- •Cardiotocography
- •Ultrasound examination
- •Self control questions.
- •3.5.2. Self control tests.
- •Gestosis
- •Oligoamnios
- •Anemia
- •Hydramnion
- •2. Identify aspects of medications that determine safety during lactation.
- •• A substance, organism, physical agents or deficiency state capable of inducing abnormal structure or function such as:
- •• Timing of exposure
- •• Developmental stage during exposure
- •• Maternal dose and duration
- •• Maternal pharmacokinetics
- •1. Recognize factors which determine drug passage across the placenta and into breast milk.
- •IV. FDA Pregnancy Categories
- •V. FDA Pregnancy Categories
- •VI. FDA Labeling Changes
- •VII. Drug Transfer to the Fetus
- •VIII. Drug Passage into Breast Milk
- •IX. Drug Transfer
- •XI. Fetal Drug Disposition
- •• 60 – 80% passes through liver, the rest travels through ductus venosus to heart and brain
- •XII. Drug Concentration in Breast Milk
- •XIII. Calculating Drug Exposure
- •Infant dose/maternal dose using mg/kg/d
- •XIV. Neonatal Factors
- •XV. Infant Adverse Effects
- •XVI. Anti-infectives
- •XVII. Penicillins
- •XVIII. Cephalosporins
- •• Category B/C/B in pregnancy
- •XXIII. Sulfonamides
- •XXV. Miscellaneous Antibiotics
- •XXVI. Miscellaneous Antibiotics
- •XXVII. Miscellaneous Antibiotics
- •XXVIII. Miscellaneous Antibiotics
- •Antiretrovirals/NNRTI (delavirdine, efavirenz, nevirapine)
- •Antiretrovirals/PI
- •Antiretrovirals/Fusion Inhibitor (enfuvirtide)
- •Antiretroviral Combinations
- •Antifungals/Echinocandins (anidulofungin, caspofungin, micafungin)
- •Antifungals/Polyenes
- •XXXII. Migraine Headache Therapy
- •Triptans (5-HT1 agonists)
- •Triptans (5-HT1 agonists)
- •Butalbital and Caffeine
- •Dichloralphenazone and Isometheptene (Midrin)
- •Questions to Ask:
- •Questions to Ask:
- •Considerations in Breastfeeding:
- •• Withhold or delay therapy if possible
XXIII. Sulfonamides
•Pregnancy Category C
–Readily cross the placenta
–Concerns of use at term
•Lactation
–Excreted into breastmilk in low levels
–Use should be avoided in premature infants
XXIV. Tetracyclines
(doxycycline, minocycline, tetracycline)
•Pregnancy Category D
–Can cause problems with teeth and bone and other defects/effects
–Have been linked to maternal liver toxicity
•Lactation
–Compatible with breastfeeding
–Serum levels in infants undetectable
XXV. Miscellaneous Antibiotics
•Aztreonam
–Pregnancy Category B, likely safe in pregnancy, little human data
–Lactation – Compatible per AAP
•Clindamycin
–Pregnancy Category B, commonly used
–Lactation – Compatible per AAP
XXVI. Miscellaneous Antibiotics
•Linezolid
–Pregnancy Category C, no human data available
–Lactation – unknown, myelosuppression in animals
•Metronidazole
–Pregnancy Category B, carcinogenic in animals, avoid in 1st trimester if possible
–Lactation – hold feeds for 12-24hrs afterward