hese sympathomimetic amines are not considered to be major teratogens. Methamphetamine enhances dopamine release and blocks its reuptake. It is prescribed to treat attention-deicit/ hyperactivity disorder and narcolepsy. Methamphetamine abuse has been rising in the United States since the late 1980s (American College of Obstetricians and Gynecologists, 2017b). In utero exposure has been consistently associated with higher rates of small-for-gestational age newborns (Gorman, 2014; Smith, 2006). Hypertensive complications, placental abruption, preterm birth, and stillbirth are other associated complications (Gorman, 2014). Behavioral abnormalities have been described in both infants and school-aged children (Eze, 2016).
TABLE 12-5. Pharmacological Actions and Adverse Effects of Some Herbal Medicines
Echinacea: purple coneflower root
Ephedra: ma huang
Garlic: ajo
Kava: awa, intoxicating pepper, kawa Valerian: all heal, garden heliotrope, vandal root Yohimbe
Contains linoleic acids, a prostaglandin precursor
Cyclooxygenase inhibitor, thromboxane synthetase inhibitor
Lowers blood glucose; inhibition of platelet aggregation Sedation, anxiolysis
Data from Ang-Lee, 2001; Briggs, 2015; Hall, 2012; Wiesner, 2017.
With this CNS stimulant, most adverse outcomes result from its vasoconstrictive and hypertensive efects. Serious potential maternal complications are cerebrovascular hemorrhage, myocardial damage, and placental abruption. Studies of congenital abnormalities and cocaine exposure have yielded conflicting results, but associations with cleft palate, cardiovascular abnormalities, and urinary tract anomalies have been reported (Chasnof, 1988; Lipshultz, 1991; van Gelder, 2009). Cocaine use is also associated with fetal-growth restriction and preterm delivery. Children exposed as fetuses have risks for behavioral abnormalities and cognitive impairments (Bada, 2011; Gouin, 2011).
The dramatic rise in narcotic use among non-pregnant and pregnant individuals has been aptly termed an epidemic. Opioids are not considered to be major teratogens. he NBDPS did identiY a slightly greater risk for spina biida, gastroschisis, and cardiac abnormalities with periconceptional opioid exposure (Broussard, 2011). The American College of Obstetricians
Allergic reactions; decreases immunosuppressant efectiveness; possible immunosuppression with long-term use arrhythmias, myocardial ischemia, stroke; depletes endogenous catecholamines; lifethreatening interaction with monoamine oxidase inhibitors Possible complications if used for labor induction
Risk of bleeding, especially when combined with other platelet aggregation inhibitors
Increased risk of bleeding
Risk of bleeding; interferes with monoamine oxidase inhibitors Hypoglycemia; hypertension; risk of bleeding
Sedation; hepatotoxicity, benzodiazepine-like acute withdrawal Hypertension, arrhythmias and Gynecologists (2017 c) stresses that this potential, small increase in birth defects with maintenance therapy should be weighed against the risks associated with uncontrolled opioid abuse. Heroin addiction is associated with adverse pregnancy outcomes from the efects of repeated narcotic withdrawal on the fetus and placenta (American College of Obstetricians and Gynecologists, 2017 c). These include preterm birth, placental abruption, fetal-growth restriction, and fetal death.