Drugs during Pregnancy and Lactation

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Drugs during Pregnancy and Lactation

Pregnancy and lactation periods not only involve the mother but also the fetus. During these stages, mothers have to observe various precautions involving their health and that of the child they are carrying or breastfeeding. It is extremely crucial for lactating mothers and pregnant women to avoid drug use. Illicit drugs such cocaine, marijuana and methamphetamine, are not the only drugs affecting children and fetus but also common over the counter drugs. Moreover, substances such as alcohol, tobacco and caffeine have an effect on fetal development. This topic raises questions on understanding the effects of drugs during lactation and pregnancy on neonatal and fetal health. The government has come up with different strategies of educating the public about these strategies as well as advocating policies that help in reducing the tendency of drug use during pregnancy and lactation. Legal and illegal use of drugs during pregnancy and lactation has significant adverse effects on neonatal and fetal development.

Medical Data on Drug Use during Pregnancy and Lactation

Surprisingly, it is a common phenomenon for women to take drugs during pregnancy and lactation. Approximately 70 percent of women take over the counter drugs during their early stages of pregnancy while about 50 percent of them take prescribed drugs during lactation (Drug Use and Pregnancy 1). Notably, every human can get sick at one point, and these groups of women are no exception. However, this group has to take more precaution because certain types of drugs have adverse effects on the fetus and neonates. Pregnant women, commonly in the first trimester, have the tendency to use over the counter drugs since some of them neither know they are pregnant while the rest are merely being ignorant. Additionally, data from the Substance Abuse and Mental Health Services Administration shows that approximately 19 percent of pregnant women in their first trimester, 8 percent in the second trimester and 6 percent in the third trimester consume alcohol. They also recorded similar results for cigarette smoking and marijuana usage.

Effects of Drug Use

Legal Drugs

Medicinal Drugs

Psychotropic Medications

Most medical researches base on the effects of psychotropic drugs and their effects. Across the globe, approximately 3 percent of both lactating mothers and pregnant women use antidepressants. There is little information regarding these drugs in spite of the frequency with which it is used. Conversely, there are certain medical concerns regarding the use of psychotropic agents on fetus development. Among these concerns are the impact it has on the alteration of serotonin levels, which affect neurological development and the adverse effects it has on the pulmonary development of the fetus after birth (Ghanemand and Movahed 39). Researchers conducted a research on one of the commonly used antidepressants, Venlafaxine and discovered that it has adverse effects on the respiratory system of the exposed infants. Most exposed infants suffer from respiratory suffering during birth and trachypnea.

In addition, more use of antidepressants during lactation increases its agents on the infant and leads to decreased levels of serum in their bodies. The transfer of psychotropic agents into breast milk after 8 hours of maternal dosage results in 37 percent of the drug into the infant’s plasma concentrations (Bedada and Engidawork 269). The infant thus suffers from the same effects as those in unborn babies. Mothers with the highest doses report of infants with more symptoms. Increased respiratory problems may result in serious complications with time. The use of these drugs affects the children’s health and tends to reduce their life expectancy.

Antiepileptic Drugs

Epileptic patients have to take their prescribed medicines disregarding their conditions, age or gender. Many adults using epileptic drugs report of their teratogeic effects including valporic acid, pheytoin and carbamazepine. This fact compelled many clinicians to prescribe newer epileptic drugs during lactation and pregnancy. Notably, infants born by mothers using antiepileptic drugs suffer from severe apnea (Pennell, Gidal, Sabers, Gordon, and Perucca 267). This is due to the increased concentrations of lamotrigine in breast milk. However, the cases of adverse effects are relatively minimal and thus, do not pose a threat to unborn and neonatal infants. Therefore, pregnant and lactating mothers should consult their respective doctors before taking any epileptic drugs.

Analgesics and Painkillers

Painkillers are the most commonly overused over the counter drugs. Many people have a tendency of prescribing and buying these drugs without visiting the hospital. Pain during pregnancy ranges from acute conditions such as infection and injury or pregnancy related. It may also be due to secondary medical underlying disorders such as arthritis. These groups of women should not suffer from unnecessary pain. Nonetheless, not all painkillers have adverse effects on fetus and neonatal infants (Pennell, Gidal, Sabers, Gordon, and Perucca 267). If taken appropriately, commonly used analgesics such as aspirin, opiods, non-steroidal anti-inflammatory drugs (NSAIDs) and paracetamol are reasonably safe.

Aspirin and Paracetamol

Most obstetricians prescribe aspirin and paracetamol while treating fever and mild pain. It is also effective when administered with heparin when treating pregnant with a known history of recurrent miscarriages and antiphospholipid syndrome. The overall usage of aspirin does not lead to any congenital problems in unborn children and neonatal infants (Drug Use and Pregnancy 1). Their bodies absorb and excrete these substances, thus reducing concentration levels of aspirin in their bodies. However, a meta-analysis of the usage of aspirin shows otherwise. Pregnant women, mostly those in their first trimester report of increased gastroschisis.

NSAIDs

During the treatment of fever and mild to moderate pain, clinicians prescribe NSAIDs, which include diclofenac, ibuprofen, naproxen and indomethacin. They work by inhibiting cyclo-organase. Cyclo-organase is responsible for the potent dilation of pulmonary opposition vessels and ductus arteriosus. Inhibition of cyclo-organase could result to the closure of the mentioned vessels. Increased dosage of NSAIDs by pregnant mothers in their third trimester may lead to reduced urine output and perfusion of the kidneys in unborn children (Ghanemand and Movahed 39). Despite the clinicians’ ability to reverse this condition, there are cases of infant death due to failure of anuric renal. Within the first trimester, use of these drugs exposes pregnant mothers to the risk of miscarriages.

Opioids

Opoids, including codeine, hydrocodone, hydromorphone, morphine and oxycodone as well as tramadol and pethidine treat both moderate and severe pain. Opioids usage among pregnant and breastfeeding mothers has no adverse effects on the infants congenital developments. Additionally, it does not result in miscarriages and birth defects among infants. However, there life threatening effects of these drugs that may cause breathing problems in infants. These drugs are also associated with withdrawal problems among lactating mothers that result in addiction among the newborn babies (Ghanemand and Movahed 39). Dependency on these drugs also threatens the lives of infants.

Antimicrobial drugs

Antimicrobials include antibiotics, antihelminthic, antimalarial, antifungul and antiviral drugs. They help prevent both viral and bacterial infections in the body. Pregnant mothers pass these drugs to the fetus through blood. It is potentially risky in neonates since they can absorb toxins or therapeutic doses of the drugs from lactating mothers. Some of these drugs have long-term effects the hepatic and renal systems of infants as well as growth and development. Unborn babies and neonates whose parents have a tendency in using antimicrobial drugs have higher risk to suffer from various infections since the drugs transfer their concentrations into the infants’ bodies.

Antiretroviral Drugs

Patients suffering from HIV and AIDS use antiretroviral drugs in order to reduce viral loads in their systems. High Active Antiretroviral Therapy (HAART) administration during pregnancy reduces the risks of transmission of the HIV virus from mothers to their unborn children. The drugs involve a combination of zidovudine and lamivudine, iopinavir and ritonavir or abacavir and lamivudine. The use of these drugs does not reveal adverse effects in neonates and fetus regarding their congenital development and teratogenicity (Drug Use and Pregnancy 1). However, there are raised concerns about the effects of these concentrations in the fetus. Exposure to high concentrations in these dosages in the first trimester leads to birth defects. Moreover, the fetus may suffer from hepatotoxicity. Other outcomes are reduced child weight during birth and impaired fertility at later stages.

Non-Medicinal Drugs

Cigarettes

Cigarette smoking is one of the commonly used non-medicinal drugs in the world. Its prolonged use causes serious illnesses among adults including lung and throat cancers as well as premature deaths. Both pregnant and lactating mothers pass considerable amounts of carcinogenic agents and nicotine to their fetus and neonates respectively. Reports from the Centre for Disease Control indicates that mothers who smoke during pregnancy often give birth to children with potential defects. Some of these defects are various heart defects such a septal defects. This means they give birth to children with a hole between the right and left chambers in their hearts. Most infants with these defects die after a short period and the surviving ones suffer from disabilities. Carcinogenic chemicals also cause placental problems. Since the placenta is responsible for the infant’s nutrition in the womb, the fetus may suffer from malnutrition. Smoking mothers give birth to children with cleft palates, low-birth weight as well as premature deliveries. Additionally, Sudden Infant Death Syndrome (SIDS) results from smoking during pregnancy (Lang, and Chen 346).

Alcohol

Alcohol consumption during pregnancy causes a wide range of disorders commonly referred to as fetal alcohol spectrum disorders (FASD) and fetal alcohol syndrome (FAS) (Onu, Oke, Ozegbe, and Oyewale 357). Fetal alcohol syndrome causes abnormality among children. It can cause central nervous system problems, growth deficiency and other abnormalities involving the facial and other body structures. Fetal alcohol spectrum disorders causes disabilities. These include learning disabilities, short-term memory and attention duration disorders. FASD also causes physical disorders including hearing and vision problems. Other studies also show that alcohol consumption among lactating and pregnant women has no secure limits. Consumption of little amounts of alcohol has distinct adverse effects on the neonates and fetus. The effects are relatively similar to children whose mothers consume high amounts of alcohol.

Caffeine

Caffeine is prevalent in drinks such as sodas and coffee and in chocolates. However, experts in the medical advice pregnant and breastfeeding mothers to consume little amounts of the legal drug. Pregnant women who consume relative higher amounts of caffeine have double risks of having a miscarriage while the rest are likely to have stillbirths (Brent, Christian, and Diener 158). Mothers are likely to suffer from insomnia since caffeine is a stimulant drug. It also contributes to heartburns during pregnancy since it stimulates acid secretions in the stomach. Finally, pregnant and lactating mothers should avoid caffeine since they contain phenol compounds. These compounds have a tendency to reduce iron absorption in the body. Pregnant women are the mostly advised to avoid caffeine since they have relatively low levels iron in their bodies.

Illegal Drugs

Cocaine

Women who use cocaine are most likely to have complications during pregnancy. Premature rupture of the placental membrane and placental abruption are some of the effects. These may result in ischemia and fetal hypoxia. In instances where cocaine crosses and gets into the placenta, there are increased fetal hypertension, circulation and cardiac output that may finally lead to hemorrhage and intracranial lesions. Other adverse effects include reduce birth weight, intrauterine growth retardation (IUGR) and reduced head circumference among infants indicating lower IQ levels (Pennell, Gidal, Sabers, Gordon, and Perucca 268). These mothers have a tendency of giving birth to premature babies. Increased abortions and genitourinary malfunctions also result from the usage of cocaine.

In neonates, there are considerable neurobehavioral impairments during the first few days. Increased concentrations of cocaine result in an increased degree of tremulousness, irritability and muscular rigidity. Consistent cocaine exposure of cocaine in neonates also causes seizures and gastrointestinal symptoms such as diarrhea and vomiting. Furthermore, there are long term adverse effects related to the use of cocaine in children. These include delayed language speech. External effects of cocaine are withdrawal problems among lactating mothers as well as the poor maternal performance (Pennell, Gidal, Sabers, Gordon, and Perucca 268). Such parents also provide an inadequate caring environment to their children, which may lead to other adverse effects involving their health.

Marijuana

Marijuana, also known as cannabis has multiple effects ranging from hallucinations, mood changes to euphoria. This psychoactive drug has Tetrahydrocannabinol (THC) as its active ingredient that works on cannabinoid receptors (Effects of Marijuana on the Fetus and Breastfeeding Infants 1). Due to its high lipid solubility nature, it is able to diffuse easily in the body resulting in high concentrations of THC in the body and brain. This means that it affects both the brain and growth development of the fetus. Researches indicate that children whose parents abused marijuana have reduced head circumferences hence have lower IQ levels, leukemia and have short-term memory. These children exhibit poor integration, planning and judgment skills.

Heroin

Heroin is an illegal hard drug, which causes multiple problems when used. Numerous complications face pregnant women who use this drug. Some of these problems affect the fetus as well as the mother. It affects fetal development, low birth weight while increasing the risks of giving birth to premature babies or miscarriages. Babies born by such women are prone to infections and diseases. This is because heroin passes through the mother’s placenta and mixes itself in the amniotic fluid making the child suffer from withdrawal problems after birth. Moreover, lactating mothers taking this substance expose their children to the effects of heroin since considerable amounts pass through breast milk. Effects after birth include low blood pressure, poor memory, and constipation, loss of appetite, increased irritability, increased heart rate as well as diarrhea and vomiting (Rocha 4). Lactating mothers who take this substance suffer from dependency on the drug and often neglect their children.

Amphetamines

Methamphetamine, Ecstasy (MDMA), amphetamine, dextroamphetamine as well as related agents including STP and mescaline refer to amphetamines. Several malfunctions appear when induced in high doses. Pregnant women using this type of drug often bear children with cardiac problems, biliary atresia and oral clefts (Drug Use and Pregnancy 1). These drugs are teratogenic. Therefore, they might cause growth retardation, increased stillborn births, premature delivery, reduced head circumference and increased morbidity in neonates. Most users combine this drug with other substances such as alcohol, smoking and other drugs. The adverse effects of these combinations are increased long-term problems including altered neurobehavioral and growth that last up to puberty levels.

Causes of Drug Use

Based on the pharmacodynamics and pharmacokinetics of common antiepileptic, anti-infective and analgesics there are significant effects associated with their use during pregnancy and lactation. These groups of women take these medicines due to their present illnesses and medical histories. For instance, in cases of epileptic mothers, they cannot avoid their drugs since the adverse effects when they neglect their medication could be fetal. Moreover, administering these medications facilitates their survival and that of the child they are either carrying or breastfeeding (Drug Use and Pregnancy 1). However, most women take these drugs without consulting their doctors. They take them because of negligence. These have adverse effects on the fetus and neonates. Additionally, others misuse the drugs without prior knowledge that they are expecting. In cases where mothers use hard drugs, their behaviors cannot be accounted. Some of them do so because of negligence, peer pressure while others are addicted to those drugs and are afraid of the withdrawal problems.

Recommendations

In order to reduce case of misuse of drugs, there are certain steps, which both expectant and lactating mothers have to observe and follow. Women who are suspicious of being expectant should confirm their suspicions with their doctors before taking any drugs. Both groups of mothers should visit their doctors and seek medical advice before taking any drugs. Women currently on hard drugs should seek help from the doctors and rehabilitation centers in order to protect the lives of their children. The government also has a role to play in the sense that they should conduct campaigns that would educate members of the public bout medicinal intake. It should also warn members of the public against using hard drugs since it not only affects pregnant and lactating mothers only but also the entire population. The government should also put strict security measure on the importation and manufacture of illegal drugs in the country. The Food and Drug Administration (FDA) should also include more information regarding the effects of medicinal drugs on expecting and breastfeeding women on the various labels of drugs. This will help reduce the side effects since it enables them make decisions on the type of drug they should use.

Conclusions

Pregnancy and lactation are the most important periods in the development of a child. Both lactating and expectant mothers are responsible for their child’s well-being. Usage of drugs during these periods has significant effects on the child while others do not. Some of the legal drugs result in adverse effects that may even lead to fetal cases. The most dangerous drugs are the hard drugs since their effects are more dangerous. Mothers in these stages have to consult clinicians before taking any form of drug. The health of both neonates and fetus depend on the care they receive from their mothers. Therefore, lactating and pregnant women should take necessary precautions regarding administration of drugs.

 

Works Cited:

Bedada, Worku, and Ephrem Engidawork. “The Neuropsychopharmacological Effects of Catha Edulis in Mice Offspring Born to Mothers Exposed During Pregnancy and Lactation.” Phytotherapy Research. 24.2 (2010): 268-276. Print.

Brent, Robert L, Mildred S. Christian, and Robert M. Diener. “Evaluation of the Reproductive and Developmental Risks of Caffeine.” Birth Defects Research Part B: Developmental and Reproductive Toxicology. 92.2 (2011): 152-187. Print.

Clifford, A, L Lang, and R Chen. “Effects of Maternal Cigarette Smoking During Pregnancy on Cognitive Parameters of Children and Young Adults: a Literature Review.” Neurotoxicology and Teratology. 34.6 (2012). Print.

Drug Use and Pregnancy. WebMD, 2014. Web. 30 April 30, 2014.

Effects of Marijuana on the Fetus and Breastfeeding Infants. Texas Tech University Health Sciences Center, 2014. Web. 30 April 30, 2014.

Ghanem, FA, and A Movahed. “Use of Antihypertensive Drugs During Pregnancy and Lactation.” Cardiovascular Therapeutics. 26.1 (2008): 38-49. Print.

Ghanem, Firas A, and Assad Movahed. “Use of Antihypertensive Drugs During Pregnancy and Lactation.” Cardiovascular Drug Reviews. 26.1 (2008): 38-49. Print.

Onu, J.E, B.O Oke, P.C Ozegbe, and J.O Oyewale. “Effects of Alcohol Consumption During Pregnancy And/or Lactation on the Morphology of Thyroid Gland in Male Wistar Rat Offspring.” Pakistan Veterinary Journal. 31.4 (2011): 357-359. Print.

Pennell, PB, BE Gidal, A Sabers, J Gordon, and E Perucca. “Pharmacology of Antiepileptic Drugs During Pregnancy and Lactation.” Epilepsy & Behavior: E&b. 11.3 (2007): 263-9. Print.

Rocha, Angelica. Acquisition of Cocaine and Heroin Self-Administration in Rats Developmentally Exposed to Lead. College Station, Tex: Texas A&M University, 2005. Print.