Therapy in Pregnancy

In pregnancy, the total body fluid increases by 8 liters, of which 80% is extracellular water. The plasma volume increases by 40 to 50% (1.2 to 1.5 liters). Consequently, in pregnancy there is an increase in plasma volume, decrease in plasma protein levels, increase in total and extracellular water compartments, and increase in total body fat. These alterations may change the volume of distribution of most drugs. 

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Repke, J.T. and Berger, N.G. (1984) Electroconvulsive therapy in pregnancy. Obstet Gynecol 63 39S-41S. 

Persson B, Swahn ML, Hjertberg R, Hanson U, Nord E, Nordlander E, Hansson LO. Insulin lispro therapy in pregnancies complicated by type 1 diabetes mellitus. Diabetes Res Clin Pract 2002 58(2) 115-21. 

Antiepileptic Drug Therapy in Pregnancy I Gestation-Induced Effects on AED Pharmacokinetics... 

Antiepileptic Drug Therapy in Pregnancy II Fetal and Neonatal Exposure... 

Wagenvoort AM, van Vugt JM, Sobotka M, van Geijn HP. Topical timolol therapy in pregnancy is it safe for the fetus Teratology 1998 58(6) 258-62. 

Abbi M, Kriplani A, Singh B. Preterm labor and accidental hemorrhage after disopyramide therapy in pregnancy. A case report. J Reprod Med 1999 44(7) 653-5. 

Schoenfeld A, Freedman S, Hod M, Ovadia Y. Antagonism of antihypertensive drug therapy in pregnancy by indomethacin Am J Obstet Gynecol 1989 161(5) 1204-5. 

Ostensen M. Disease specific problems related to drng therapy in pregnancy. Lupus 2004 13(9) 746-50. 

Strangles HT, Arnolds CW. 1992. Environment and pregnancy. In Elkayam U, Galbraith RM, Gall SA, et al., eds. Principles and practice of medical therapy in pregnancy. 2nd ed. Norwalk, CT Appleton Lange, 89-105. 

Drug therapy in pregnancy presents a vexing dilemma. When drugs are used during pregnancy, risks apply to the fetus as well as the mother. ... 

Magnesium plays an important role in the transmission of nerve impulses. It is also important in the activity of many enzyme reactions, for example carbohydrate metabolism. Magnesium sulfate is used as replacement therapy in hypomagnesemia Magnesium sulfate (MgS04) is used in die prevention and control of seizures in obstetric patients with pregnancy-induced hypertension (PIH, also referred to as eclampsia and preeclampsia). It may also be added to TPN mixtures. 

A recent consensus panel recommends calcium- or magnesium-containing antacids as first-line therapies for heartburn in pregnancy.21 This recommendation was based on the added benefit of calcium and magnesium supplementation. Avoid antacids containing aluminum hydroxide owing to associations with fetal neurotoxicity.22... 

Treat conditions during pregnancy that pose a risk to the fetus or neonate. Choose therapy as recommended by guidelines or those with the longest history of safe use in pregnancy. 

Pregnancy Agents contraindicated in pregnancy include podofilox, fluorouracil, and podophyllin. Imiquimod is not approved for use in pregnancy, although it has been considered after signed consent has been obtained. Bichloroacetic and trichloroacetic acid have been used without problems. Ablative therapy is also a viable option. 

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