Major Teratogenic Effects on Pregnancy

Major Teratogenic Effects on Pregnancy

Drugs which should not be used in pregnancy except in except in exceptional circumstances can be regarded as falling in this class. They are few in number. Thalidomide is not longer available. Its mode of actins was probably a combination of impairment of folic acid, riboflavin and glutamic acid metabolism, together with effects on the primordial neurons, particularly those related to the affected limbs.

 Cytotoxic Drugs –in Pregnancy

These are all potentially teratogenic in the first trimester, with their specific action on rapidly dividing cells. Some of them have proved less dangerous than was at first thought. Of the alkyl ting agents, cyclophosphamide and chlorambucil have been reported to cause major abnormalities, though successful pregnancies have also been recorded. With busulphan the abnormality rate is about 10%. Of the antimetabolities, the antifolate agents’ aminopterin and methotraxate cause abortion in 50% of women and a proportion of the surviving fetuses are grossly abnormal. In contrast, many women have had normal babies after taking 6- mercaptopurine throughout pregnancy and azathioprine seems to be benign in humans. There are some grounds for avoiding cytarabine, which affects the developing brain in animal experiments, and the antimitotic alkaloids such as actnomcin with their widespread toxic effects on mucleic acid synthesis, but there is no clear evidence of these effects in humans. Whilst data are limited, none of the cytotoxic agents has been demonstrated to be teratogenic in humans when given in the second and third trimesters.

Teracycline Drugs –in Pregnancy

 The teracyclines pass through to the fetus, chelate with calcium ortho-phosphate in the developing deciduous teeth and cause hypoplasia and brown Staining due to an oxidation product. In the third trimester, developing secondary dentition can also be affected.

Radioactive isotopes –in Pregnancy

Radioactive ¹³¹ I can pass through to the fetus and cause neonatal goiter and bypothroidism. Technetium can be used for radioactive scans –its radioactivity is minimal and its half-life short. ³² P may localize in the fetal bones and perhaps affect fetal bone marrow activity deleteriously.

Role of progesterone and hCG Treatment in Early Pregnancy

Role of progesterone and hCG Treatment in Early Pregnancy

Once implantation occurs, the pregnancy hormone Human chorionic Gonadotropin (HCG) will develop and begin to rise.

When the egg is fertilized, the corpus luteum will continue to produce progesterone for the developing pregnancy until the placenta takes over around ten weeks. Progesterone is the hormone that helps maintain the pregnancy until birth. Sometimes, the failure of the corpus luteum to adequately support the pregnancy with progesterone can result in an early pregnancy loss. Progesterone inhibits immune responses, decreases prostaglandins, and prevents the onset of uterine contractions.

With both hcg and progesterone levels, it is not he single value that can predict a healthy pregnancy out come. It is more important to evaluate two different values to see if the numbers are increasing. Levels of hCG should be increasing by at least 60% every 2-3 days, but ideally doubling every 48-72 hours. Progesterone levels rise much differently than hCG levels, with an average of 13-ng/ml every couple days until they reach their peak for that trimester. In situation when there is a concern of an ectopic pregnancy or miscarriage, hcg levels will often start out normal, but will not show a significant increase or will stop rising all together, and progesterone levels will be low from the beginning.

Efficacy and Safety of Progestogens as a Preventative Therapy against Miscarriage

The meta-analysis of all women, regardless of gravidity and number of previous miscarriages, showed no statistically significant difference in the risk of miscarriage between progestogen and placebo or no treatment groups and no statistically significant difference in the incidence of adverse effect in either mother or baby.

In a subgroup analysis of three trials involving women who had recurrent showed a statistically significant decrease in miscarriage rate compared to placebo or no treatment. No Statistically significant differences were found between the route of administration of progestogen versus placebo or no treatment.

Authors’ personal opinion is that there is evidence to support the routine use of progestogen to prevent miscarriage in early to mid pregnancy in those patients who have a history or diagnose to have luteal phase deficiency. However, further trials in women with a history of recurrent miscarriage may be warranted, given the trend for improved live birth rates in these women and the finding of no statistically significant difference between treatment and control groups in rates of adverse effects suffered by either mother or baby in the available evidence.

After Pregnancy - Drugs Used During Breastfeeding- Effects on Newborn Baby

After Pregnancy - Drugs Used During Breastfeeding- Effects on Newborn Baby

Before prescribing any medication to a lactating mother pediatrician should consider the following conditions:

a.       Is drug therapy absolutely necessary

b.      Whether infant has got ability to metabolize the medication

c.       How far we can minimize drug exposure to infant

d.      The pharmacokinetics of the drug

e.      Will the drug interact with the medication the infant is prescribed, whether the drug may have adverse effect in the nursing infants and lastly

f.        To choose the safest drug as far as possible

Types of Drugs Prescribed

Cytotoxic Drug- after Pregnancy

Cyclophosphamide, cyclosporine, doxorubicin and methotrexate, etc. were thought to interfere with cellular metabolism in nursing infants. Immune-suppression, and neutropenia may cause in the nursing infant Effects of growth and carcinogenesis are not known.

Drug of Abuse- After Pregnancy

Amphetamine, cocaine, heroin, marijunana, phencyclidine may lead to poor sleeping and irritability- vomiting, diarrhea, tremors, seizures, restlessness, poor feeding, decreased weight gain in infants and possible increased respiratory illness in the infants.

Psychotropic Drugs- After Pregnancy

Antianxiety, Antidepression, Antipsychotic drugs. These drugs usually appear in breast milk in low concentration leads to limited adverse effects in infants but its long-term effects although unknown but colic, irritability, feeding and sleep disorders and slow weight gain are reported with fluoxetine, chlorpromazine may lead to drowsiness and lethargy and declining development score has been reported.

Padioactive Compounds- After Pregnancy

Drug like copper 64, ¹³¹ I, etc. when prescribed in a nursing mother is better to be avoided. A short acting radio nucleotide may be appropriate. It is very much important to screen milk samples, to find out any radioactive drugs in the milk before receiving feeding.

Other Drugs- After Pregnancy

Amiodarone may cause hypothyroidism, cholraphenicol leads to idiosyncratic bone marrow suppression. Metronidazole and tinidazole are in vitro mutagenic agents. Clofazimine may increase skin pigmentation. Atenolol cause cyanosis and bradycardia. Phonobarbitone may lead to sedation, infantile spasm and methemogloginemia and ergotamine may cause vomiting, diarrhea and convulsions.

Homeopathy Drugs during Pregnancy

Homeopathy Drugs during Pregnancy

Homeopathy drug is ideal for women in their childbearing years as it is a gentle yet highly effective system of medicine. During pregnancy, some women will chose to live with the discomfort of minor complaints such as morning sickness or heartburn, rather than seek treatment because they are concerned about the possible side effects of orthodox medicines on their unborn child.

                Homeopathic medicines are safe for your growing baby because only a minute amount of the active ingredient is used in their preparation. They work by stimulating the body’s own healing powers. Good homeopathic treatment prior to conception can prepare you for a healthy pregnancy.

                By stimulating your vitality in pregnancy, homeopathic treatment will automatically benefit your baby and by staying as healthy as possible during pregnancy, you are giving your baby the ideal conditions in which to thrive. Many homeopaths will also offer advice on your diet and lifestyle to encourage a healthy pregnancy and birth.

                Physical and emotional changes during pregnancy may cause minor health problems such as nausea, mild urinary problems, diarrhea heartburn, anemia, varicose veins, backache, cramps, thrush or emotional distress. All these problems and more potentially complicated symptoms such as raised blood pressure can also be helped by professional homeopathic treatment.

Symptoms or pregnancy and its management

Morning Sickness

Symptoms of morning sickness include nausea, occasional vomiting and tiredness. Many women experience these symptoms during the first three months of pregnancy, usually in the morning when the stomach is empty, although it can occur at any time of the day.

                The traditional cure of eating a dry biscuit before getting out of bed worth trying. Avoid rich, fatty foods and try eating little and often if your nausea is worse when you are hungry.

                Seek professional help if your vomiting is sever for example, if you are unable to keep food down and are losing weight or if it persists past your third month. The following remedies are the more commonly indicated. 

Ipecac: Constant, nausea with empty belching and retching; vomiting is difficult and does not relieve your nausea.

Nux vomica: Nausea with retching that is relieved by vomiting; sour belching, indigestion and heartburn. You may have a sensation that there is a knot in your stomach. You feel bad-tempered.

Pulsatilla: Nausea (with little vomiting), worse after eating and drinking, better in the fresh air and for company. You feel weepy, moody and like to be comforted.

Sepia: Intermittent nausea which is worse in the mornings and worse for the smell or thought of food; there is an empty, sinking feeling in the stomach which is temporarily relieved by eating. You feel apathetic, exhausted and heavy but oddly are better for vigorous exercise. You are indifferent or cross with children and partner.

Constipation in pregnancy

Constipation is common in pregnancy as the hormones, which prepare the muscles of the pelvis for labor, can slow the digestive processes down. Adjusting your diet can often help mild constipation. Increase your intake of fluids, fruit and vegetables, go easy on wheat products and avoid iron tablets.

Any lasting change in your usual pattern of bowel movements should be assessed professionally but for a simple case of constipation in pregnancy, try one of the following remedies:

Bryonia: Large, hard, dry stools which are difficult to expel; often with a headache which is worse for the slightest movement. You are irritable.

Nux vomica: Frequent urging to pass a stool but in spite of straining, passing only small amounts each time; it feels as if some is left behind; piles that may itch and bleed.

Sepia: Straining to pass a large, hard stool; your stomach feels full and there is a sensation of a lump in the rectum that may remain even after passing a stool.

You feel generally sluggish.

Sulphur: Constipation with piles that itch and burn and are worse for heat. You are generally restless, thirsty and sensitive to the heat.

Diet in Pregnancy

During pregnancy, it is especially important to eat well, from a wide range of foods as this will provide you with the extra trace minerals and vitamins that you need. If you are on a restricted diet or wish to take vitamin and mineral supplements, then it is important that you do so on the advice of a competent medical practitioner, nutritionist or homeopath. Do avoid smoking and alcohol as these are bad for your health and that of your unborn child. Be sure to get plenty of rest and sleep and to exercise regularly. Yoga has been found to be particularly helpful during pregnancy. Increase your intake of iron-rich foods to keep up with an increase demand. Foods rich in iron include green, leafy vegetables, black strap molasses, dried peaches and apricots, beans and lentils, whole grains, seeds (sunflower and pumpkin), nuts and eggs.

                Vitamin C helps the body to absorb iron so take a fresh citrus drink with a meal to increase your iron intake. Avoid tea, especially with a meal, as it actually prevents iron from being absorbed. Iron tablets often have side effects such as constipation so ask your homeopath about safe homeopathic alternatives if you need extra iron and are not able to get it from your diet. 

                Many of the above foods are also high in frolic acid, an important trace mineral that helps with the absorption of iron and is essential for a health pregnancy.

 

Childbirth

There are effective remedies to help deal with possible problems during childbirth, such as a cervix which is slow to dilate, pain, excessive bleeding, retained placenta and other difficulties.

Aconite: The labor is too fast, the pins are very strong and you have a feeling of panic.

Arnica: An indispensable remedy that can be given from time to time during labor to help the muscles function properly, to relieve the over-exertion of labor and reduce the bruised feeling after delivery.

Kali phos: For simple exhaustion during labor, mental, emotional and physical.

Caullophyllum: For a difficult labor where the cervix is slow to dilate and the pains are strong but ineffective. You feel cold and trembly.

Pulsatilla: When contractions are irregular and weak, the cervix is slow to dilate and you feel miserable, clingy and tearful. You may talk about wanting to give up and go home.

Healing after the Childbirth

After the birth, you can use homeopathic remedies to speed up healing for yourself and your baby- This will help you to enjoy the whole experience more:

Aconite: For shock following the fear of the intensity of birth, in yourself, your partner or your baby.

Amica: To relieve soreness, bruising and after-pains. Also helpful for babies who are bruised. If you are still sore after three days, take Bellis perennis to help with bruising to deep muscle tissues.

Kali phos: For mental exhaustion after delivery, with headache, tiredness but too excited to sleep, especially in the first day or two after the birth.

Pulsatilla: Postnatal ‘blues’, especially when the milk comes in. You feel utterly miserable and burst into tears at the slightest thing but you feel much better for being comforted.

Breastfeeding

Homeopaths recognize that breast milk gives babies a good start in life, so do keep in touch with your midwife, breastfeeding counselor and/or your homeopath if you want to breastfeed but find it painful or difficult or both.

                One useful remedy is Phytolacca for sore, cracked nipples, which hurt when the baby nurses. It is also useful for breast infections where there are painful lumps in the breast.

Treating Babies

Babies tend to respond quickly to homeopathic treatment. There are homeopathic remedies to help relieve the pains of colic or teething, nappy rash and more serious problems. We advise you to consult one of our members if you want homeopathic treatment for your baby and see our leaflet “Homeopathy for Babies and Children.”

Alcohol in Pregnancy

Alcohol in Pregnancy

A syndrome of malformations found in infants born to mothers who have consumed alcohol during pregnancy. Abnormalities include structural malformations, growth restriction, and neurologic abnormalities including mental retardation. Estimates vary from 6 to 10000 births (1193) to 1-2 of 1000 births (2000).

Etiology and Pathogenesis

Alcohol consumption during pregnancy. There does not appear to be a lower limit of safety nor are the effects confined to one part of pregnancy. The severity of the effects does appear to be proportional to the amount and during of exposure. Clinically identifiable effects are generally not seen with sporadic exposures of less than 1 oz of alcohol per day. Although absolute safety cannot be assured even at this dose.

 

Alcohol used during pregnancy

Clinical characteristics

 Sign and Symptoms

Facial deformities- microcephaly, short palpebral fissures, flat midface, underdeveloped philtrum and thinned upper lip; low masal bridge, epicanthal folds, minor ear anomalies, small teeth with faulty enamel, foreshortened nose and micrognathia may also be seen; two or more abnormal facial features must be present to make the diagnosis.

Cardiac Malformations – these include the following:

a.       Deformities of joints, limbs, and fingers vision difficulties including nearsightedness.

b.      Intrauterine and extra uterine growth restriction.

c.       Mental retardation and developmental abnormalities, brain and spinal defects.

d.      Abnormal behavior such as short attention span, hyperactivity, poor impulse control, extreme nervousness, and anxiety.

 

Diagnostic approach

Differential Diagnosis

Other chromosomal or congenital syndromes.

Associated conditions: Maternal- other substance abuse sexually transmitted disease. Fetal- dental caries, cardiac defects, and ophthalmic problems.

Management and therapy

No pharmacological

General measures: For the mother – counseling , alcohol and substance abuse programs. For the fetus – evaluation, special education and support, surveillance for dental caries and cardiac and ophthalmic problems. 

Specific measures: None.

Diet: Reduction of elimination of alcohol for the duration of pregnancy.

Activity: No restriction.

Drug choice: None.

 

Follow-Up

Patient monitoring: Normal health maintenance, surveillance for dental caries and cardiac and ophthalmic problems.

Prevention/Avoidance: Reduction or elimination of alcohol use during pregnancy. No safe level of exposure has been demonstrated although sporadic use of less than I oz of alcohol per day has been associated with the syndrome.

Possible complications: Higher rate spontaneous miscarriage in heavy users of alcohol.

Expected outcome: Infants affected by fetal alcohol syndrome vary from mildly to profoundly mentally retard. Similarly, structural anomalies are variable, but life-long.