Ppt chapter 07-1

Chapter 7
Life Span: Pregnant or
Breast-Feeding Women
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Question
• Most drugs given during pregnancy will not pass to the
fetus.
– A. True
– B. False

Answer
• B. False
• Rationale: Unlike the blood–brain barrier, the
placenta allows most drugs to travel through the
maternal circulation to the fetus.

Pharmacotherapeutics
• The important consideration in drug therapy for pregnant
women is the potential adverse effects on the developing
fetus.
• A clear clinical indication for drug therapy must exist
before a drug is prescribed or self-administered.
• Some health problems occur secondarily to pregnancy
and require drug therapy.
• If the fetus has a health problem, drugs are administered
to the pregnant woman with the intent of treating the
fetus as the drug passes through the placenta.

Pharmacokinetics
• Several physiologic and anatomic changes occur during
pregnancy.
• These changes can alter the pharmacokinetics of drugs.
• The primary changes occur in the endocrine, GI,
cardiovascular, circulatory, and renal systems.

Absorption
• Changes in the GI system are influenced by pregnancy
hormones and mechanical pressure from the growing
uterus.
• Progesterone decreases gastric tone and motility and
prolongs stomach emptying time.
• Progesterone also promotes functional respiratory system
changes during pregnancy.
• Tidal volume increases 30% to 40%, with a 50% increase
in minute volume by term.

Questions
• What will be the effect of inhaled medications during
pregnancy?
– A. Increased absorption
– B. Decreased absorption

Answer
• A. Increased absorption
• Rationale: Tidal volume increases 30% to 40%, with
a 50% increase in minute volume by term. These
increases, along with the pulmonary vasodilation that
occurs during pregnancy, enhance the absorption of
drugs that are inhaled.

Distribution and Metabolism
• Hemodynamic changes in the cardiovascular system alter
drug distribution and metabolism.
• Drugs are also distributed into breast milk.
• Drugs that are widely distributed throughout the
mother’s body are usually minimally passed into breast
milk.
• Not all drugs present in breast milk are well absorbed by
the neonate.
• Drug metabolism is not altered by pregnancy or breast-feeding.

Excretion
• By the third trimester, the renal blood flow has increased
40% to 50% from the prepregnancy level.
• The glomerular filtration rate increases by approximately
50%.
• Drug excretion rates may be increased during pregnancy.

Pharmacodynamics
• Two dramatic physical changes occur in the mother
during pregnancy:
– By 32 weeks’ gestation, cardiac output is increased
by 50%.
– From the second trimester on, arterial blood pressure
is decreased.

Contraindications and Precautions
• Some drugs and vaccines are contraindicated during
pregnancy, and others should be given with caution if
they pose a threat to the developing fetus by passing
through the placenta.
• Some drugs and vaccines can cause teratogenic effects
(physical defects) in the developing fetus.
• The precise effects of drug therapy on the fetus are
mostly undetermined.
• A drug is traditionally identified as a teratogen based on
the findings of animal teratology studies.

Drugs Contraindicated in Pregnancy

Pregnancy Categories

Lactation Categories
• In 2005, the American Academy of Pediatrics Committee
on Drugs published its updated recommendations on
drugs and breast-feeding.
• The report identifies several categories of drugs and their
potential to cause problems with breast-feeding.

Adverse Effects
• The common symptoms of pregnancy may mask the
adverse effects of drug therapy.
• Administration of drugs during pregnancy takes careful
evaluation of the effects of the drugs on the fetus.
• The critical period of organogenesis is from implantation
up to approximately days 58 to 60 after conception.
• If drugs that cause teratogenic effects are administered
during this period, major malformations of fetal organ
systems may result.

Drug Interactions
• Drug interactions are unchanged during pregnancy and
breast-feeding.

Question
• Which of the following are common complications of
pregnancy?
– A. Heartburn
– B. Hypotension
– C. Nausea
– D. All of the above

Answer
• D. All of the above
• Rationale: All of the above are common complications of
pregnancy, making it difficult to determine whether the
pregnancy or medications that are prescribed during the
pregnancy are causing the adverse effect.

Health Status
• Several considerations must be taken into account when
assessing health status during pregnancy.
• First, if the patient has a preexisting condition that
requires drug therapy, the health care providers must
consider whether the prescribed drug therapy will have
adverse effects on the fetus.
• Second, any adverse effects the pregnancy may have on
the mother’s health must be identified because they may
require changes in drug therapy.
• Third, if the pregnancy does induce changes in health
status that require new drug therapy, any adverse effects
of this drug therapy on the fetus will have to be
determined.

Conditions of Concern
• Cardiovascular
– Changes occur in the cardiovascular system
• Seizure disorders
– Antiseizure medications have been shown to be
teratogenic.
• Depression
– Unclear about long-term effects on the fetus
• Diabetes mellitus
– Increased incidents of congenital abnormalities

Life Span and Gender
• Teenage pregnancy continues to be a problem in the
United States.
• Teenaged girls may be at additional risk for teratogenic
drug effects because of sharing of prescription
medication.

Lifestyle, Diet, and Habits
• The lifestyle, diet, and habits of pregnant or breast-feeding
women can have a serious impact on the course
of the pregnancy and the development of the fetus or
infant.
• Alcohol is a known human teratogen.
• Cocaine abuse is also known to cause adverse fetal
effects and is suspected to be a human teratogen.
• Opiate abuse does not appear to significantly increase
the risk for congenital anomalies.

Environment
• Some changes in health status that occur in pregnancy
require drug therapy to be administered in the hospital
setting.
• However, most drug therapy given during pregnancy or
breast-feeding is administered in the patient’s home.

Culture and Inherited Traits
• Cultural beliefs may affect whether a woman accepts
certain drug therapies while she is pregnant or breast-feeding.
• Assess for these beliefs when managing drug therapy in
the pregnant or breast-feeding woman.

Nursing Diagnoses and Outcomes
• Risk for Injury to the fetus related to adverse effects of
maternal drug therapy
– Desired outcome: The patient will demonstrate
therapeutic drug effects with minimal adverse effects to
the fetus.
• Anxiety related to perceived danger of drug therapy to the
fetus or infant
– Desired outcome: The patient’s anxiety will be
minimal during drug therapy.
• Risk for Injury to the patient related to failure to receive
needed drug therapy because of its potential adverse
effects on the fetus or infant
– Desired outcome: The patient will not sustain an
injury from choices made about receiving drug therapy.

Maximizing Therapeutic Effects
• An important element of patient teaching is adverse
reactions to medications.
• Discuss the risks versus the benefits of the medication to
the patient and unborn fetus.

Minimizing Adverse Effects
• Limiting drug use in pregnancy decreases maternal and fetal
adverse effects.
• No drug can be considered absolutely safe when administered
during pregnancy.
• Women of childbearing age should always be assessed for
pregnancy before any drug therapy is initiated.
• During pregnancy, nonpharmacologic alternatives to drug
therapy should be used if possible.
• Monitor the pregnant woman and the fetus for both therapeutic
and adverse effects of drug therapy.
• When evaluating a patient, be careful to distinguish discomforts
of pregnancy from possible adverse drug effects.

Providing Patient and Family Education
• The nurse’s role in counseling about pregnancy and fetal
drug effects ideally begins before pregnancy.
• Informing women of childbearing age about fetal drug
effects can help them make decisions about planning
pregnancy and about what to do when they become
pregnant.
• Patient and family education during pregnancy and
breast-feeding is primarily focused on adverse effects to
the fetus and infant.
• The pregnant patient should also be taught how to
anticipate adverse effects of drug therapy and distinguish
them from normal pregnancy-related problems.

Assessment and Evaluation
• Nursing management of drug therapy during pregnancy
and lactation is considered effective when maternal
therapeutic needs have been met without harm to the
fetus or the breast-feeding infant.
• Other measures of effective drug therapy include
successful patient- and family-oriented drug education.
• Assessment findings indicate that the mother and child
are not experiencing adverse drug effects.

Ppt chapter 07-1

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