Suggestions for Prescribing Medication in
Use medication only if absolutely indicated.
- Avoid initiating therapy during the
- Select a medication with a proven
track record in human pregnancy.
- Use a
- Use the lowest effective dose.
- Discourage the use of over-the
counter drugs that might interact with prescription medications.
Norwitz ER, Greenberg JA.Antibiotics in pregnancy: are they safe? Rev Obstet
Prescription Drugs of Choice During Pregnancy -perinatology.com
Medications recommended as first line agents
during pregnancy by various organizations and authorities .
Breastfeeding and Maternal Medication(PDF file)
World Health Organization, 2002
Thomas W. Hale, R.Ph. Ph.D.
Common Drugs of Abuse
National Institute on Drug Abuse web site for physicians and other health
professionals. DART Database Developmental and Reproductive Toxicology Database
- References to developmental and reproductive toxicology
Drugs in Breastmilk West Midlands Regional Medicines Information Services guide is
based on information compiled by the Trent and West Midlands Medicines
Information Services. It contains a summary of the significance of the excretion
of the commonly used drugs via breast milk, and their absorption by the
in Pregnancy Motherisk's published studies on the safety or risk of specific
drugs during pregnancy
Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk Classic text by Briggs GG, Freeman RK, Yaffe S.J.
Referenced information on specific medications and vaccine use in
pregnancy and breastfeeding.
Pregnancy, and Lactation Archive of Ob.Gyn.News articles written by Lee Cohen, Gerald G. Briggs, and
Drug Safety in Lactation
FDA Use in Pregnancy Ratings
and Diagnostic Agents in Pregnancy List of links from the OBfocus directory.
MotherToBaby (Organization of Teratology
Information Specialists) has compiled "fact sheets" on
various exposures of concern. Fact Sheets answer frequently asked questions
about exposures during pregnancy.
OBPharmOffice of Dietary Supplements
LactMed -Drugs and Lactation Database (LactMed) - A peer-reviewed and fully referenced database of drugs to which breastfeeding mothers may be exposed. Among the data included are maternal and infant levels of drugs, possible effects on breastfed infants and on lactation, and alternate drugs to consider.
Physicians Desk Reference
Package insert information on prescription drugs.Pregnancy Drug
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1.Pacifici GM, Nottoli R. Placental
transfer of drugs administered to the mother. Clin Pharmacokinet.
|Factors that Appear to Determine the Extent of Placental
Transfer of Drugs Administered to the Mother [1-5]
- The molecular weight of the drug;
Drugs with molecular weights (MW) less than 500 D appear to
cross the placenta easily, drugs with MW greater than 500
transfer across the human placenta. Drugs with very high MW , such
as insulin with a M.W ~ 5800 do not normally cross the placenta.
- The pKa (pH at which the drug is 50%
ionised); Strongly dissociated acid drug molecules should have an
incomplete transfer, but this does not seem to be an absolute rule
the extent of drug binding to the plasma protein.
- Physiological properties of the
placenta (blood flow, gestational age)
- Expression and activity of metabolizing
enzymes and efflux transporters (e.g. ATP-binding
cassette (ABC) transporters ). For example placental
11beta-hydroxysteroid dehydrogenase 2 (11beta-HSD2) enzyme
inactivates prednisolone by interconversion into
prednisone , and ABC transporters pump tenofovir disoproxil
fumarate from trophoblast back to maternal circulation.
- The extent of drug binding to plasma protein
does not appear to influence the type of drug transfer across the
human placenta to a significant degree.
2. Menon RK, et. al. Transplacental passage of insulin in pregnant
women with insulin-dependent diabetes mellitus. Its role in fetal
macrosomia. N Engl J Med. 1990 Aug 2;323(5):309-15. Erratum in: N
Engl J Med 1992 Jan 23;326(4):280.
3. van Runnard Heimel PJ, et al., The transplacental passage of
prednisolone in pregnancies complicated by early-onset HELLP syndrome. Placenta.
2005 Nov;26(10):842-5.PMID: 16226134
4. Neumanova Z, et. al Interactions of tenofovir and tenofovir
disoproxil fumarate with drug efflux transporters ABCB1, ABCG2, and
ABCC2; role in transport across the placenta.AIDS. 2014 Jan
5. Hemauer SJ, et al., Role of human placental apical membrane
transporters in the efflux of glyburide, rosiglitazone, and
metformin.Am J Obstet Gynecol. 2010 Apr;202(4):383.e1-7. doi:
36. Nausea and vomiting of pregnancy. Practice Bulletin No. 153. American College of Obstetricians and Gynecologists. Obstet Gynecol 2015;126:e12–24.
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