers how pregnancy affects drug pharmacokinetics and transfer to the fetus and infant. It also discusses maternal drug risks and challenges in assessing these effects, focusing on emergency department medications.
Area of Science:
- Pharmacology
- Obstetrics
- Neonatal Medicine
Background:
- Pregnancy significantly alters maternal physiology.
- Drug pharmacokinetics (absorption, distribution, metabolism, excretion) change during pregnancy.
- Placental drug transfer and excretion into breast milk are critical considerations.
Purpose of the Study:
- To review the impact of pregnancy on drug pharmacokinetics.
- To examine drug transport across the placenta and into breast milk.
- To discuss adverse effects of maternal drug therapy on the fetus and neonate.
Main Methods:
- Literature review of physiological changes during pregnancy.
- Analysis of pharmacokinetic principles in pregnant and lactating women.
- Examination of drug transfer mechanisms (placental, milk).
- Review of adverse event data and risk assessment challenges.
Main Results:
- Altered maternal physiology impacts drug absorption, distribution, metabolism, and excretion.
- Placental transfer varies significantly between drugs.
- Drug excretion into breast milk is influenced by drug properties and maternal factors.
- Assessing risks of maternal drug therapy is complex due to ethical and practical limitations.
Conclusions:
- Understanding pharmacokinetic changes in pregnancy is crucial for safe drug prescribing.
- Risk-benefit assessment for maternal drug use requires careful consideration of fetal and neonatal exposure.
- Specific drug examples from emergency settings illustrate these principles.