Drug selection during pregnancy

and lactation
General advices for pregnant
women
Nutrition:
1)Fruit and vegetables:
 They provide the vitamins and minerals as well as fibre which helps
digestion and prevents constipation.
 Citrus fruits, tomatoes, broccoli and peppers are good sources of
vitamin C, which the pregnant woman needs to help her absorb iron.

2)Starchy foods:
 They must be found in any meal.
 A pregnant woman will get the optimum benefit from foods like
bread, potatoes, rice, sweet potatoes and breakfast cereals.

3)Lean meat, fish, poultry, fish, eggs, beans and cheese:

 A pregnant woman should eat moderate amounts of these foods.
 They are important for their iron content.
 They should be cooked with minimum amount of fat, and skin from
poultry should be removed completely.
 Oily fish should be eaten at least once a week to provide vitamin D.

4)Dairy foods and milk:

 They are important as they contain calcium and other nutrients
needed for the baby’s development.
 Calcium is vital for making bones and teeth.
 Pregnant woman should choose low-fat varieties whenever possible
and eat moderate amounts.

Take care !!!

1) Cook all meat and poultry thoroughly so that there is

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no trace of pink or blood and wash all surfaces and utensils after
preparing raw meat. This will help avoid infection with Toxoplasma,
which may cause toxoplasmosis and can harm the baby.

2) Wash fruit, vegetables and salads to remove all traces of soil which
may contain Toxoplasma.

3) Make sure eggs are thoroughly cooked until the whites and yolks are
solid, to prevent the risk of Salmonella food poisoning so avoid foods
containing raw and undercooked eggs like ice-cream, cheesecake or
mousse.

4) Avoid blue veined cheese because of the

risk of Listeria infection. You can eat hard cheeses such as cheddar, and
other cheeses made from pasteurised milk such as cottage cheese,
mozzarella cheese and cheese spreads.

5) Drink only pasteurised milk which has had the harmful germs
destroyed.

6) Don’t eat liver or liver products as they may contain a lot of vitamin
A. Too much vitamin A could harm your baby. You should also avoid
high-dose multivitamin supplements, fish liver oil supplements or any
supplements containing vitamin A.

7) Avoid eating shark, marlin and swordfish and limit the amount of tuna
you eat, as these types of fish contain high levels of mercury which can
damage the baby’s developing nervous system. This also applies for
lactating mothers.

8) Avoid eating peanuts and foods containing peanut products (e.g.

peanut butter, peanut oil,) if you or your husband have a history of
hayfever, asthma, eczema or other allergies.

9) Cut down on sugar and sugary foods like sweets, biscuits and cakes
and sugary drinks like cola. Sugar contains calories without providing any
other nutrients the body needs. It also adds to the risk of tooth decay.

10)Cut down on fat and fatty foods. Fat is very high in calories and too
much can increase the risk of heart disease, and it can contribute to

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being overweight.Avoid fried foods, trim the fat off meat, use spreads
sparingly and go easy on foods like pastry, chocolate and chips which
contain a lot of fat.

Physical activity:
It is very important for a pregnant woman to exercise to adapt easily to
her changing shape and weight gain.

Some important tips:

1) If you were inactive before you were pregnant, don’t suddenly take
up strenuous exercise.
2) Try to keep active on a daily basis.
3) Avoid any strenuous exercise in hot weather.
4) Drink plenty of fluids.
5) Some of the very important exercises for a pregnant woman are:
a) Stomach strengthening exercises
b) Pelvic tilt exercises.
c) Pelvic floor exercises.
d) Foot exercises.
6) Swimming helps pregnant women adapt to their weight gain.
7) Protect your back by:
i) Sitting up straight with your bottom against the back of your
chair. Tuck a small cushion behind your waist.
ii) When picking something up, bend your knees not your back.
iii) Try to stand tall.

Drug Selection
Pregnancy-influenced issues:
1) Constipation:
Safe & recommended:
 Physical exercise
 Dietary fibers and fluid
 Lactulose
 Sorbitol
 Bisacodyl

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  Psyllium
Egs of High Fiber Foods:
Grain Products
Fruits: such as apricots, dates, prunes and raisins, berries such as
blackberries, blueberries, raspberries and strawberries, oranges,
apple with skin, avocado, kiwi, mango and pear
Vegetables: such as broccoli, spinach, green peas and other dark
green leafy vegetables, dried peas and beans
Nuts and Seeds: such as almonds, whole flaxseed and soynuts

Contraindicated:
 Castor oil
 Mineral oil
 Senna

2)GERD
Safe & recommended:
 Small, frequent meals
 Food avoidance 3 hours before bedtime
 Elevation of the head off the bed
 Aluminum, calcium, or magnesium antacids
 Sucralfate
 Ranitidine
 Lansoprazole, omeprazole
 Metoclopramide

Contraindicated:
 Sodium bicarbonate
 magnesium trisilicate

3) Hemorrhoids:
Safe & recommended:
 lie on your side when reading or watching TV
 Dietary fiber & fluids
 Sitz baths
 Topical anesthetics(eg: lidocaine)
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  Skin protectants & astringents

# Sitz baths (hip bath) is a type of bath in which only the hips and
buttocks are soaked in water or saline solution. Its name comes from the
German verb "sitzen," meaning "to sit."

Contraindicated:
 Sitting for long periods(which puts pressure on the veins in your
anus and rectum)

4) Nausea and Vomiting:

Safe & recommended:
 Eating small, frequent meals
 Antihistamines (e.g. doxylamine)
 Vitamins (e.g. pyridoxine, cyanocobalamine)
 Dopamine antagonists (e.g. metoclopramide)

Contraindicated:
 Fatty foods
 Acupressure(application of pressure on specific points on the
body)
 Acustimulation(Mild electrical stimulation of acupuncture points
done to control symptoms such as nausea and vomiting)
 Dexamethasone or prednisolone(the risk of oral clefts for
newborn is increased)

5) Gestational diabetes mellitus:

Safe & recommended:
 Nutritional and exercise interventions
 Caloric restrictions for obese women
 Recombinant human insulin

6) Hypertension:
Safe & recommended:
 Methyldopa

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Contraindicated:
 ACE inhibitors
 Labetalol
 Calcium channel blocker

In cases of very high blood pressure in pregnancy:

Contraindicated:
 Magnesium sulfate
 high-dose diazoxide
 nimodipine
 chlorpromazine

7) Headache & migraine:

Safe & recommended:
 Exercise and massage
 ice packs(a plastic sac of crushed or cubed ice, refrigerant gel or
liquid, or even frozen vegetables can absorb a considerable
amount of heat)
 Acetaminophen

Contraindicated:
 NSAIDs
 If possible, avoid Salicylates and indomethacin

8) Urinary tract infection:

Safe & recommended:
 Cephalexin
 Nitrofurantoin (but should not be used after 9th month because it
may cause hemolytic anemia in the newborn)

Contraindicated:
 Sulfa-containing drugs
 Folate antagonists (e.g. trimethoprim).
 Fluoroquinolones and tetracyclines.

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9)Allergic rhinitis and asthma:
Here we follow benefit against risk concept
 β2- agonist (albuterol is preferred)

 corticosteroids (e.g. Budesonide & Beclomethasone)

 Nasal cromolyn and first-generation antihistamines

(chlorpheniramine, tripelennamine, and cydroxyzine)

10) Dermatologic conditions:

Safe & recommended:
Topical agents :

 Bacitracin
 Clindamycin
 Erythromycin
 Metronidazole
 Mupirocin
 Permethrin
 Terbinafine
 Calamine
 Benzoyl peroxide

Systemic agents:

 Acyclovir
 Amoxicillin
 Azithromycin
 Cephalosporins
 Dicloxacillin
 Nystatin
 Penicillin
 Chlorpheniramine
 Diphenhydramin

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Contraindicated:
 Acitretin
 Tetracycline
 Fluorouracil
 Isotretinoin
 Methotrexate
 Thalidomide

11) Epilepsy:
Safe & recommended:
 If drug withdrawal is planned, it should be done at least 6 months
prior to conception.
 All women with epilepsy should take a folic acid supplement 0.4 to
5 mg daily.
 To correct vitamin K deficiency in newborns, women should take
10 mg oral vitamin K1 daily during the last month of pregnancy.

Contraindicated:
 Benzodiazepines
 Carbamazepine
 Phenobarbital
 Phenytoin
 Valproic acid

12)Cold and Flu:

Safe & recommended:
 Acetaminophen
 Warm salt/water gargle
 Saline nasal drops or spray

Contraindicated:
 NSAIDs
 Most antihistamines, decongestants and cough medicines(except
when the physician approves them)

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 Drug use during lactation

1) Mastitis:
Safe & recommended:
 Bedrest
 adequate oral fluid intake
 frequent evacuation of breast milk
 analgesia
 10 to 14 days of antibiotic therapy for the mother (cloxacillin,
dicloxacillin, oxacillin, or cephalexin)
 local creams (mainly contain panthenol )

2) Postpartum depression:
Safe & recommended:
 emotional support from family and friends
 education about the condition
 psychotherapy
 Tricyclic antidepressants and SSRIs(treatment should be
continued for at least 29 weeks)
 Nortriptyline, amitriptyline, clomipramine, desipramine,
fluvoxamine, and bupropion have been used successfully.

3) Relactation:
Safe & recommended:
Metoclopramide

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