Malformation of Malformation of ExtremitiesExtremities

Deformation of face and Deformation of face and eyes and covered in a eyes and covered in a white substance with white substance with unknown propertiesunknown properties

Child with Child with Meningomyelocele Meningomyelocele at thoracic spineat thoracic spine

Twins with Twins with deformities of deformities of faces, clip lips faces, clip lips and palatesand palates

Severe deformities of Severe deformities of mouth and eyes, mouth and eyes, indicating open indicating open

wounds, or wounds, or unformed skin tissueunformed skin tissue

Child with Child with hydrocephalushydrocephalus

PregnancyPregnancy with with DrugsDrugs

Kris TrairatanaKris Trairatanatrairatana@hotmail.comtrairatana@hotmail.com

Pregnancy with DrugsPregnancy with Drugs

More than More than 90%90% of pregnant women of pregnant women take prescription or nonprescription (over-take prescription or nonprescription (over-the-counter) drugs or use social drugs, the-counter) drugs or use social drugs, such as tobacco and alcohol, or illicit such as tobacco and alcohol, or illicit drugs at some time during pregnancy. In drugs at some time during pregnancy. In general, drugs, unless absolutely general, drugs, unless absolutely necessary, should not be used during necessary, should not be used during pregnancy, because many can harm the pregnancy, because many can harm the fetus. About fetus. About 2 to 3%2 to 3% of all birth defects of all birth defects result from the use of drugs.result from the use of drugs.

Drugs taken by a pregnant woman reach the Drugs taken by a pregnant woman reach the fetus primarily by crossing the placenta, the same fetus primarily by crossing the placenta, the same route taken by oxygen and nutrients, which are route taken by oxygen and nutrients, which are needed for the fetus's growth and development. needed for the fetus's growth and development. Drugs can affect the fetus in several ways:Drugs can affect the fetus in several ways:

•act directly on the fetus, causing damage, act directly on the fetus, causing damage, abnormal development (leading to birth defects), abnormal development (leading to birth defects), or death. or death.

• alter the function of the placenta, usually alter the function of the placenta, usually by reducing the supply of oxygen and nutrients to by reducing the supply of oxygen and nutrients to the fetus thus resulting in an underweight and the fetus thus resulting in an underweight and underdeveloped baby. underdeveloped baby.

•cause the muscles of the uterus to contract cause the muscles of the uterus to contract forcefully, thus injuring the fetus by reducing its forcefully, thus injuring the fetus by reducing its blood supply or triggering preterm labor and blood supply or triggering preterm labor and delivery. delivery.

How Drugs Cross the PlacentaHow Drugs Cross the Placenta

Food and Drug Administration (FDA)Food and Drug Administration (FDA) •ThalidomideThalidomide caused extreme underdevelopment of caused extreme underdevelopment of

arms and legs and defects of the intestine, heart, and blood arms and legs and defects of the intestine, heart, and blood vessels in the babies vessels in the babies

•MeclizineMeclizine taken for motion sickness, nausea, and taken for motion sickness, nausea, and vomiting; causes birth defects in animal.vomiting; causes birth defects in animal.

•Oral hypoglycemicOral hypoglycemic drugs can cross the placenta and drugs can cross the placenta and cause low blood sugar level in newborn; preferring use Insulin cause low blood sugar level in newborn; preferring use Insulin because not cross the placenta in diabetes in pregnancy.because not cross the placenta in diabetes in pregnancy.

•EtretinateEtretinate used to treat skin disorders, is stored in fat used to treat skin disorders, is stored in fat beneath the skin and is released slowly. It can cause birth beneath the skin and is released slowly. It can cause birth defects 6 months or longer after women discontinue it. defects 6 months or longer after women discontinue it. Therefore, women are advised to wait at least 1 year after Therefore, women are advised to wait at least 1 year after discontinuing the drug before they become pregnant.discontinuing the drug before they become pregnant.

•AntihypertensivesAntihypertensives may be needed by pregnant may be needed by pregnant women who have had high blood pressure (a complication women who have had high blood pressure (a complication called preeclampsia), markedly reduce blood flow to the called preeclampsia), markedly reduce blood flow to the placenta if they lower blood pressure too rapidly in pregnant placenta if they lower blood pressure too rapidly in pregnant women. women.

•Digoxin Digoxin treats heart failure and some abnormal heart treats heart failure and some abnormal heart rhythms, readily crosses the placenta, has little effect on the rhythms, readily crosses the placenta, has little effect on the baby before or after birth.baby before or after birth.

Some Drugs That Can Some Drugs That Can Cause Problems During Cause Problems During PregnancyPregnancy • Antianxiety DrugAntianxiety Drug – –

diazepamdiazepam

• AntibioticsAntibiotics – – chloramphenical, chloramphenical, ciprofloxacin, ciprofloxacin, kanamycin, kanamycin, nitrofurantoin, nitrofurantoin, streptomycin, streptomycin, sulfonamides, sulfonamides, tetracyclinetetracycline

• AnticoagulantsAnticoagulants – – heparin, warfarinheparin, warfarin

• AnticonvulsantsAnticonvulsants – – carbamazepine, carbamazepine, phenobarbital, phenobarbital, phenytoin, phenytoin, trimethadione, trimethadione, valproatevalproate

• AntihypertensivesAntihypertensives – – angiotensin, angiotensin, thaiazide diureticthaiazide diuretic

• Chemotherapy Chemotherapy DrugDrug – busulfan, – busulfan, chlorambucil, chlorambucil, cyclophosphamide, cyclophosphamide, mercaptopurine, mercaptopurine, methotrexatemethotrexate

• Mood-stability DrugMood-stability Drug – lithium– lithium

• Nonsteriodal Anti-Nonsteriodal Anti-inflammatory inflammatory DrugsDrugs – aspirin, – aspirin, other salicylatesother salicylates

• Oral hypoglycemicsOral hypoglycemics – chlorpropamide, – chlorpropamide, synthetic synthetic progestins, progestins, diethylstilbestroldiethylstilbestrol

• Skin TxSkin Tx – etretinate, – etretinate, isotretinoinisotretinoin

• Thyroid DrugsThyroid Drugs – – methimazole, methimazole, propylthiouracil, propylthiouracil, radioative iodineradioative iodine

• VaccinesVaccines – live – live virus vaccine, i.e. virus vaccine, i.e. MMR, OPV, chicken MMR, OPV, chicken pox, yellow feverpox, yellow fever

Social DrugsSocial Drugs

• Cigarette Smoking:Cigarette Smoking: The most consistent The most consistent effect of smoking on the fetus during effect of smoking on the fetus during pregnancy is a pregnancy is a reduction in birth weightreduction in birth weight. . Birth defects of the Birth defects of the heartheart, , brainbrain, and , and faceface are are more common among babies of smokers more common among babies of smokers than among those of nonsmokers, including than among those of nonsmokers, including sudden infant death syndromesudden infant death syndrome (SIDS), (SIDS), miscarriagesmiscarriages, , deficienciesdeficiencies in physical growth in physical growth and in intellectual and behavioral and in intellectual and behavioral development. These effects are thought to development. These effects are thought to be caused by carbon monoxide and nicotine.be caused by carbon monoxide and nicotine.

•Alcohol:Alcohol: leading known cause of leading known cause of birth birth defectsdefects. The risk of . The risk of miscarriagemiscarriage, , low birth low birth weightweight about 4 pounds. about 4 pounds.

Fetal alcohol syndrome is one of the most Fetal alcohol syndrome is one of the most serious consequences of drinking during serious consequences of drinking during pregnancy. This syndrome includes pregnancy. This syndrome includes inadequate growth before or after birth, inadequate growth before or after birth, facial defectsfacial defects, a small head, , a small head, mental mental retardationretardation, and abnormal behavioral , and abnormal behavioral development. Abnormal and development. Abnormal and heart defectsheart defects are present.are present.

Babies of women who drank alcohol during Babies of women who drank alcohol during pregnancy may have severe behavioral pregnancy may have severe behavioral problems, such as problems, such as antisocial behaviorantisocial behavior and and attention deficit disorderattention deficit disorder. .

•Caffeine:Caffeine: harms the fetus is harms the fetus is unclear. It is a stimulant that readily unclear. It is a stimulant that readily crosses the placenta to the fetus. Thus, crosses the placenta to the fetus. Thus, it may stimulate the fetus, it may stimulate the fetus, increasing increasing the heart and breathing ratesthe heart and breathing rates. Caffeine . Caffeine also may decrease blood flow across also may decrease blood flow across the placenta and decreases the the placenta and decreases the absorption of iron (possibly increasing absorption of iron (possibly increasing the risk of anemia).the risk of anemia).

Drinking 7-8 cups or more/day Drinking 7-8 cups or more/day increases the risk of having a stillbirth, increases the risk of having a stillbirth, premature birthpremature birth, l, low-birth-weightow-birth-weight baby, or baby, or miscarriagemiscarriage is also unclear. is also unclear.

• Aspartame:Aspartame: Aspartame, an artificial Aspartame, an artificial sweetener, appears to be safe during sweetener, appears to be safe during pregnancy when it is consumed in pregnancy when it is consumed in small amountssmall amounts, such as in amounts , such as in amounts used in artificially sweetened foods used in artificially sweetened foods and beverages. Not suggestion to and beverages. Not suggestion to use a lot.use a lot.

Illicit DrugsIllicit Drugs

• Use of illicit drugs (particularly cocaine and Use of illicit drugs (particularly cocaine and opioids) during pregnancy can cause opioids) during pregnancy can cause complications during pregnancy and serious complications during pregnancy and serious problems in the developing fetus and the problems in the developing fetus and the newborn. Injecting drug using is Increasing newborn. Injecting drug using is Increasing the risk of infections that can affect or be the risk of infections that can affect or be transmitted to the fetus, transmitted to the fetus, hepatitishepatitis and and STDSTD (including (including AIDSAIDS). ).

• Fetus growth is more likely to be Fetus growth is more likely to be inadequate, and premature births are more inadequate, and premature births are more common.common.

• Cocaine:Cocaine: Cocaine readily crosses the placenta Cocaine readily crosses the placenta and affects the fetus. It constricts blood vessels, and affects the fetus. It constricts blood vessels, reducing blood flow (and the oxygen supply) to reducing blood flow (and the oxygen supply) to the fetus, particularly of the bones and the the fetus, particularly of the bones and the intestine. Rarely, use of cocaine results in birth intestine. Rarely, use of cocaine results in birth defects of the defects of the brainbrain, , eyeseyes, , kidneyskidneys, and , and genital genital organsorgans..

• Use of cocaine during pregnancy can also cause Use of cocaine during pregnancy can also cause complications during pregnancy, about complications during pregnancy, about 31% have 31% have a preterm deliverya preterm delivery and and 15% have premature 15% have premature detachment of the placentadetachment of the placenta (placental abruption). (placental abruption).

• Newborns may have Newborns may have withdrawal symptomswithdrawal symptoms. Their . Their behavior is also behavior is also affectedaffected. Newborns interact less . Newborns interact less with other people. Babies of cocaine users may be with other people. Babies of cocaine users may be hyperactive, tremble uncontrollably, and have hyperactive, tremble uncontrollably, and have difficulty learning (which may continue through difficulty learning (which may continue through age 5 years or even longer).age 5 years or even longer).

• Opioids:Opioids: such as heroin, methadone, such as heroin, methadone, and morphine, readily cross the and morphine, readily cross the placenta. Consequently, the fetus may placenta. Consequently, the fetus may become addicted to them and may become addicted to them and may have withdrawal symptoms 6 hours to 8 have withdrawal symptoms 6 hours to 8 days after birth. However, use of days after birth. However, use of opioids rarely results in birth defects opioids rarely results in birth defects and increases the risk of complications, and increases the risk of complications, such as such as miscarriagemiscarriage, , abnormal abnormal presentationpresentation of the baby, and of the baby, and preterm preterm deliverydelivery. Babies of heroin users are . Babies of heroin users are more likely to be small.more likely to be small.

• Amphetamines:Amphetamines: Use of Use of amphetamines during pregnancy amphetamines during pregnancy may result in may result in birth defectsbirth defects, especially , especially of the of the heartheart..

• Marijuana:Marijuana: harm the fetus is harm the fetus is unclear. The main ingredient of unclear. The main ingredient of marijuana, tetrahydrocannabinol, can marijuana, tetrahydrocannabinol, can cross the placenta and thus may cross the placenta and thus may affect the fetus. If marijuana is used affect the fetus. If marijuana is used heavily during pregnancy, newborns heavily during pregnancy, newborns may have may have behavioral problemsbehavioral problems..

Drugs Used During Labor Drugs Used During Labor and Deliveryand Delivery

• Local anesthetics, opioids, and other Local anesthetics, opioids, and other analgesics usually cross the placenta analgesics usually cross the placenta and can affect the newborn. For and can affect the newborn. For example, they can weaken the example, they can weaken the newborn's urge to newborn's urge to breathebreathe. . Therefore, if these drugs are needed Therefore, if these drugs are needed during labor, they are given in the during labor, they are given in the smallest effective doses smallest effective doses

ConclusionConclusion• Try to avoid any kind of drugs before, during, and Try to avoid any kind of drugs before, during, and

after pregnancyafter pregnancy• If necessarily use, under the prescription and If necessarily use, under the prescription and

strictly follow doctor’s directionstrictly follow doctor’s direction• No self-medicationNo self-medication• Provide sufficient and healthy foodProvide sufficient and healthy food• Follow up doctor’s appointmentFollow up doctor’s appointment• The best choice of addictive pregnancy, consult The best choice of addictive pregnancy, consult

your doctor, counseling center, AA, NA, and other your doctor, counseling center, AA, NA, and other servicesservices

• Participate with every teaching classesParticipate with every teaching classes• Enjoy life, have fun, and prepare for a new Enjoy life, have fun, and prepare for a new

membermember

ReferencesReferences• Drug use during pregnancy, The MERCK manual of Drug use during pregnancy, The MERCK manual of

medical information-second home edition, online medical information-second home edition, online version, version, http://www.merck.com/mmhe/index.htmlhttp://www.merck.com/mmhe/index.html

• Teenage pregnancy and drug abuse,Teenage pregnancy and drug abuse,

• Illicit drug use in pregnancy, Illicit drug use in pregnancy, http://www.marchofdimes.com/professionals/14332http://www.marchofdimes.com/professionals/14332_1169.as/_1169.as/

• Drug abuse and treatment, National Women's Drug abuse and treatment, National Women's Health Information Center, Health Information Center, http://www.4woman.gov/http://www.4woman.gov/

• Alcohol research group, National research center, Alcohol research group, National research center, Public Heath Institute, Public Heath Institute, http://www.arg.org/studies.htmlhttp://www.arg.org/studies.html

Thank YouThank You