Download 24 Contraceptive

Chapter 24
Pregnancy and Breast-Feeding
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Pregnancy and Breast-Feeding
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Teratogenesis
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From the Greek (producing a monster)
Difficult to identify drugs that are teratogenic
Teratogenic effects may not be evident for
many years after birth
Timing and exposure varies from drug to drug
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Pregnancy and Breast-Feeding
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Pregnancy Trimesters
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During the first trimester of pregnancy the fetus’ organs
are forming.
This is the most critical time for teratogenicity.
Oftentimes, the woman does not know she is pregnant
during the first six weeks of the first trimester.
The second trimester is the ideal time for dental
prophylaxis. She is usually most comfortable during this
time.
During the third trimester the woman is usually
beginning to feel uncomfortable and it is difficult for to be
in the prone position.
Drugs that could effect the newborn child should not be
given at this time.
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FDA Pregnancy Categories
for Medication Use
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Category A
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Adequate studies have failed to demonstrate a
risk to fetus (in first trimester) and no evidence
of risk in later trimesters; possibility of fetal
harm appears remote.
Thyroid supplements (levothyroxine), vitamins
(folic acid, riboflavin; vitamins A, D, and C)
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FDA Pregnancy Categories
for Medication Use
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Category B
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Animal studies have failed to demonstrate a
risk to the fetus, and there are no adequate
studies in pregnant women; or animal studies
show an adverse effect on the fetus but wellcontrolled studies in pregnant women have
failed to demonstrate a risk to the fetus.
Acetaminophen, opioids, penicillins,
cephalosporins, erythromycin, prednisone,
caffeine, sulfonamides, cimetidine, fluoxetine,
insulin, NSAIDs
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FDA Pregnancy Categories
for Medication Use
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Category C
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Animal studies have shown an adverse effect
on the fetus and there are no adequate studies
in humans, or no studies are available in either
animals or women. Potential benefits may
warrant its use.
Epinephrine, phenylpropanolamine,
trimethobenzamide, aspirin, atropine,
promethazine, theophylline, lisinopril,
potassium chloride, disulfiram, acyclovir,
propranolol
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FDA Pregnancy Categories
for Medication Use
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Category D
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Positive evidence of human fetal risk based on
adverse reaction data, but potential benefits in
serious situations may warrant its use.
 Warfarin, tetracycline, phenytoin, diazepam,
trimethadione, lorazepam, amitriptyline
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FDA Pregnancy Categories
for Medication Use
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Category X
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Studies in animals or humans have
demonstrated fetal abnormalities and/or there
is positive evidence of human fetal risk, and
the risks clearly outweigh any potential
benefits.
Isotretinoin, diethylstilbestrol, phencyclidine
(PCP), triazolam, X-rays, chemotherapy
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Managing Pregnant
Dental Patients
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Avoid elective dental treatment except in the second trimester.
Avoid any unnecessary drugs, especially during the first trimester.
If drugs are needed, check the FDA categories to choose the
safest.
Minimize periodontal problems, perform oral prophylaxis before
pregnancy or during second trimester; monitor for periodontal
conditions.
Avoid radiographs unless absolutely necessary; use lead apron.
Pay particular attention to periodontal disease because it has
been associated with low-birth-weight newborns.
Position patient in recumbent position in last trimester with right
hip elevated (not Trendelenburg).
If morning sickness is a problem, schedule an afternoon
appointment.
Give frequent breaks for urination, especially during the first
trimester.
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Nursing Safety Options to Consider for
Breast-Feeding Patients
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Take the medicine just prior to nursing.
Pump and store breast milk prior to
starting medicine.
Pump and dump breast milk until therapy
is completed.
Stop nursing.
Follow the FDA pregnancy categories to
determine whether or not the drug can be
given to a nursing mother.
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