Chonnam Med J.
2001 Jun;37(2):85-97.
Optimal Drug Therapy During Pregnancy and Lactation
- Affiliations
-
- 1Department of Pharmacology, Chonnam National University Medical School, Kwangju, Korea.
- 2Research Institute of Medical Science, Chonnam National University, Kwangju, Korea.
Abstract
- Although there are various risks of adverse drug reactions like teratogenesis, etc. in treating specific diseases during pregnancy and lactation, physicians have many difficulties to execute the optimal drug therapy during these periods mainly because reliable data such as controlled drug studies of safety and efficacy in pregnant women is quite lacking due to the difficulties in conducting studies in pregnant women. Drug therapy in pregnancy and lactation is recommended only in cases that benefits of drug usage clearly outweighs potential risks to the fetus, pregnant or lactating women. In order to aid physicians to conduct the optimal drug therapy on pregnant and lactating women, this article describes the pharmacokinetic characteristics during pregnancy and lactation, adverse drug reactions in each periods of pregnancy, and other recent informations on clinical pharmacology related with drug therapy in these periods. The typical pharmacokinetic changes in pregnant women are plasma volume increase, decrease in albumin concentration, increase in glomerular filtration rate, and changes of drug-meta-bolizing enzymes and gastrointestinal motilities. The placenta and fetus also manifest the characteristic pharmacokinetic features. Teratogenesis by drugs is possible, if the human fetus is exposed to certain drugs with risks of causing teratogenic abnormalities between approximately 18 and 55 days following conception, during which the fetus undergoes organogenesis. Unlike the structural abnomalities like teratogenesis during the early stages of pregnancy, the functional abnormalities are the major adverse drug reactions during the later stages of pregnancy. Some drug therapy and adverse drug reactions according to the periods of pregnancy are briefly described. Categorizing systems of drugs based on their potential risks during pregnancy and lactation, which are used in USA, are also introduced. Principles of optimal drug therapy and drug use consultation during pregnancy and lactation are finally discussed.
