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Diabetes is another common complication of pregnancy. How safe are drugs used to manage this condition?
Pre-existing diabetes in this age group will almost always be controlled with insulin. The woman will almost always be on this already. In the unlikely event that she has used dietary control, conception will almost certainly mean a switch to insulin..
Insulin is not only safe, it is actually beneficial in preventing birth defects. Those diabetic mothers whose diabetes had been well controlled before conception reduce the risk of congenital malformation quite significantly. In poorly controlled diabetics, the risk of major malformation in their children is up to three times that of the general population.
Insulin is not only safe, it is actually beneficial in preventing birth defects. Those diabetic mothers whose diabetes had been well controlled before conception reduce the risk of congenital malformation quite significantly. In poorly controlled diabetics, the risk of major malformation in their children is up to three times that of the general population.
Apart from insulin, what drugs are used to control diabetes in pregnancy?
In non-pregnant individuals, there is a place for what are known as "oral hypoglycaemics". These have an effect of lowering blood-sugar levels, to various degrees. Most of them (Chlorpropamide, Glibenclamide, Gliquidone, Glipizide and Tolbutamide) cross the placenta and are likely to cause a catastrophic fall in fetal blood-sugar. They are not used in pregnancy.
Metformin (Glucophage®) is one oral hypoglycaemic that does not cross the placenta and therefore has no direct effect on the fetus. Even with this known fact, it is not usually used in pregnancy. This is because insulin is infinitely better and more reliable. There has been some debate that in desperate situations - such as with some very obese diabetic expectant mothers - where insulin has failed to bring about the required control, metformin may be a useful supplement. This is contentious and, fortunately, the need to put it into practice rarely arises.
Metformin (Glucophage®) is one oral hypoglycaemic that does not cross the placenta and therefore has no direct effect on the fetus. Even with this known fact, it is not usually used in pregnancy. This is because insulin is infinitely better and more reliable. There has been some debate that in desperate situations - such as with some very obese diabetic expectant mothers - where insulin has failed to bring about the required control, metformin may be a useful supplement. This is contentious and, fortunately, the need to put it into practice rarely arises.
Systemic Lupus Erythematosus (SLE) in Pregnancy
Some people suffering from SLE are maintained on "antimalarials" such as hydroxy-chloroquine (Plaquenil®). What is the advice regarding their use in pregnancy?
These drugs are very effective in controlling the disease. Discontinuing their use can cause a flare-up of the disease. Moreover, such a step may increase the risk of miscarriage or fetal death in the uterus quite substantially. It is known for a fact that women suffering from SLE are prone to repeated pregnancy loss. Stopping this medication will therefore not only have an adverse effect on the mother but on the fetus as well. It is also true that there is no evidence that use of this drug in pregnancy has any adverse effect on the baby, short or long-term. Plaquenil® is also used for active rheumatoid arthritis.
There is a wide choice of cough preparations on the market. How safe are these for use in pregnancy?
For coughs, there are two main groups of preparations: the cough suppressants and the expectorants.
Cough suppressants are marketed with a claim that they will reduce the frequency and intensity of coughing. Their effect is modest at best and they may help the person to sleep better. Most of them are based on opioids, especially codeine and sedatives such as diphenhydramine.
Those containing codeine will tend to cause constipation. Constipation is a common problem in pregnancy and if the pregnant woman is already having this trouble, then she should think hard before taking such preparations. They are likely to make the problem worse without really giving her much benefit.
Those cough suppressants based on sedatives will cause drowsiness and may not be ideal for a pregnant woman who is working, looking after small children or needs to drive. Their effectiveness, again, is modest at best.
Cough suppressants are marketed with a claim that they will reduce the frequency and intensity of coughing. Their effect is modest at best and they may help the person to sleep better. Most of them are based on opioids, especially codeine and sedatives such as diphenhydramine.
Those containing codeine will tend to cause constipation. Constipation is a common problem in pregnancy and if the pregnant woman is already having this trouble, then she should think hard before taking such preparations. They are likely to make the problem worse without really giving her much benefit.
Those cough suppressants based on sedatives will cause drowsiness and may not be ideal for a pregnant woman who is working, looking after small children or needs to drive. Their effectiveness, again, is modest at best.