Drugs in Pregnancy

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Teratogenicity and Breast Feeding

The use of drugs during pregnancy and lactation is controversial and pre- sents great challenge to clinicians. The use of drugs during pregnancy is of special concern because of medi- cal, social, and legal implications. Congenital anomalies or birth defects are among the leading causes of infant morbidity and mortality.

Drugs in Pregnancy

Congenital malformation is defined as structural abnormalities of prenatal origin that are present at birth that seriously interfere with viability or physical well being.

Some drug induced defects relate to changes in functions or conditions that are not structural abnormalities e.g. mental or physical growth retardation, CNS depression, deafness, tumours or biochemical changes. Congenital anomalies i.e. birth defects, include both these toxicities and structural changes.

The prevalence of major malfor- mations is 3% and similar rate is dis- covered in months or years following birth. Anomalies of internal organs e.g. heart, kidneys, reproductive system and GIT may go unrecognized for years or discovered only at autopsy.

Minor malformations are not included in this percentage e.g. umbilical and inguinal hernias, phimosis, external ear, cryptorchidism, hydrocele, and

angiomas. The malformations of little medical significance are not included in incidence data even if they have emotional cosmetic effects. Approximately 6 newborn infants in every
100 will be with a major malformation, but only 3 of these will be identified at birth or in the neonatal period.
To these, one can add an unknown number of infants with mental and
physical growth retardation and those of minor structural anomalies.

Drug consumption during pregnancy

Many drugs are regularly consumed during gestation including some that are potential teratogens. Women consume an average of 5 to 9 medications. Vitamins and iron supplements are the most commonly used followed by anti-infective and analgesic antipyretic anti-inflammatory agents.