Drug Maternal Considerations Fetal Considerations Breast-Feeding Considerations
Analgesics Lack of consensus regarding
Whole category management of women who have both ---------------------------------------------------------------- (aspirin, antiphospholipid antibodies and a acetaminophen, history of recurrent pregnancy loss ibuprofen) reflects the wide range of clinical manifestations. A large cohort study concluded the antenatal use of nonsteroidal antiinflammatory drugs such as ibuprofen, naproxen, and aspirin but not acetaminophen increased the risk of spontaneous abortion. Aspirin Collectively, large trials demonstrate Crosses human placenta. Compatible with breast-feeding. low-dose aspirins relative safety Associated with an increased risk Some experts suggest breast- during pregnancy and generally of fetal vascular disruptions, feeding mothers use the lowest positive effects on reproductive particularly gastroschisis, small effective dose and for the shortest outcomes. intestine atresia, and possibly duration taken after feeding. Understanding the mechanism of premature closure of the ductus Women requiring high doses action still incomplete. arteriosus. such as that used for arthritis or Gastrointestinal lesions, renal or Should be avoided in the first rheumatic fever should avoid hepatic dysfunction, asthma, trimester to prevent gastroschisis. breastfeeding because neonatal hypoprothrombinemia, tachypnea, salicylate levels may reach toxic hyperthermia, and lethargy are the levels. most significant risks. Has small but significant effect on reducing the rate of preterm delivery but not perinatal death. Used to improve pregnancy outcomes in women who have both antiphospholipid antibodies and a history of recurrent pregnancy loss: - theorized that aspirin interferes with the potential of these antibodies to compromise implantation and placental angiogenesis. - aspirin plus heparin remains the most efficacious treatment8 for women with a history of at least two spontaneous miscarriages or one intrauterine fetal death without apparent cause other than inherited or acquired thrombophilias. - however, in a 2002 randomized trial, a high success rate was achieved when low-dose aspirin alone was used for the treatment of antiphospholipid syndrome; the addition of low molecular weight heparin did not improve outcome. Prescribed to reduce the risk of maternal thrombosis: alone is not sufficient to prevent thrombosis. not without risk: may contribute to maternal bleeding due to its effect on platelet cyclooxygenase enzymes, and clinicians often avoid recommending it during the third trimester. Use for prevention of preeclampsia also remains controversial: several meta-analyses suggest a modest reduction in preeclampsia and intrauterine growth restriction. but most recent meta-analysis indicates that antiplatelet agents are associated with moderate but consistent reductions in the relative risk of preeclampsia. Acetaminophen (Tylenol, Apacet) One of the most widely used Used to treat the fever of Compatible with breast-feeding. medications during pregnancy. chorioamnionitis during labor and Some experts suggest breast- Most common maternal problems associated with improved feeding mothers use the lowest relate to chronic abuse and overdose: umbilical blood gases effective dose and for the shortest damage appears secondary to free (improvements in the umbilical duration taken after feeding. radical toxicity with the cord bicarbonate concentration and consumption of glutathione during base deficit) apparently by the acetaminophen metabolism. reducing fetal oxygen demand as N-acetylcysteine is the treatment the maternal core temperature of choice for an acute overdose. declines. Former suggestion that first trimester exposure in combination with propoxyphene is associated with clubfoot and digital abnormalities is not sustained by large series tests. Possible link between acetaminophen, gastroschisis, and small bowel atresia in the offspring of genetically predisposed mothers exposed to the drug early in pregnancy. The drug has no antiplatelet activity and does not pose a hemorrhagic risk to the fetus. Ibuprofen (Advil, Alaxan, Drug of choice for management of Crosses human placenta. Compatible with breast-feeding. Brofen, Motrin, postabortal pain, acute postoperative Fetal levels are dependent on Some experts suggest breast- Paduden) pain, and postpartum pain. maternal because nonsteroidal feeding mothers use the lowest antiinflammatory drugs are not effective dose and for the shortest efficiently metabolized by the fetal duration taken after feeding. kidney. As effective as indomethacin in closing the ductus arteriosus but possibly with less adverse effect on renal function. Chronic exposure of the fetus to the drug requires close follow-up because of its potentially lifethreatening effect (fetal right heart decompensation after critical constriction of the ductus arteriosus). Sumber: S. Buhimschi, Catalin. Weiner, Carl P. 2009. Medications in Pregnancy and Lactation Part 2. Drugs With Minimal or Unknown Human Teratogenic Effect. VOL. 113, NO. 2. http://journals.lww.com/greenjournal/pages/default.aspx. Di akses pada tanggal 14 Maret 2017.