EFFECTS OF MATERNAL DRUGS ON THE FETUS

INTRODUCTION
In most instances the risk of adverse fetal effects from drugs taken by the
mother is not known. Properly designed scientific studies cannot be performed
ethically because they would require that women take drugs when they did not need
them in order to eliminate the confound effect of maternal disease or disorder.
When problem occurs in association with a history of maternal drug ingestion,
any other of following can be the cause :
1. he drug itself
!. he maternal disease state. "g. #iabetes, maternal infection or
environmental to$icity.
%. Pree$istent physical disorders. "g. &'mitotic bands( producing deformation
and distruption.
). *nrecogni+ed illness. "g. viral illness
,. 'n already omalous pregnancy may have produced symptoms that led to
drug ingestion.
-. .enetic aberration
/. 0pontaneous malformation rate of ! 1 %2 a still birth risk of 12 and a
spontaneous abortion rate of 132.
4. *nknown cause.
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PREGNANCY RISK CATEGORY
Category A 1 5ontrolled studies show no risk, adequate, well controlled studies in
pregnant women have not demonstrated a risk to the fetus in the first
trimester of pregnancy and there is no evidence of risk in later
trimester.
Category B 6 7o evidence of risk in humans. 'nimals studies have not
demonstrated a risk to the fetus but there are no adequate studies in
pregnant women or animal studies have shown an adverse effect, but
adequate studies in pregnant women have not demonstrated a risk to
the fetus during the first trimester of pregnancy and there is no
evidence of risk in later trimesters.
Category C 6 8isk cannot be rule out. 'nimal studies have shown an adverse affect
on the fetus, but there are no adequate studies in humans or there
are no animal reproduction studies and no adequate studies in
humans.
Category D 6 here is evidence of human fetal risk but the potential benefits from
the use of the drug in pregnant women may be acceptable despite its
potential risks.
Category X 6 5ontraindicated in pregnancy studies in animals or humans
demonstrate fetal abnormalities or adverse reaction reports indicate
evidence of fetal risk. he risk of use in pregnant women clearly out
weighs any possible benefit to the patient
2
Class Drg
R!s"
#ategory
P$ar%a#o"!&et!#'re(orte) e**e#ts o& *ets
'nalgesics In9.'cetaminophan : 5rosses placenta
7ot implicated as a te$atogen when used within dosing
recommendations and for short term use.
5ontinuous use or high to$icdosages have been assiated
with maternal anaemia, maternal hepatorenal failure,
maternal death, fetal hepatorenal failure, fetal death.
'spirin 5I# full dose
aspirin %
rd

trimester
7o fetal or new born effects have been shown with low
dose aspirin therapy.
;ull dose aspirin associated with delayed onset and
prolonged duration of labour
buprofen #
8educed amniotic fluid volume
Pulmonary hyper tension in the new born
'nesthetic agents
used during labour
and delivery
In9 'nalgesics
In9 'ntropine
&'nesthetic
premedication(
5 Parasympatholytic anticholinergic
8apidly crosses the placenta with fetal uptake
<ay directly affect fetal heart rate.
In9 =etamine : When used high doses increase in maternal blood pressure,
increased uterine tone and contractions.
7ew born depression
Increased muscle tone in the infant
>ower doses no effect.
In9 propofol : #ecreased 'pgar scores and decreased neuro behavioural
scores compared with infants born by spontaneous vaginal
delivery.
In9 hiopental 5 'P.'8 scores decreased and neuro behavioural scores also
1
Class Drg
R!s"
#ategory
P$ar%a#o"!&et!#'re(orte) e**e#ts o& *ets
decreased
'nticoagulants In9 ?eparin 5 #oes not cross the placenta
<aternal complications include bleeding
In9 warfarin #:@<
5entral Aralanticogulenta
7ervous system defects
0till birth
Prematurity, hemorrhage
0ei+ures, hearing loss
5ongenital heart diseases
#eath
'nti convulsants In9 5arpama+epine # 5rosses the placenta
5raniofacial defects, spina bifids
#evelopmental delay
In9 Phenobar bitone # 5ardiovascular defects, clefflip and cleff palate,
impaired cognitive development
In9 phenytoin # :roud nasal bridge, wide fontanelle, low set hairline,
small or absent nails,
Impaired growth, congential heart defects, mental
deficiency
0yrup valporic acid # 7eural tube defect, hypospadisis, cogenital heart
diseases, delayed growth and development
'nti infectives 'mtebicides
In9. metronida+ole
: 7o significant risk to the fetus
In9 'minoglycosides 5,:,#,< 8apidly crosses the placenta.
2
Class Drg
R!s"
#ategory
P$ar%a#o"!&et!#'re(orte) e**e#ts o& *ets
In9. 'mikacin
7ot considered a teratogen theoretical risk of
ototo$icity
In9. .entamicin 5 7euromuscular weakness, ototo$icity
'ntibiotics general In9. clindamycin : 5rosses the placenta
7o considered a teratogen
In9. "rythnomycin : 5rosses the placenta, but in very low concentration
'ntivital In9. 'yclovir : 7o side effects
In9. penicilins : <any pencilin derivatives have been shown to readly
cross the placenta, as a class of drug, penicillins not
considered teratogenic
In9. etracyclines : <aternal hepatoto$icity
Bellow staining of bones
Possible risk for minor fetal anomalies
'ntimalarials In9. 5hloroquine 5 5rosses the placenta
0mall birth defects could not be e$cluded
'nti parasitics . <ebenda+ole 5 7o strong evidence to suggest association with
congenital malformation.
'nti tuberculosis . "thambutol
. "thionamide
. Isonila+id
:
5
5
5rossess placenta, 7o reports of associate congenital
defects
Increased congenital anomalies
3
Class Drg
R!s"
#ategory
P$ar%a#o"!&et!#'re(orte) e**e#ts o& *ets
. 8ifampicin 5 ?aemorrhagic disease of the new born
#eformaties no, but hemorrgeic disease of the new
born
. 0treptomycin #i$ Atoto$icity
5ardiovascular '5" Inhibitors
"g. 5aptopril
"nalapril
5
#6infused in
!
nd
of %
rd

irimesters
;etal hypotension, reduced renal blood flow resulting
in anemia
8enal failure, pulmonary hypo plasia
7eonatal death
'ntiarrythmic agents
In9. >ignocaine
: 8apidly crosses the placenta
>imited significant risk to the fetus
:etablockers . Propranolol 5 Intra uterine growth restriction
?ypoglycemia, bradycardia
5alcium channel
blockers
. #il+aem
. Cerapamil
5 Increased risk of cardiovascular effects
5rosses the placenta
?as not been linked to congenital anomalies
#igo$in 5 ransplacental passage and uptake by the fetus
increasing with advancing gestational age.
7eonatal death has been reported after maternal
overdose.
#iuretics In9. ;urosemide 5 and #if
used in PI?
?ypospadiases
. 0pironolactone 5 Potassium 1 conserving diuretic aldosterone
4
Class Drg
R!s"
#ategory
P$ar%a#o"!&et!#'re(orte) e**e#ts o& *ets
antagonist in the distal concluded renal tubule.
#ecrease placental perfusion
Ather
antihypertensives
. #iar+o$ide 5 5rosses the placenta
Induced hyper tension due to fetal urine production
8isk for hyposapadias
#rug of habit or
abuse
In9. 5affeine :
5rosses the placenta
7o association with congenital anomalies
<oderate to heavy consumption associated with
increased risk of late 1
st
and !
nd
trimester
spontaneous abortion
7ew born cardiac arrhythmias have been described
possibly related to caffine withdrawal
.astrointestinal In9. 8enitidine : >ike renitidine does not shown antiadrehergic
activities in animal or human studies
In9. <etoclopramide : *sed in pregnancy for antiemetic effect and to
decrease gastric emptying time crosses the placenta
at term. 7o linkage to fetal to$icity or congenital
malformations
Casodilators In9. 7itroglycerin :, 5 :radycardia and loss of beat to beat variability in
response to a reduction in maternal blood pressure,
these fetal cardiac effects are apparently of no
lasting clinical significance.
5
Class Drg
R!s"
#ategory
P$ar%a#o"!&et!#'re(orte) e**e#ts o& *ets
5hemotherapy
agents
In9. #actinomycin 5 >imited reports of use during pregnancy
Ane report of si$ e$posed pregnancies did not reveal
an association with congenital anomalies
In9 Procara+ine # 'ssociated with congenital abnormalities may
produce gonatal dysfunction
In9 Cincaalicabids # 'ntimitotic
<ay produce gonatal dysfunction
'ssociated with chromosomal abnormalities
:en+odia+epines . 'lpra+olam # 7o linkage to congenited anomalies with alpra+olam,
however reported associations with other drugs in
this class
hyroid
medications
>evothryro$ine ' <ost documented to readily cross the placenta with
fetal accumulation of levels
6
SUMMARY
:ecause of tremendous variability in maternal elimination and drug disposition
characteristics, very little predictabilities come from knowing the maternal dose.
BIBLIOGRAPHY
1. Dohn .P 5loherts, &!33)(, E<anual of 7eonatal 5areE, ,
th
edition, >ippincott and
Williams Publishers Pvt. >td., :altimore, >ondon, Page no: /)F 6 /-4.
!. .uha, &1FF/(, E<anual of Practical 7ew :orn 5areE, !
nd
edition, D.P :rothers
<edical Publishers Pvt. >td, #elhi, Page no: 1-3 6 1-!.
%. 5I<0 e$t :ook of <edical #rugs.
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