NBDPS, at least 20 percent of pregnant women recall first trimester NSAID use, particularly ibuprofen and aspirin, and such exposure is not a major risk factor for birth defects (Her nandez, 2012).
However, when taken in late pregnancy, indomethacin may cause constriction of the fetal ductus arteriosus and subsequent pulmonary hypertension. Fetal ductal constriction is more likely when the drug is taken in the third trimester for longer than 72 hours. he risk is IS-fold higher among indomethacin-exposed pregnancies (Koren, 2006). he drug also may decrease fetal urine production and amnionic luid volume (Rasanen, 1995; van der Heijden, 1994; Walker, 1994). In one systematic review, indomethacin tocolysis was associated with neonatal morbidity (Hammers, 2015a,b). Specifically, the risk for bronchopulmonary dysplasia, severe intraventricular hemorrhage, and necrotizing enterocolitis was increased approximately 50 percent (odds ratio 1.5).
With aspirin, a low dosage of 100 mg daily or less does not confer a greater risk for constriction of the ductus arteriosus or for adverse infant outcomes (Di Sessa, 1994; Grab, 2000). As with other NSAIDs, however, high-dose aspirin use should be avoided, particularly in the third trimester.
his is a pyrimidine-synthesis inhibitor used to treat rheuma toid arthritis but is contraindicated in pregnancy. In several animal species, it results in fetal hydrocephalus, eye anoma lies, skeletal abnormalities, and embryo death when given at or below human-equivalent doses (Sanoi-Aventis, 2016). The active metabolite, terilunomide, is detectable in plasma for up to 2 years following discontinuation of the medication. Women who become pregnant while taking leflunomide, and even those of childbearing potential who have discontinued it, are recommended to undergo an accelerated drug elimination procedure with either cholestyramine or activated charcoal (Sanoi-Aventis, 2016). Reassuringly, in a cohort of 60 women with irst-trimester lelunomide exposure who completed cholestyramine washout, the rate of birth defects was not increased (Chambers, 2010).
Medications used to treat infections are among those most frequently administered during pregnancy. Over the years, experience has accrued regarding their general safety. With a few exceptions cited below, most of the commonly used antimicrobial agents are considered safe for the embryo-fetus.
Some preterm neonates treated with gentamicin or streptomycin have developed nephrotoxicity and otoroxicity. Despite theoretical concern for potential fetal toxicity, no adverse efects have been demonstrated, and no congenital defects resulting from prenatal exposure have been identified.
his antimicrobial is not considered teratogenic and is no lon ger routinely used in the United States. More than 50 years ago, a constellation of findings termed the gray baby syndrome was described in neonates who received the medication. Pre..i term newborns were unable to conjugate and excrete the drug and manifested abdominal distention, respiratory abnormali ties, an ashen-gray color, and vascular collapse (Weiss, 1960).
due to theoretical concerns.