Prescribing in Pregnancy, Fourth Edition PDF
Preview Prescribing in Pregnancy, Fourth Edition
BLUK112-Rubin October10,2007 10:41 Prescribing in Pregnancy BLUK112-Rubin October10,2007 10:41 Prescribing in Pregnancy Fourth edition Editedby Peter Rubin NottinghamUniversityHospitals Queen’sMedicalCentreCampus Nottingham,UK Margaret Ramsay NottinghamUniversityHospitals Queen’sMedicalCentreCampus Nottingham,UK BLUK112-Rubin October10,2007 10:41 (cid:2)C 2000BMJPublishingGroup (cid:2)C 2008byBlackwellPublishing BMJBooksisanimprintoftheBMJPublishingGroupLimited,usedunderlicence BlackwellPublishing,Inc.,350MainStreet,Malden,Massachusetts02148-5020,USA BlackwellPublishingLtd,9600GarsingtonRoad,OxfordOX42DQ,UK BlackwellPublishingAsiaPtyLtd,550SwanstonStreet,Carlton,Victoria3053,Australia TherightoftheAuthortobeidentifiedastheAuthorofthisWorkhasbeenassertedin accordancewiththeCopyright,DesignsandPatentsAct1988. Allrightsreserved.Nopartofthispublicationmaybereproduced,storedinaretrieval system,ortransmitted,inanyformorbyanymeans,electronic,mechanical, photocopying,recordingorotherwise,exceptaspermittedbytheUKCopyright, DesignsandPatentsAct1988,withoutthepriorpermissionofthepublisher. Firstpublished1987 SecondEdition1995 ThirdEdition2000 FourthEdition2008 1 2008 LibraryofCongressCataloging-in-PublicationData Prescribinginpregnancy/editedbyPeterRubin,MargaretRamsay.–4thed. p.;cm. ISBN978-1-4051-4712-5(pbk.) 1.Obstetricalpharmacology. I.Rubin,PeterC. II.Ramsay,M.M.,M.D. [DNLM:1.DrugTherapy. 2.Pregnancy. 3.Pharmaceutical Preparations–administration&dosage. 4.PregnancyComplications–drugtherapy. WQ200P9322007] RG528.P742007 618.2’061–dc22 2007017554 ISBN:978-1-4051-4712-5 AcataloguerecordforthistitleisavailablefromtheBritishLibrary Setin9.5/12ptMeridienbyAptaraInc.,NewDelhi,India PrintedandboundinSingaporebyMarkonoPrintMediaPteLtd CommissioningEditor:MaryBanks EditorialAssistant:VictoriaPittman DevelopmentEditor:SimoneDudziak ProductionController:RachelEdwards ForfurtherinformationonBlackwellPublishing,visitourwebsite: http://www.blackwellpublishing.com Thepublisher’spolicyistousepermanentpaperfrommillsthatoperateasustainable forestrypolicy,andwhichhasbeenmanufacturedfrompulpprocessedusingacid-free andelementarychlorine-freepractices.Furthermore,thepublisherensuresthatthetext paperandcoverboardusedhavemetacceptableenvironmentalaccreditationstandards. BlackwellPublishingmakesnorepresentation,expressorimplied,thatthedrugdosages inthisbookarecorrect.Readersmustthereforealwayscheckthatanyproduct mentionedinthispublicationisusedinaccordancewiththeprescribinginformation preparedbythemanufacturers.Theauthorandthepublishersdonotaccept responsibilityorlegalliabilityforanyerrorsinthetextorforthemisuseor misapplicationofmaterialinthisbook. BLUK112-Rubin October10,2007 10:41 Contents Contributors,vii Preface,xi 1 Identifyingfetalabnormalities,1 LenaM.Macara 2 Treatmentofcommon,minorandself-limiting conditions,16 AnthonyJ.Avery,SusanL.Brent 3 Antibioticsinpregnancy,36 TimWeller,ConorJamieson 4 Anticoagulantsinpregnancy,56 BethanMyers 5 Treatmentofcardiovasculardiseases,77 AsmaKhalil,PatO’Brien 6 Treatmentofendocrinediseases,89 AnastasiosGazis 7 Drugsinrheumaticdiseaseduringpregnancy,98 MaryGayed,CarolineGordon 8 Psychotropicdrugsinpregnancy,114 NeelamSisodia 9 Managingepilepsyandanti-epilepticdrugsduring pregnancy,126 MichaelF.O’Donoghue,ChristineP.Hayes 10 Treatmentofdiabetesinpregnancy,150 NickVaughan,KateMorel,LouiseWalker 11 Treatmentofasthma,168 CatherineWilliamson,AnitaBanerjee 12 Drugsofmisuse,187 MaryHepburn v BLUK112-Rubin October10,2007 10:41 vi Contents 13 Prescribingforthepregnanttraveller,205 PaulineA.Hurley 14 Drugsinbreastfeeding,216 JaneM.Rutherford Index,231 BLUK112-Rubin October10,2007 10:41 Contributors AnthonyJ.Avery,DM,FRCGP NottinghamUniversityHospitals ProfessorofPrimaryHealthCare Queen’sMedicalCentreCampus DivisionofPrimaryCare Nottingham,UK SchoolofCommunityHealth Sciences CarolineGordon,MRCP NottinghamUniversityHospitals ReaderandConsultantin Queen’sMedicalCentreCampus Rheumatology Nottingham,UK DepartmentofRheumatology DivisionofImmunityand AnitaBanerjee,BSc,MBBS,MRCP Infection SpREndocrinologyandDiabetes MedicalSchool Mellitus UniversityofBirmingham EndocrinologyDepartment Birmingham,UK HammersmithHospital London,UK ChristineP.Hayes,MPhil, SusanL.Brent,BSc(Hons), BSc(Hons) MRPharmS EpilepsySpecialistNurse DirectorofPharmacy Neurosciences RegionalDrugandTherapeutics NottinghamUniversityHospitals Centre Queen’sMedicalCentreCampus WolfsonUnit Nottingham,UK NewcastleuponTyne,UK MaryHepburn,BSc,MD,MRCGP, MaryGayed,MBChB FRCOG AcademicFoundationYearTwo ConsultantObstetrician Doctor PrincessRoyalMaternity CityHospital Glasgow,UK SandwellandWestBirmingham HospitalsNHSTrust Birmingham,UK PaulineA.Hurley,FRCOG ConsultantObstetrics,Fetal AnastasiosGazis,DM,MRCP Medicine ConsultantPhysician TheWomen’sCentre DepartmentofEndocrinologyand JohnRadcliffeHospital Diabetes Oxford,UK vii BLUK112-Rubin October10,2007 10:41 viii Contributors ConorJamieson,BSc,PhD, MargaretM.Ramsay,MA,MD, MRPharmS MRCP,FRCOG PrincipalPharmacist– ConsultantinFetomaternal Anti-infectives Medicine HeartofEnglandNHSFoundation NottinghamUniversityHospitals Trust Queen’sMedicalCentreCampus Birmingham,UK Nottingham,UK AsmaKhalil,MB,BCh PeterC.Rubin,MA,DM,FRCP SeniorResearchFellow ProfessorofTherapeutics HomertonUniversityHospital NottinghamUniversityHospitals London,UK Queen’sMedicalCentreCampus Nottingham,UK LenaMacara,MD,FRCOG JaneM.Rutherford,DM,MRCOG ConsultantObstetrician ConsultantinFetomaternal TheQueenMother’sHospital Medicine Glasgow,UK DepartmentofObstetrics NottinghamUniversityHospitals KateMorel Queen’sMedicalCentreCampus DiabetesNurseSpecialistManager Nottingham,UK BrightonandSussexUniversity HospitalsNHSTurst NeelamSisodia,MBBS,MA, Brighton,UK MRCPsych ConsultantinPerinatalPsychiatry BethanMyers,MA,MRCP, PerinatalPsychiatricService FRCPath,DTM&H MotherandBabyUnit ConsultantHaematologist NottinghamUniversityHospitals DepartmentofHaematology Queen’sMedicalCentreCampus NottinghamUniversityHospitals Nottingham,UK Queen’sMedicalCentreCampus Nottingham,UK N.J.A.VaughanMA,MD,FRCP ConsultantEndocrinologist PatO’Brien,MRCOG BrightonandSussexUniversity ObstetricLead HospitalsTrust UniversityCollegeLondon RoyalSussexCountyHospital Hospitals Brighton,UK London,UK LouiseWalker,RD MichaelF.O’Donoghue,BSc,MB SpecialistDiabetesDietician BS,MD,MRCP(UK) DiabetesCentre ConsultantNeurologist BrightonandSussexUniversity NottinghamUniversityHospitals Hospitals Queen’sMedicalCentreCampus RoyalSussexCountyHospital Nottingham,UK Brighton,UK BLUK112-Rubin October10,2007 10:41 Contributors ix TimWeller,MBChB,MD, CatherineWilliamson, FRCPath(deceased) MD,MRCP PreviouslyConsultant SeniorLecturerinObstetric Microbiologist Medicine DepartmentofMicrobiology HammersmithHospital CityHospital ImperialCollege Birmingham,UK London,UK BLUK112-Rubin October10,2007 10:41 Preface Theuseofdrugsinwomenwhoarepregnantorbreastfeedingis aquestionoffinebalance.Harmmaybefallababybecauseadrug hasbeenused,butmotherandbabycouldsufferifadiseasegoes untreated. Information about the safe and effective use of drugs in pregnancy has not kept pace with the advances in other areas oftherapeutics.Systematicresearchinvolvingdrugsinpregnancy is fraught with ethical, legal, emotional and practical difficulties and in many cases our knowledge is based on anecdote or small studies. The purpose of this book is to bring together what is known about prescribing in pregnancy and to put that information in a clinicalcontext.Thefirstthreeeditionswerewellreceivedandthis hasencouragedustoproduceafourthedition.Allchaptershave been extensively revised or rewritten, with several new authors bringingtheirclinicalexperienceofthischallengingsubject. WewouldliketothankLouiseSabirwhoonceagainhasdone muchbehind-the-scenesworkincontactingauthors. Acknowledgement DrWellerdiedsuddenlywhiletrainingfortheLondonMarathon shortly after submitting his chapter. He had also contributed to thethirdeditionandwegratefullyacknowledgetheprofessional mannerinwhichheapproachedthesetasks. PeterRubin MargaretRamsay Nottingham xi BLUK112-Rubin October9,2007 10:34 CHAPTER 1 Identifying fetal abnormalities LenaM.Macara Keypoints (cid:2) Days18–55postconceptionisthetimeofmaximalteratogenic potentialwhenmostorgansaredifferentiating (cid:2) Teratogeniceffectsofmedicationsmayaffectbothorganstructure andorganfunction (cid:2) Detailedultrasoundassessmentofthefetusbytrainedpersonnel shoulddetectmostmajorstructuralabnormalities,butminor abnormalitiesareoftenundetected (cid:2) Patientsatriskofneuraltubedefects(NTDs)shouldhave5mgof folicaciddailyforaminimumof6wkpriortoconception Introduction It is estimated that 2–3% of all pregnancies in the United King- domareaffectedbycongenitalabnormality.Almosthalfofthese abnormalities remain of uncertain aetiology, a further 25% may belinkedtoavarietyofgeneticproblemsandonly2%arelikely tobeassociatedwithenvironmentalfactorsthatincludemedicinal products. Whilethisisaverysmallproportionofallbirthdefects,itisacrit- ical group, since the avoidance of some medications will prevent theseabnormalitiesfromoccurring.Forparentsandphysicians,it is therefore one of the few areas in which the outcome of preg- nancycanbeinfluenced. PrescribinginPregnancy,4thedition.EditedbyPeterRubinandMargaretRamsay, (cid:2)c 2008BlackwellPublishing,ISBN:978-1-4051-4712-5. 1
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