Gynecology Specialist Op.Dr. Nuri Ceydeli, gave information about drug use during pregnancy.
Nowadays, with the changing environmental conditions, pregnancy follow-up is getting a little complicated. Many mothers are inadvertently exposed to various environmental factors. It is not possible to protect from some of these environmental factors. For example, air pollution, gases generated by the exhausts of cars, radioactive substances caused by various wastes, electromagnetic waves emitted by telephone transmitters. Besides, mothers are obliged to use medicine due to various diseases encountered during pregnancy. Although these drugs are recommended to patients by their doctors, they are not used by patients on the assumption that they may be harmful to the baby. The point to be considered here; to determine the profit-loss ratio of the drug to be used. If the expectant mother is going to use a drug, the benefit of that drug should be greater than the harm it will cause. Otherwise, the necessity of using the drug should be questioned again. Apart from these, there are medicines that the mothers use because of their pre-existing diseases and they have to use during pregnancy. For example, antihypertensive drugs used by a patient with chronic hypertension, insulin used by a diabetic patient, thyroid drugs used by a thyroid patient, antiepileptic drugs used by an epileptic patient. As mentioned at the beginning of the article, all medications to be used during pregnancy are classified by international scientific organizations. This classification is accepted all over the world. If a drug is to be administered to a pregnant or breastfeeding mother, it is necessary to know which group this drug is. This classification is roughly as follows;
Group A: In controlled studies in humans, no risk was detected on the fetus.
Group B: There is no risk in animal studies, but no controlled studies in pregnant women.
Group C: There is a risk to the fetus in animal studies, but no controlled studies in pregnant women. These drugs should be used only if the expected benefit is greater than the harm to the fetus.
Group D: There is evidence of fetal risk in humans. Definitely contraindicated.
X group: Fetal anomalies have been shown in animal or human studies.
It is not even possible for the experts to know which class of all drugs is. There are books that regulate and update periodically. In daily practice, these books can be consulted, especially on drugs that are not frequently used. This is really a matter of time and effort. It has taken a long time to develop a reference guide that assesses the risks of all or used drugs on the fetus and newborn. Nowadays, it is better to understand how difficult it is, given that drugs are constantly developing and active ingredients are updated.
Even if a drug rarely causes problems in the group with extensive use, it is necessary to avoid drug use without any justification during pregnancy. In addition, individual sensitivities should not be ignored. Teratogenic effects of drugs may cause anatomical malformations on the fetus. This effect is related to dose and duration of use. The fetus is more vulnerable to external factors in the first 3 months of pregnancy. The effect of drugs on the fetus has not been clearly established. It may affect the mother's receptors indirectly or directly affect embryonic development and cause anomalies. Changes in the metabolism of the placenta affect the development of the fetus. Most of the drugs taken by pregnant women cross the placenta and enter the bloodstream of the fetus. Since the fetus cannot metabolize the drug like a mother, its development is affected and a number of damages occur. The doctor should not be left alone in terms of drug use. Every woman of childbearing age should take the responsibility to be careful about her medication.
If use of a medicament is required, it should be preferred to be of group A and B according to the classification described above. The C group can also be used if necessary.
To give an example to a few commonly used drugs in daily life;
Used as painkiller or antipyretic paracetamol: It's group B. But if high doses are used for a long time, anemia in the mother can cause kidney disease in the baby.
Again used as a stronger painkiller NSAIDs'Most of the s except naproxen: C group.
Hepatitis B vaccine, influenza vaccine: Group C. Even if it is to be done, it should be done after the first trimester.
Used for genital herpes Acyclovir: It's group B. The safety of systemic use in pregnant women has not been established.
penicillin gurbu amoxicillin: group B.
penicillin ampicillin group: B group.
cephalosporins: It's group B.
erythromycin: It's group B.
tetracycline and doxycycline: It's group D. Selected for discharge and upper respiratory tract infections macrolides group azithromycin: group B.
Used as artificial sweetener
Aspartame: It's group B.
cyclamate: C group. Used in preeclampsia or various diseases aspirin: C group. However, teratogenic effect was not observed in low dose use (40-150 mg./day).
Used to treat prolactin height Bromocriptine: C group.
Consumed in average amounts during pregnancy caffeine: It's group B.
Used in the treatment of typhoid fever chloramphenicol: C group.
Used in stomach complaints
cimetidine, famotidine: It's group B.
Proton pump inhibitors: C group. Used in urinary tract infections ciprofloxacin: C group.
Used in ovulation induction clomiphene: X is the group.
Cortisone Usage: Group C.
Blood thinner oral anticoagulants: It's group D.
Low molecular weight heparins: It's group B.
Sedative Diazepam: It's group D.
Cholesterol lowering drugs fluvastatin, lovastatin: X is the group.
1-3 months before the onset of pregnancy and continued for the first 3 months folic acid: A group.
aminoglycosides Gentamicin from the group: C group.
Oral antidiabetic glipizide: group C.
Oral antihyperglycemic metformin: B group.
Hepatitis B and tetanus immunoglobulin: C group.
Insulin: It's group B. It is accepted that it does not pass through the placenta because it is a large molecule.
Used in the treatment of hypothyroidism You levotrok: A group.
Antiinfective, amebicide metronidazole: It's group B.
Used in early nausea of pregnancy ondansetron: It's group B.
It is possible to extend the list in this way. Here we want to give the message; There are also drugs suitable for use in pregnancy. The important thing is to know their risks and benefits very well and use them properly. Healthy mothers are required for healthy pregnancies.