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Web-Based Curriculum & Reference  
Editors
Kurt J. Pfeifer, MD, FACP
Steven L. Cohn, MD, FACP
 
Medical College of Wisconsin
State University of New York - Downstate
 
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  Pregnancy
Michael P. Carson, MD & David A. Halle, MD
 
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    RISK MANAGEMENT

    Medication Management
       
    Weigh Risks versus Benefits
    • Patients may have issues (i.e. nausea) that do not “require” treatment, but there are treatment options that are reasonable to use during pregnancy.
    • Consider what treatments are clearly indicated for non-pregnant patients with the condition, then consider how that treatment may impact the pregnancy and what data is available regarding that treatment.
    • Often the benefit of a treatment/test is well established, but practitioners may withhold them because of medical-legal concerns and theoretical effects on the fetus.
    Altered Metabolism of Medications in Pregnancy
    • For some meds increased renal clearance and volume of distribution may require upwardd dose adjustments.
    • Similarly, protein binding may be altered leading to changes in the levels of other meds (i.e. antiepileptics).

     
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    AVOID THINKING IN TERMS OF "SAFE” OR "UNSAFE".

    ASK YOURSELF IF THE BENEFITS WARRANT THE USE OF A PARTICLUAR MEDICATION.

    Medications for maternal comfort, control of pain, and control of nausea should be used as indicated for non-obstetric patients. No teratogenic risk associated with short term use.

    No addiction risk for the mother or fetus with appropriate short term use.
    		 
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