DRUGS ASSOCIATED WITH THE FEMALE REPRODUCTIVE

CYCLE

Pregnancy and Preterm Labor

General Adverse Effects of Selected Substances Commonly Abused During

Pregnancy
Substance Maternal Effects Fetal Effects
Alcohol (high risk: 6oz Increased risk for Fetal Alcohol
or more) spontaneous abortion Syndrome: mild to
(2-4 times) moderate mental
retardation, altered
facial features, growth
retardation, low birth
weight, small head
circumference,
hypotonia, and poor
motor coordination.
Caffeine 2 cups increase Excess consumption
epinephrine (>6-8 cups/day) likely
concentrations after 30 toxic to embryo. No
min and decrease evidence of
intevillous blodd flow teratogenicity.
with potential for
spontaneous abortion.
Cocaine 48-h clearance via 4-5d clearance time via
urine. Increased urine of newborn
incidence of because of liver
spontaneous abortion immaturity and lack of
in first trimester. cholineasterase.
Continued use of Intrauterine growth
sporadic use related to retardation, decreased
premature delivery and head circumference,
abruptio placenta intrauterine cerebral
secondary to placental infarction. No true
vasoconstriction and withdrawal syndrome
hyperextension. but increased
irritability,
hyperreflexia and
tremulousness.
Heroin First trimester Neonatal meconium
spontaneous abortion, aspiration syndrome;
premature delivery, decreased weight and
inadequate maternal length through
calorie and protein postnatal month 9;
intake. impaired interactive
abilities; inconsistent
behavioural responses;
 increased
tremulousness and
irritability.
Marijuana Heavy use (5 or more No higher incidence of
marijuana cigarettes serious birth defects
per week); shortened caused solely by
gestation (<37 wks) marijuana. Higher
may hasten delivery incidence of meconium
through uterine passage during labor.
stimulation.
Tobacco/nicotine Degenerative placental Short stature, smaller
lesions with areas of head circumference
poor oxygen exchange; and arm
higher incidence of circumferences; no
abruption placenta, increase in mortality
placenta previa, rate or congenital
vaginal blleding during anomalies; increased
pregnancy, possible respiratory infections
PROM; possible beyond the perinatal
amnionitis; less likely period.
to choose to
breastfeed.
Methadone If taken before Smaller weight and
pregnancy, pregnancy length through
will need to slow postnatal month 9;
detoxification during smaller head
pregnancy and circumference;
decrease dose 5 mg withdrawal-induced
every 2 wk. Do not fetal distress if mother
detoxify before week detoxifies after week
14 of gestation 32 of gestation.
because of increased
risk of spontaneous
abortion.
Tranquilizers Dose-dependent; toxic Benzodiazepine
reactions include (diazepam [valium])
ataxia, syncope vertigo use in first trimester
and drowsiness control associated with oral
of acute eclampic clefts or other
seizures during labor. anomalies. Chronic
third trimester or labor
exposure in high doses
associated with
hypotonia,
hypothermia,
hyperbilirubinimia and
poor sucking reflex.
 Therapeutic Drug and Herbal Use in Pregnancy
IRON
During pregnancy approximately twice the normal amount of iron is
needed to meet fetal and maternal daily requirements. Supplementation
of iron is not generally necessary until the second trimester. Although a
normal diet generally provides the 18mg recommended daily allowance
(RDA) of iron for non-pregnant clients, non-anemic pregnant women are
usually instructed to supplement using a dosage that provides 60mg of
elemental iron; anemic clients should receive 120mg of elemental iron.
Adverse Reactions:
• Nausea
• Constipation
• Black tarry stool
• Gastrointestinal irritation
• Epigastric pain
• Vomiting
• Diarrhea

FOLIC ACID
Folic acid supplementation as part of pre-conception planning improves
the outcome of pregnancy. During pregnancy folic acid is needed in
increased amounts. Folic acid deficiency early in pregnancy can result in
spontaneous abortion or birth defects (failure of the embryonic neural
tube to close properly, leading to spina bifida or skull and brain
malformations). Deficiency of folic acid may also contribute to premature
birth, low birth weight and premature separation of the placenta. The RDA
of folic acid in the non-pregnant client is 180mcg.
Adverse Effects:
• Allergic bronchospasm
• Rash
• Pruritus
• Erythema
• General malaise
• May cause urine to turn more intensely yellow

MULTIPLE VITAMINS
Prenatal vitamin preparation routinely is recommended for pregnant
client. These preparations generally supply vitamins A, D, E, C, B complex
(B1, B2, B3, B5, B6), B12, iron, calcium and other minerals. The role of
prenatal vitamins in preventing congenital defects (e.g., cleft lip or palate,
limb defects) remains undetermined.

Drugs for Minor Discomforts of Pregnancy

The average prenatal client uses three drugs during pregnancy, two of
which are vitamin and mineral supplements. Drug ingestion is most likely
during the first and the third trimesters, when the minor discomforts of
pregnancy tend to be most bothersome. Many of the complaints
associated with pregnancy will be related to the gastrointestinal tract
(nausea and vomiting, heartburn, constipation).

Drugs for Management of Nausea and Vomiting during Pregnancy

(Recommendation not implied)

Generic (Brand) Route and Dosage Uses and Considerations

Antihistamines Mechanism of action: Considered
Meclizine PO: 20-50mg/d mild; available as OTC drug. Site
(Antivert) of action: labyrinth and CNS.
Blocks CTZ, which act on
vomiting center.
Side Effects: Dizziness,
drowsiness, dry mouth and nose,
blurred vision, diplopia, urinary
retention, urticarial, rash and
headache. Cardiovascular effects
can include hypotension,
palpitations and tachycardia.
Contraindications:
Hypersensitivity to drug or any
component.
Pregnancy Category: B;
metabolized in liver ad excreted
unchanged in feces and as
metabolites in urine. T1/2: 6 h;
onset: 1-2 h; duration: 8-24 h
Phenothiazines Mechanism of action: Blocks
Promethazine PO, IV, IM, PR: postsynaptic mesolimbic
(Phenergan) 12.5-25mg dopaminergic receptors in the
q4-6 h prn brain; exhibits a strong alpha-
adrenergic blocking effect and
depresses the release of
 hypothalamic and hypophyseal
hormones; competes with
histamine for the H1 receptor.
Adverse Reactions: Dizziness,
drowsiness, excitation, fatigue,
insomnia, photosensitivity
reactions, nausea and vomiting
and constipation.
Contraindications:
Hypersensitivity to drug or any
component of the formulation;
CNS depression or coma.
Pregnancy Category: C, t1/2: 9-12
h; onset: IM 20 min, IV 3-5min,
duration 2-6h
Anticholinergics Mechanism of action:
Scopolamine PO, IM, IV, subQ: Antagonizes histamine and
(scopace) o.3-o.65 mg serotonin.
q4-6h Adverse Effects: Confusion,
drowsiness, headache, fatigue,
dry skin, constipation, vomiting,
bloated feeling. Cardiovascular
side effects include orthostatic
hypotension, ventricular
fibrillation, tachycardia,
palpitations.
Contraindications:
Hypersensitivity to the active
ingredient or any component of
the formulation. Narrow-angle
glaucoma, acute haemorrhage, GI
or GU obstruction, tachycardia
secondary to cardiac
insufficiency and myasthenia
gravis
Pregnancy Category: C: onset IM
0.5-1 h, duration 4-6 h
Prokinetic Agents Mechanism of action: Blocks
Metoclopramide PO: 10-15 mg QID dopamine receptors in the
(reglan) 30 min -7 h a.c chemoreceptor trigger zone of
the CNS, causes enhanced
motility and accelerated gastric
emptying without stimulating
secretions.
 Adverse Effects: Restlessness,
drowsiness, diarrhea, weakness,
insomnia
Contraindications:
Hypersensitivity to the
metoclopramide or any
component of the formulation. GI
obstruction, perforation or
haemorrhage;
pheochromocytoma; history of
seizure disorder.
Pregnancy Category: B; t1/2 4-7;
onset 0.5-1h; duration 1-2h.
Other Mechanism of Action: Obscure
Trimethobenzami 200 mg rectally action; may be mediated through
de q6-8h CTZ. Does not inhibit direct
(tigan, T-Gen) impulse to vomiting center.
Chemically classified as an
ethanolamine derivative.
Side Effects: Drowsiness,
headache, blurred vision,
diarrhea, depression,
hypotension, muscle cramps,
allergic reactions and
extrapyramidal symptoms; blood
dyscrasias

Over-the-Counter Antacids Commonly Used in Pregnancy

Generic (Brand) Route and Dosage Uses and Considerations

Aluminium A: PO: As desired Contains aluminium hydroxide
hydroxide gel (320 mg) per 300 mg tablet
(amphojel) or per 5 ml; ANC 8; contains
saccharin and sorbitol. OTC
preparation.
Use: For heartburn secondary to
reflux
Side Effects: Constipation
Adverse Reactions: Dehydration,
hypophosphatemia (long-term
use), GI obstruction
Drug Interactions: Decreased
 effects with tetracycline,
phenothiazine, benzodiazepines,
isoniazid, digoxin; follow dose
with water
Magnesium 40 to 125 mg PO Mylanta Extra Stregth Liquid:
hydroxide and q.i.d after meals Each 5 ml contains aluminium
aluminium and at bedtime; up hydroxide (400 mg), simethicone
hydroxide with to 500 mg/d (40 mg), parabens, saccharin,
simethicone sorbitol and sodium (2 mg) OTC
(Mylanta extra Almacone Tablets: Each tablets
strength Liquid, contain aluminium hydroxide
Amacone) (200 mg), magnesium hydroxide
(200 mg), simethicone (20 mg)
OTC. Tablets must be thoroughly
chewed.
Use: Same as above with addition
of anti-flatulence action.