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Prescribing in Pregnancy, Fourth Edition BLUK112-Rubin October 10, 2007 10:41 Prescribing in Pregnancy BLUK112-Rubin October 10, 2007 10:41 Prescribing in Pregnancy Fourth edition Edited by Peter Rubin Nottingham University Hospitals Queen’s Medical Centre Campus Nottingham, UK Margaret Ramsay Nottingham University Hospitals Queen’s Medical Centre Campus Nottingham, UK BLUK112-Rubin October 10, 2007 10:41 C 2000 BMJ Publishing Group C 2008 by Blackwell Publishing BMJ Books is an imprint of the BMJ Publishing Group Limited, used under licence Blackwell Publishing, Inc., 350 Main Street, Malden, Massachusetts 02148-5020, USA Blackwell Publishing Ltd, 9600 Garsington Road, Oxford OX4 2DQ, UK Blackwell Publishing Asia Pty Ltd, 550 Swanston Street, Carlton, Victoria 3053, Australia The right of the Author to be identified as the Author of this Work has been asserted in accordance with the Copyright, Designs and Patents Act 1988. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, except as permitted by the UK Copyright, Designs and Patents Act 1988, without the prior permission of the publisher. First published 1987 Second Edition 1995 Third Edition 2000 Fourth Edition 2008 1 2008 Library of Congress Cataloging-in-Publication Data Prescribing in pregnancy / edited by Peter Rubin, Margaret Ramsay. – 4th ed. p. ; cm. ISBN 978-1-4051-4712-5 (pbk.) 1. Obstetrical pharmacology. I. Rubin, Peter C. II. Ramsay, M. M., M.D. [DNLM: 1. Drug Therapy. 2. Pregnancy. 3. Pharmaceutical Preparations–administration & dosage. 4. Pregnancy Complications–drug therapy. WQ 200 P932 2007] RG528.P74 2007 618.2’061–dc22 2007017554 ISBN: 978-1-4051-4712-5 A catalogue record for this title is available from the British Library Set in 9.5/12pt Meridien by Aptara Inc., New Delhi, India Printed and bound in Singapore by Markono Print Media Pte Ltd Commissioning Editor: Mary Banks Editorial Assistant: Victoria Pittman Development Editor: Simone Dudziak Production Controller: Rachel Edwards For further information on Blackwell Publishing, visit our website: http://www.blackwellpublishing.com The publisher’s policy is to use permanent paper from mills that operate a sustainable forestry policy, and which has been manufactured from pulp processed using acid-free and elementary chlorine-free practices. Furthermore, the publisher ensures that the text paper and cover board used have met acceptable environmental accreditation standards. Blackwell Publishing makes no representation, express or implied, that the drug dosages in this book are correct. Readers must therefore always check that any product mentioned in this publication is used in accordance with the prescribing information prepared by the manufacturers. The author and the publishers do not accept responsibility or legal liability for any errors in the text or for the misuse or misapplication of material in this book. BLUK112-Rubin October 10, 2007 10:41 Contents Contributors, vii Preface, xi 1 Identifying fetal abnormalities, 1 Lena M. Macara 2 Treatment of common, minor and self-limiting conditions, 16 Anthony J. Avery, Susan L. Brent 3 Antibiotics in pregnancy, 36 Tim Weller, Conor Jamieson 4 Anticoagulants in pregnancy, 56 Bethan Myers 5 Treatment of cardiovascular diseases, 77 Asma Khalil, Pat O’Brien 6 Treatment of endocrine diseases, 89 Anastasios Gazis 7 Drugs in rheumatic disease during pregnancy, 98 Mary Gayed, Caroline Gordon 8 Psychotropic drugs in pregnancy, 114 Neelam Sisodia 9 Managing epilepsy and anti-epileptic drugs during pregnancy, 126 Michael F. O’Donoghue, Christine P. Hayes 10 Treatment of diabetes in pregnancy, 150 Nick Vaughan, Kate Morel, Louise Walker 11 Treatment of asthma, 168 Catherine Williamson, Anita Banerjee 12 Drugs of misuse, 187 Mary Hepburn v BLUK112-Rubin October 10, 2007 10:41 vi Contents 13 Prescribing for the pregnant traveller, 205 Pauline A. Hurley 14 Drugs in breastfeeding, 216 Jane M. Rutherford Index, 231 BLUK112-Rubin October 10, 2007 10:41 Contributors Anthony J. Avery, DM, FRCGP Nottingham University Hospitals Professor of Primary Health Care Queen’s Medical Centre Campus Division of Primary Care Nottingham, UK School of Community Health Sciences Caroline Gordon, MRCP Nottingham University Hospitals Reader and Consultant in Queen’s Medical Centre Campus Rheumatology Nottingham, UK Department of Rheumatology Division of Immunity and Anita Banerjee, BSc, MBBS, MRCP Infection SpR Endocrinology and Diabetes Medical School Mellitus University of Birmingham Endocrinology Department Birmingham, UK Hammersmith Hospital London, UK Christine P. Hayes, MPhil, Susan L. Brent, BSc (Hons), BSc (Hons) MRPharmS Epilepsy Specialist Nurse Director of Pharmacy Neurosciences Regional Drug and Therapeutics Nottingham University Hospitals Centre Queen’s Medical Centre Campus Wolfson Unit Nottingham, UK Newcastle upon Tyne, UK Mary Hepburn, BSc, MD, MRCGP, Mary Gayed, MBChB FRCOG Academic Foundation Year Two Consultant Obstetrician Doctor Princess Royal Maternity City Hospital Glasgow, UK Sandwell and West Birmingham Hospitals NHS Trust Birmingham, UK Pauline A. Hurley, FRCOG Consultant Obstetrics, Fetal Anastasios Gazis, DM, MRCP Medicine Consultant Physician The Women’s Centre Department of Endocrinology and John Radcliffe Hospital Diabetes Oxford, UK vii BLUK112-Rubin October 10, 2007 10:41 viii Contributors Conor Jamieson, BSc, PhD, Margaret M. Ramsay, MA, MD, MRPharmS MRCP, FRCOG Principal Pharmacist – Consultant in Fetomaternal Anti-infectives Medicine Heart of England NHS Foundation Nottingham University Hospitals Trust Queen’s Medical Centre Campus Birmingham, UK Nottingham, UK Asma Khalil, MB, BCh Peter C. Rubin, MA, DM, FRCP Senior Research Fellow Professor of Therapeutics Homerton University Hospital Nottingham University Hospitals London, UK Queen’s Medical Centre Campus Nottingham, UK Lena Macara, MD, FRCOG Consultant Obstetrician Jane M. Rutherford, DM, MRCOG The Queen Mother’s Hospital Consultant in Fetomaternal Glasgow, UK Medicine Department of Obstetrics Nottingham University Hospitals Kate Morel Queen’s Medical Centre Campus Diabetes Nurse Specialist Manager Nottingham, UK Brighton and Sussex University Hospitals NHS Turst Neelam Sisodia, MBBS, MA, Brighton, UK MRCPsych Consultant in Perinatal Psychiatry Bethan Myers, MA, MRCP, Perinatal Psychiatric Service FRCPath, DTM & H Mother and Baby Unit Consultant Haematologist Nottingham University Hospitals Department of Haematology Queen’s Medical Centre Campus Nottingham University Hospitals Nottingham, UK Queen’s Medical Centre Campus Nottingham, UK N.J.A. Vaughan MA, MD, FRCP Consultant Endocrinologist Pat O’Brien, MRCOG Brighton and Sussex University Obstetric Lead Hospitals Trust University College London Royal Sussex County Hospital Hospitals Brighton, UK London, UK Louise Walker, RD Michael F. O’Donoghue, BSc, MB Specialist Diabetes Dietician BS, MD, MRCP (UK) Diabetes Centre Consultant Neurologist Brighton and Sussex University Nottingham University Hospitals Hospitals Queen’s Medical Centre Campus Royal Sussex County Hospital Nottingham, UK Brighton, UK BLUK112-Rubin October 10, 2007 10:41 Contributors ix Tim Weller, MBChB, MD, Catherine Williamson, FRCPath (deceased) MD, MRCP Previously Consultant Senior Lecturer in Obstetric Microbiologist Medicine Department of Microbiology Hammersmith Hospital City Hospital Imperial College Birmingham, UK London, UK BLUK112-Rubin October 10, 2007 10:41 Preface The use of drugs in women who are pregnant or breast feeding is a question of fine balance. Harm may befall a baby because a drug has been used, but mother and baby could suffer if a disease goes untreated. Information about the safe and effective use of drugs in pregnancy has not kept pace with the advances in other areas of therapeutics. Systematic research involving drugs in pregnancy is fraught with ethical, legal, emotional and practical difficulties and in many cases our knowledge is based on anecdote or small studies. The purpose of this book is to bring together what is known about prescribing in pregnancy and to put that information in a clinical context. The first three editions were well received and this has encouraged us to produce a fourth edition. All chapters have been extensively revised or rewritten, with several new authors bringing their clinical experience of this challenging subject. We would like to thank Louise Sabir who once again has done much behind-the-scenes work in contacting authors. Acknowledgement Dr Weller died suddenly while training for the London Marathon shortly after submitting his chapter. He had also contributed to the third edition and we gratefully acknowledge the professional manner in which he approached these tasks. Peter Rubin Margaret Ramsay Nottingham xi BLUK112-Rubin October 9, 2007 10:34 CHAPTER 1 Identifying fetal abnormalities Lena M. Macara Key points r Days 18–55 postconception is the time of maximal teratogenic potential when most organs are differentiating r Teratogenic effects of medications may affect both organ structure and organ function r Detailed ultrasound assessment of the fetus by trained personnel should detect most major structural abnormalities, but minor abnormalities are often undetected r Patients at risk of neural tube defects (NTDs) should have 5 mg of folic acid daily for a minimum of 6 wk prior to conception Introduction It is estimated that 2–3% of all pregnancies in the United King- dom are affected by congenital abnormality.
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