Pregnancy monitoring recommendations

Supplementation of iodine during pregnancy is recommended to eliminate iodine-deficiency diseases, especially cretinism in iodine deficiency areas. However, for pregnant women who lived in iodine-excess areas or were exposed to iodine-containing medication during pregnancy, the total iodine intake and their TH status should be closely monitored. 

Penicillamine (29) can be effective in patients with refractory RA and may delay progression of erosions, but adverse effects limit its useflilness. The most common adverse side effects for penicillamine are similar to those of parenteral gold therapy, ie, pmritic rash, protein uria, leukopenia, and thrombocytopenia. Decreased or altered taste sensation is a relatively common adverse effect for penicillamine. A monthly blood count, platelet count, and urinalysis are recommended, and also hepatic and renal function should be periodically monitored. Penicillamine is teratogenic and should not be used during pregnancy. 

Carbamazepine Manufacturer recommends CBC and platelets (and possibly reticulocyte counts and serum iron) at baseline, and that subsequent monitoring be individualized by the clinician (e.g., CBC, platelet counts, and liver function tests every 2 weeks during the first 2 months of treatment, then every 3 months if normal). Monitor more closely if patient exhibits hematologic or hepatic abnormalities or if the patient is receiving a myelotoxic drug discontinue if platelets are less than 100,000/mm3, if white blood cell (WBC) count is less than 3,000/mm3 or if there is evidence of bone marrow suppression or liver dysfunction. Serum electrolyte levels should be monitored in the elderly or those at risk for hyponatremia. Carbamazepine interferes with some pregnancy tests. 

The drug may cause liver toxicity and is contraindicated in patients with preexisting liver disease. The ALT should be monitored monthly initially and periodically thereafter. Leflunomide may cause bone marrow toxicity a complete blood cell count with platelets is recommended monthly for 6 months and then every 6 to 8 weeks thereafter. It is teratogenic and should be avoided during pregnancy. 

Lithium clearance increases by 50% to 100% during pregnancy. Serum levels should be monitored monthly during pregnancy and weekly the week before delivery. At delivery, a dose reduction to prepregnancy doses and adequate hydration are recommended. 

It is thought that progesterone derivatives have the least effect on liver metabolism and provide a reliable assurance against pregnancy. Hepatic disturbance is not considered a contraindication to progesterone therapy [2], but in practice the method cannot be recommended in active viral hepatitis or severe decompensated cirrhosis [4], Viral hepatitis carriers can use the POC methods in any circumstance [30]. When patients with acute hepatitis recover fully and LFTs have returned to normal, the full spectrum of contraceptive choices can be considered however, such patients should be monitored carefully during the initiation period [2]. 

Long-term UFH therapy has been linked to significant bone loss and osteoporosis, requires multiple daily injections, and mnst be monitored frequently (every 1 to 2 weeks) throughout pregnancy. Becanse of these limitations, many experts recommend the use of LMWHs over UFH throughout pregnancy... 

Routine serum level monitoring of medications (when applicable) is recommended during pregnancy, with dosage adjustments if indicated... 

The coneurrent use of intravenous diazoxide and hydralazine should be undertaken extremely eautiously with thorough monitoring. Note that the doses of diazoxide used in the above reports were frequently higher than those eurrently recommended for hypertensive erises. In addition, there are now many more options available for the treatment of very severe hypertension, and the BNF in the UK considers intravenous diazoxide to be one of the less suitable choices. Moreover, diazoxide was frequently associated with clinically important hypotension when used in pregnancy, and is not considered a good choice in this situation. ... 

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