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Although subjects classified as slow metabolizers will probably have greater embryo­fetal exposure to desloratadine, and possibly to its active metabolite, there is no reported evidence that such exposure will result in embryo­fetal toxicity. In four studies, the outcomes of 16 pregnancies (12 women) were 14 normal newborns, one stillbirth (twins), and one elective abortion (6­9). Six pregnancy losses were recorded, four described earlier (6) and two new cases of fetal deaths at 18 and 26 weeks, both in women with lupus anticoagulant and previous fetal loss. No adverse effects, including bradycardia, were observed in the fetus or newborn, who was growing normally at 1 year of age. Onset of the pattern occurred 6 minutes after drug injection and persisted for approximately 58 minutes. Although the cause of the neurologic toxicity in the newborn was unknown, the authors could not rule out a possible role for the herbal preparation. However, the rates of perinatal deaths and congenital malformations did not differ between 3007 infants born to women heavily exposed to hexachlorophene in 31 hospitals and 1653 infants born to women working in 18 hospitals where the antiseptic was not used at all or was used only sporadically (19). However, the highest dose in rats was associated with embryo, fetal, and neonatal death, and reduced postnatal growth. No evidence of soft tissue, nerve, or muscle damage at the sites of injection was observed in the newborns. Eye examinations were conducted on the 2nd or 3rd day of life by one ophthalmologist who was blinded to the maternal smoking history. Direct treatment of fetal supraventricular tachycardia after failed transplacental therapy. At least one source considers the use of large amounts of garlic during pregnancy to be contraindicated because of the potential for inducing menstruation or uterine contractions (1). Crizotinib is metabolized to inactive metabolites and plasma protein binding is moderately high (91%). These antineoplastic agents may cause fetal injury by blocking the conversion of folic acid to tetrahydrofolic acid in both the fetus and the mother. After undergoing a craniotomy to remove the metastatic tumor and whole brain irradiation early in pregnancy, she was treated with docetaxel and cisplatin on days 1 and 8 every 21 days for four cycles (gestational weeks 9­18). Contribution to the question of side effects of chloramphenicol therapy in newborns. The American Academy of Pediatrics classifies butorphanol as compatible with breastfeeding (8). A number of studies have evaluated calcium supplementation with calcium carbonate to prevent or reduce the risk of hypertensive disorders in pregnancy (gestational hypertension and preeclampsia), preterm birth, maternal hemodynamic dysfunction, and long-term effects on the blood pressure of offspring (4­15). If all procedures for safe handling, such as those recommended by the Commission are complied with, the potential for exposure will be minimized. In either case, neonatal hypoglycemia secondary to glyburide appears to be a low risk. It is available only in combination with atropine (to discourage overdosage) for the treatment of diarrhea. However, other muscle relaxants are excreted in milk and do not appear to harm a nursing infant. Dopamine treatment for prevention of renal failure in patients with severe eclampsia. The clinical significance of these findings is unknown, but because these abnormalities may persist for several years, the potential existed for an increased risk of cancer as well as for a risk of genetic damage in the next generation (28). Because desloratadine is a major metabolite of loratadine, it is reasonable to presume that desloratadine also is not a major teratogen (1). The origin of oral clefts is multifactorial and involves both genetic and environmental factors, one of which is believed to be cigarette smoking. A brief 1993 report compared the closely related anesthetic agents, desflurane and enflurane (10 patients in each group), during cesarean delivery (6). Seven (23%) of the exposed infants were admitted to a neonatal intensive care unit (six respiratory distress, four meconium aspiration, and one cardiac murmur) compared with none of the controls (ns). However, a 1986 report described four women admitted to a hospital because of marked alcohol intoxication (56).

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When caffeine use was considered, daily consumption of 300 mg combined with smoking 15 cigarettes caused an additional significant reduction in weight. In a brief 1995 communication, a newborn exposed to gabapentin and carbamazepine during pregnancy had a cyclops holoprosencephaly (no nose and one eye) (9). It is indicated for the treatment of postmenopausal women with osteoporosis at high risk for fracture or for patients who have failed or are intolerant to other available osteoporosis therapy. The drug is teratogenic in mice and rats, but not in rabbits, at high doses (1­5). Because hairy cell leukemia usually has an indolent disease course, deferring treatment until after delivery may be appropriate (1). If the agent is used in pregnancy, the patient should be informed of the animal data and limited human pregnancy experience. Moreover, using microsomal preparations obtained from aborted 10- to 30-week-old human fetuses and live newborn infants, the average activity of O-demethylation was less than 1% of the adult value and did not begin to rise until after birth (6). Reproduction studies have been conducted with oral flunisolide in rats and rabbits. A 1999 publication described the use of epoprostenol for the treatment of pulmonary hypertension in three women in the 3rd trimester (18). Other reviewers have also stated that flurbiprofen can be safely used during breastfeeding (17,18). Unlike the thiazide diuretics, neonatal thrombocytopenia has not been reported for furosemide. The molecular weight (about 153,000) and minimal metabolism suggest that exposure of a nursing infant will be limited, if it occurs at all. Norfluoxetine concentrations in infant serum on day 13 and 21 were 58 and 57 ng/mL, respectively. A 2004 study examined the effect of inhaled corticosteroids on low birth weight, preterm births, and congenital malformations in pregnant asthmatic patients (4). No adverse effects were noted in the nursing infant from this small concentration. No malformations were observed in the surviving rabbit offspring, but only a few were available for examination (1). Systemic absorption is poor after ingestion of recommended doses, so the amount of alkaloids in milk is most likely very low. No transfer to the fetal side was noted in an ex vivo study, even with very high concentrations on the maternal side (2). Nitric oxide and prostacyclin inhibit fetal platelet aggregation: a response similar to that observed in adults. Suspected birth defect diagnoses occurred in 6564 offspring of 104,339 women in a retrospective analysis of women who had delivered in Michigan hospitals during 1980­1983 (6). Cord blood levels of the narcotic were always significantly lower than maternal serum levels (cord:maternal ratios were approximately 0. The uterine effects of halothane (relaxation and increased blood loss) also appear to be similar to those of other agents in this class. The high molecular weight (about 1621) should limit passive transfer across the placenta. The metabolites have low potencies and concentrations and are not significant contributors to the hypnotic activity of estazolam. Fetuses of women with the phenotype for slow dextromethorphan metabolism should have higher concentrations of the drug than fetuses of mothers with normal metabolism, but this may not be clinically significant in the absence of a demonstrated dose­effect. The main active constituents are thymoquinone, dithymoquinone, thymohydroquinone, and thymol (1,2). In another report, didanosine was given to pregnant mice in doses ranging from 10 to 300 mg/kg/day, through all or part of gestation, without resulting in teratogenic effects or other toxicity (2). No reports describing the outcomes of human pregnancies following the use of dinoprostone in failed medical abortions have been located. Because this is a relatively large molecule, it does not cross the placenta (2,3) and, thus, presents a low risk to the fetus. In six other pregnancies, hydroxychloroquine was started after conception, three during the 1st trimester. The cause of the anomalies was unknown, but it could not have been secondary to fluconazole because of the timing of the exposure.

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Because of the potential for severe adverse effects, breastfeeding is not recommended. Pancytopenia secondary to folate deficiency has also been reported during pregnancy (31). Approximately 50% of the agent is protein bound in the plasma and the metabolites are inactive (4). Treatment of allergy of the respiratory tract with beclomethasone dipropionate steroid aerosol. Moreover, the nearly complete absence of reported human pregnancy experience, combined with the expected frequent use in pregnancy, provides some reassurance that topical hydroquinone is not associated with embryo or fetal toxicity. The authors of this second report, however, could not exclude the fact that some men may be unusually sensitive to the drug, resulting in testicular toxicity (35). The clinical significance of occasional garlic odor in milk appears to relate only to the amount of time the infant will be attached to the breast and this effect will disappear if the mother ingests the herb frequently. A report published in 1994 assessed the neurological, cognitive, and behavioral development of 21 children (8­10 years of age) who had been exposed in utero to coumarin derivatives (26). Despite possible virilization of early behavior with characterization as "tomboys". A second episode of pancreatitis prompted labor induction at 35 weeks and a female infant (about 2355 g) with a 5-minute Apgar of 9 was delivered vaginally. Mean systolic blood pressures (supine/standing) before treatment were about 160/164 mmHg compared with 136/139 mmHg just before parturition. Hydroxyurea use during pregnancy: a case report in sickle cell disease and review of the literature. A survey of 117 users compared to 562 nonusers discovered that 14% of the former had given birth to a low-birth-weight infant vs. In other series, no correlation was found between low levels of folic acid and this complication (16,69,83). Studies with pregnant rats, mice, and baboons did not observe congenital malformations after in utero exposure to the agent during organogenesis (1­3). At follow-up, the physical and neurologic examination and developmental assessment were normal at 4. The agents were prepared without the use of vertical-airflow biologic-safety hoods or protective clothing (58). Paroxetine and fluoxetine in pregnancy: a multicenter, prospective, controlled study (abstract). The relatively low molecular weight (about 201 for the free base) suggests that dexmedetomidine will cross the human placenta, but the plasma protein binding and short terminal elimination half-life might limit the exposure of the embryo and/or fetus, at least early in gestation. However, the investigators cautioned that their results could not exclude the possibility that vitamins might be of benefit in a high-risk population. Except for respiratory distress due to prematurity and hyperkalemia that required treatment, the infant did well. On the first postpartum day, the mother took an oral analgesic product containing codeine 30 mg and acetaminophen 500 mg, 2 tablets every 12 hours, for episiotomy pain. Concentrations of prostanoids, cytokines, and nitric oxide were altered by the treatment, resulting in decrease in the incidence compared with controls of preterm parturition. Serum folate concentrations during pregnancy in women with epilepsy: relation to antiepileptic drug concentrations, number of seizures, and fetal outcome. Breastfeeding was not allowed in any of these studies and has been actively discouraged by most sources because of concerns for potential toxicity in the nursing infant (13,14,16). In a third case, a pregnant patient was treated with chlorambucil at the 10th week of gestation (5). A prospective observational cohort study from a Teratology Information Service in Berlin compared the pregnancy outcomes of four groups: exposure to glatiramer (N = 31) or interferon (N = 69) (either beta-1a (N = 48) or beta-1b (N = 21), women with multiple sclerosis not exposed to these agents (N = 64), and a healthy comparative group (N = 1556) (2). Although the number of exposures is small, these data are supportive of previous experience for a lack of association between the drug and congenital defects. The maximum concentrations of the active metabolite fexofenadine were 309 and 41 ng/mL, respectively-both occurring approximately 4 hours after the last dose. Although the specific components of garlic in the amniotic fluid were not identified, allicin (diallyl thiosulfinate) and at least one of its degradation products (diallyldisulfide) were most likely present because these are responsible for the characteristic odor of garlic (see above). Analysis of fetal development in rats following maternal exposure to subanesthetic concentrations of halothane.

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Fluconazole in Candida albicans sepsis during pregnancy: case report and review of the literature. These authors described nine pregnancies (plus seven from an earlier paper) in which hydroxychloroquine (200 mg/day) was used throughout gestation without producing congenital malformations. The Collaborative Perinatal Project monitored 50,282 mother­child pairs, 300 of whom took dextromethorphan during the 1st trimester (7, p. The drug is a potent antiemetic that is effective for the treatment of severe nausea and vomiting of pregnancy. Negative associations between anticonvulsant-induced folate deficiency and birth defects have also been reported (70,75). Three pregnant women with gastric hemorrhage secondary to peptic ulcer disease were described in a 1982 report (16). The molecular weight (about 605) and the terminal half-life are consistent with placenta transfer. If diazoxide is needed after other therapies have failed, small doses are recommended. It is unknown if the ability to respond to these challenges returns to normal after clearance of daclizumab (2). Three hours later, a cesarean section under general anesthesia was conducted because of persistent late decelerations in the fetal heart rate. Oral dosing in pregnant rats and rabbits did not cause congenital malformations (1). Since the maternal benefits of therapy are great, breastfeeding should be temporarily discontinued, at least until the therapy is completed and the drug eliminated from the maternal system. Following placement of a stent, the woman again experienced chest pain, and thrombus was discovered in three coronary arteries that were removed under coverage of abciximab and intracoronary adenosine. The use of dexamethasone for the pharmacologic suppression of the fetal adrenal gland has been described in two women with 21-hydroxylase deficiency (32,33). Risk of infantile hypertrophic pyloric stenosis after maternal postnatal use of macrolides. The molecular weight (about 447) and long elimination half-life suggest that gefitinib also will cross the human placenta. Pregnancy in established non-insulin-dependent diabetics: a five-and-a-half year study at Groote Schuur Hospital. A 4020-g newborn, whose mother had taken 100 mg/day of clomipramine, had symptoms similar to those observed in the first infant. Nageotte and coworkers (2) analyzed the same data to arrive at a different conclusion. Hepatotoxicity was observed, however, in newborn baboons and rhesus monkeys exposed to chenodiol during gestation (3,6). Erythropoietin has a mitogenic and positive chemotactic effect on endothelial cells. Use of remifentanil in a patient with Eisenmenger syndrome requiring urgent cesarean section. The molecular weight (about 287 for the free base), its low plasma protein binding (18%), and moderately long plasma elimination half-life (about 7 hours) suggest that galantamine will be excreted into breast milk. Two spontaneous abortions occurred: one at 7 weeks in a 44-year-old woman and one at 11 weeks in a 41-year-old diabetic patient. The mother was treated with bleomycin (30 mg), etoposide (165 mg), and cisplatin (55 mg) (all given daily for 3 days), 1 week before delivery, for an unknown primary cancer with metastases to the eye and liver. The next day, she was started on clopidogrel, aspirin, and propranolol and discharged home on these agents. Because the cells are injected intradermal they should not be in the systemic circulation. The molecular weight (about 369) suggests that the drug will be excreted into breast milk.

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No malformations were observed and, except for her small size and mild respiratory problems, she did well and was discharged home on day 50 of life. In both rats and rabbits, the maximum doses evaluated were by maternal toxicity (acute neurotoxicity) (1). A 2009 case report described a pregnant 40-year-old woman with severe primary hyperparathyroidism (2). Respiratory depression in the neonate similar to that produced by meperidine or morphine should be expected (1) (see also Codeine). Maternal drug use and its effect on neonates-a population-based study in Washington state. Two infants with birth defects were exposed to cimetidine: an encephalocele and an unstable hip (see Omeprazole for additional details of this study) (38). In: the Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. Antenatal betamethasone therapy: effects on maternal, fetal, and neonatal mineralocorticoids, glucocorticoids, and progestins. Potent topical corticosteroids also can cause structural anomalies after dermal application (2,3). The authors considered the anomalies relatively common with a benign prognosis (8). The broad categories of drug exposures associated with the syndrome were opioids and related narcotics, cocaine, and other psychotropic agents. The use of fluocinolone for the treatment of pruritus vulvae in 17 pregnant women was described in a 1967 reference (4). Two reports suggest an increased incidence of diarrhea in infants when nursing mothers are given cascara sagrada or senna for postpartum constipation (7,8). Is disordered folate metabolism the basis for the genetic predisposition to neural tube defects? Approximately 1 year before presentation, she had undergone a modified radical mastectomy followed by chemotherapy for treatment of breast cancer. Pyelonephritis in pregnancy: once-a-day ceftriaxone versus multiple doses of cefazolin. Secretion of cefoxitin in breast milk following short-term prophylactic administration in caesarean section. The total number of women (1776) was approximately equally divided among the four quarters. A study published in 1997 described the effects of continuous extradural bupivacaine and buprenorphine on analgesia and breastfeeding in 20 healthy women who had undergone a cesarean section at term (19). Of 1067 exposed pregnancies, famciclovir was taken during the 1st trimester in 7 pregnancies. Normal pregnancy after curative multiagent chemotherapy for choriocarcinoma with brain metastases. Her pregnancy was uncomplicated and she gave birth to a term, healthy, female infant whose birth weight (actual birth weight not specified) was appropriate for gestational age. Studies to evaluate the potential for carcinogenicity or potential effects on fertility have not been conducted. Studies for carcinogenicity in mice and rats were negative, as were various assays for mutagenic and clastogenic effects. Although no reports of toxicity in offspring that were attributable to bleomycin were observed, the most frequent adverse effects in adults involve the skin and mucous membranes. The average daily doses for medicinal indications are 4 g of fresh garlic, 8 mg of essential oil, and one or two fresh garlic cloves (1­5). Analysis of the atropine test for placental transfer in gravidas with toxemia and diabetes. One report calculated the amount of alcohol received in a single feeding from a mother with a blood concentration of 100 mg/dL (equivalent to a heavy, habitual drinker) as 164 mg, an insignificant amount (72). Until human experience is available, the safest course is to avoid fesoterodine in pregnancy. The two women were on a steadystate dose of glipizide (5-mg immediate-release tablet every morning for 6 and 15 days). Acute myocardial infarction associated with pregnancy successfully treated with percutaneous coronary intervention. Glucagon, insulin and glucose levels in maternal and umbilical cord plasma with studies of placental transfer.

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Based on the previous findings that prenatally exposed newborns had reduced pain responses, biobehavioral responses to acute pain (heel lance) were prospectively studied in 2-month-old infants. All of the women were treated during (gestational age of exposure not specified) or shortly before pregnancy for vaginal candidiasis, even though the authors noted that fluconazole was contraindicated for the treatment of this condition in pregnancy. Several limitations of the study that might have affected their findings were identified, including a general increase in childhood asthma but not necessarily an increase in allergic asthma (7). However, other investigators have questioned whether this study has accurately assessed the total caffeine intake of the women (19,20). She was treated conservatively with diclofenac while hospitalized (50 mg twice daily; duration not specified) and delivered a healthy female infant 5 weeks later. A 2006 report described six women taking quetiapine and other psychotropic agents during breastfeeding (13). Fetal renal insufficiency following trastuzumab treatment for breast cancer in pregnancy: case report and review of the current literature. In an earlier study, 20 women were administered a single, 200-mg bolus injection of cimetidine prior to delivery (19 vaginal, 1 cesarean section) (13). In contrast to bismuth, salicylate is rapidly absorbed with >90% of the dose recovered in the urine. Cimetidine (Tagamet) in peptic ulcer therapy during pregnancy: a report of three cases. Low-dose aspirin in prevention of miscarriage in women with unexplained or autoimmune related recurrent miscarriage: effect on prostacyclin and thromboxane A2 production. The strongest evidence for an association between folic acid and fetal defects comes from cases treated with drugs that either are folic acid antagonists or induce folic acid deficiency, although agreement with the latter is not universal (70,74,75). Prenatal administration of buprenorphine using the osmotic minipump: a preliminary study of maternal and offspring toxicity and growth in the rat. Maternal trough serum concentrations of buprenorphine and the metabolite, norbuprenorphine, obtained a few days before delivery were 0. In rats, the defects were hydrocephaly and microphthalmia, whereas those in rabbits were limb malformations and gastroschisis. In each of the cases, the electric current took a presumed hand-to-foot pattern through the body and, thus, probably through the uterus. Anticholinergic effects are much less frequent and less severe than those observed with other antidepressants. Both preparations are indicated for the acute treatment of migraine headaches with or without aura. The American Academy of Pediatrics classifies other cephalosporins as compatible with breastfeeding. These numbers are small, but no evidence was found to suggest any association with congenital abnormalities. The plasma half-life in newborns is significantly increased due to a decreased clearance of the drug. However, a possible association with retrolental fibroplasia in premature infants has been reported. There were no significant differences between the groups in terms of gestational age at birth, premature births, birth weight and length or, at followup, in sex distribution or gain in weight and length (expressed at percentage). Although growth restriction is a serious concern, the benefits of maternal therapy with -blockers, in some cases, might outweigh the risks to the fetus and must be judged on a case-bycase basis. During the neonatal period, the infant was treated for a urinary tract infection and jaundice. The highest daily average concentration of the drug ranged from 270 to 1529 ng/mL, with milk:plasma ratios on days 2, 3, 4, and 5 of 3. A 1988 correspondence listed 22 documented etretinate exposures during pregnancy in West Germany as of September 1988 (9). The placental transfer of the prostaglandin has not been characterized, but it is unlikely if clinically significant amounts of exogenous epoprostenol reach the fetus.

Diseases

• Pulmonary alveolar proteinosis
• Meier Blumberg Imahorn syndrome
• Aneurysm
• Sequeiros Sack syndrome
• Myxomatous peritonitis
• Reactive attachment disorder of early childhood
• Walker Dyson syndrome
• Chudley Rozdilsky syndrome
• Infantile sialic acid storage disorder
• Caratolo Cilio Pessagno syndrome

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A brief case report, published in 1997, described a normal outcome in the third pregnancy of a woman with levodopa-responsive dystonia (Segawa disease) who was treated throughout gestation with 500 mg/day of levodopa alone (10). Twelve hours after birth, the 3140-g male infant became dusky and was hypothermic (rectal temperature 35. On day 21, the milk concentrations of the drug and metabolite were 38 and 28 ng/mL (mixed milk), respectively. Reproductive studies with diphenhydramine in rats and rabbits at doses up to 5 times the human dose revealed no evidence of impaired fertility or fetal harm (2). Blood pressure was well controlled on this regimen, and no evidence of active lupus occurred during pregnancy. Milk concentrations of the metabolite ranged from "not detectable" (lower limit of detection 7 ng/mL) to 11 ng/mL. Dinoprostone is also available as a controlled-release vaginal insert and in gel form, and is used for cervical ripening in term or near-term pregnancies. Use during the 1st and 2nd trimesters has been associated with congenital and chromosomal abnormalities (21,28­30). Although the animal data suggest moderate risk, the human data are too limited to allow a complete assessment of risk to the embryo. Congenital anomalies in relation to the use of doxylamine/dicyclomine and other antenatal factors. In a surveillance study of Michigan Medicaid recipients involving 229,101 completed pregnancies conducted between 1985 and 1992, 31 newborns had been exposed to desipramine during the 1st trimester (F. The animal data are reassuring but more human pregnancy experience is required to assess the risk this agent presents to the embryo­fetus. Both kidneys were morphologically normal by renal ultrasonogram, but no urine output was observed, and no urine was found in the bladder. The animal reproduction data suggest low risk, but the doses tested were very low. In the three women who breastfed, their doses were 600, 1800, and 2100 mg/day, respectively. The remaining six women were being treated at the time of conception with 10­20 mg/day for essential hypertension or lupus-induced hypertension. The results of three other studies, one conducted in 12 Irish hospitals beginning in 1981 (53), one in Spain between 1974 and 1990 (54), and one in the United States and Canada from 1988 through 1991 (55,56), indicated that folic acid may be protective at a much lower dosage. The difference in the percentage of pregnancies may have been because all of the control women were married while the marriage status of the study women was not known (12). Reproduction studies have been conducted in mice, rats, and rabbits with oral doses of 0. Diatrizoate meglumine is a water-soluble contrast medium of organically bound iodine that is instilled directly into the bladder. Monuril Effectiveness and Tolerability in the Treatment and Prevention of Urinary Tract Infections. A randomized controlled trial of ginger to treat nausea and vomiting of pregnancy. Other antineoplastic agents in the subclass are capecitabine, floxuridine, fluorouracil, and gemcitabine. Two grossly bloody stools were observed in a nursing infant whose mother was receiving clindamycin and gentamicin (8). Environmental pollution and pregnancy: risks and uncertainties for the fetus and infant. She had taken the tablets periodically over the past 9 years and throughout her pregnancy. The closely related drug amphetamine is concentrated in breast milk with milk:plasma ratios ranging from 2. Moreover, preterm infants have been treated with epoetin alfa, a closely related agent. The lack of animal and human pregnancy experience prevents an assessment of the embryo­fetal risk. In addition to fluorouracil, other antineoplastic agents in the subclass are cytarabine, floxuridine, and gemcitabine. A second Registry report, published in 2006 and covering the years 1995­2003, analyzed the relationship between antidepressants and major malformations or cardiac defects (43).

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A 1988 case report described a woman with pregnancy-induced hypertension who was treated with methyldopa and verapamil for 6 weeks with poor control of her blood pressure (4). The pregnancy outcomes included gestational age at delivery, preterm delivery, birth weight, neonatal intensive care admission, and length of stay in the neonatal intensive care if admitted (21). In this study of 155 adult volunteers, 144 (93%) metabolized dextromethorphan rapidly, and 11 (7%) were poor metabolizers, but the poor (slow) drug metabolizer phenotype has been reported in 5%­10% of whites (6). There was no evidence of teratogenic effects or other fetal harm in animals (mice, rats, rabbits, and monkeys) given doses of 10 times or more the topical human dose by various routes of administration (1). A brief 2011 report described three women with multiple sclerosis who received glatiramer throughout gestation (4). Utilizing various concentrations of the drug in a whole-embryo culture system and direct administration to pregnant females (200 mg/kg subcutaneously every 4 hours for three doses) during organogenesis, in vitro vidarabine showed the highest potential to interfere with embryonic development, whereas in vivo acyclovir had the highest teratogenic potential. No accumulation in the milk was observed, as evidenced by a steady milk:plasma ratio. A prescription-event monitoring study, with special reference to the outcome of pregnancy. Bivalirudin is not bound to plasma proteins (other than thrombin) or to red blood cells (1). Therefore, the maternal benefits of balsalazide appear to outweigh the unknown risks to the fetus. Peak carisoprodol and meprobamate blood concentrations, obtained 2 hours postdose, were 3 and 9 mcg/mL, respectively, whereas the milk concentrations, obtained at the same time, were 1. Because the recommended dose is given over several weeks, use during pregnancy could result in multiple exposures of the embryo and/or fetus to a cytotoxic agent. Skeletal abnormalities were produced with high doses, but no other developmental toxic effects were observed. The American Academy of Pediatrics classifies chloral hydrate as compatible with breastfeeding (see Chloral Hydrate). It is indicated for monitored anesthesia care sedation in adult patients undergoing diagnostic or therapeutic procedures. Long-term heparin therapy during pregnancy has been associated with maternal osteopenia (15­19). It has also been used as an emmenagogue, antispasmodic, antirheumatic, laxative, or for colic, sore throat, hiccups, epilepsy, hysterics, and uterine inflammation (2,3). However, the extensive metabolism and protein binding will decrease the amount of parent drug available for transfer at the maternal:fetal interface. The molecular weight of the free base (about 584) and long elimination half-life suggest that the drug will cross the placenta, but the extensive protein binding will limit passage. From these cases, 10 infants had been born with congenital defects, at least 3 of which appeared to be genetic in origin. A significant decrease in the number of infections was documented without fetal toxicity. No gross defects were observed, but fetal death and growth restriction were noted. In one study, doses up to 13 times the human dose (presumed to be based on body weight) revealed no evidence of impaired fertility or fetal harm. After about 9­10 months of treatment, she was found to be pregnant and all therapy was stopped. Transplacental passage apparently has not been described in humans but should occur because of the low molecular weight (about 238). The dosage taken by the exposed group consisted of a single, 150 mg dose (N = 105, 47%), multiple doses of 150 mg (N = 81, 36%), 50-mg single dose (N = 3, 1%), 50-mg multiple doses (N = 23, 10%), 100-mg single dose (N = 5, 2%), or 100-mg multiple doses (N = 9, 4%). There were 627 outcomes exposed to didanosine (370 in the 1st trimester and 257 in the 2nd/3rd trimesters) in combination with other antiretroviral agents. Although the systemic absorption of capreomycin in a neonate has not been studied, <1% of an oral dose is absorbed by adults, so the risk, if any, to a nursing infant appears to be minimal. A 1978 publication noted 4 intrauterine fetal deaths occurring from a total of 39 pregnancies following danazol treatment, presumably after elimination of the drug from the mother (18). No adverse fetal effects were observed in pregnant rats administered chlorhexidine by gastric intubation on days 6 through 15 of gestation (2). In comparison to the group of 20 cases from the literature, there were significant differences discovered in the number of live births (94% vs.

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Regardless, mothers taking hydrocodone products while breastfeeding should observe their infants for breathing difficulty, sedation, excessive sleepiness, gastrointestinal effects, and changes in feeding patterns. It is indicated to reduce the frequency of painful crises and to reduce the need for blood transfusions in adult patients with sickle cell anemia with recurrent moderate to severe painful crises. She subsequently delivered a healthy but growthrestricted (1650-g; <10th percentile) infant. At the highest dose, abortions and severe external or soft-tissue malformations were observed. Nagao T, Kuwagata M, Saito Y Effects of prenatal exposure to 5-fluoro-2-deoxyuridine on developing. Her condition markedly improved after the glucagon, but intrauterine fetal death had occurred and an induced abortion was performed 10 days later (10). This is consistent with the molecular weights of the two compounds, about 288 and 371, respectively. The authors concluded not only that cocaine impaired fetal growth but also that urine assays (or another biologic marker) were important to show the association (3). Induced abortions, however, occurred in significantly more cefuroxime-exposed women than in controls, possibly due to misinformation and misperception of the risk the antibiotic posed to a pregnancy (12). Five women with chorioamnionitis and in labor received cefotaxime (dose not specified) (3). Sporadic anomalies have been reported, but these are not believed to be related to the drug therapy (23,27). The elimination half-life of clomipramine in the infant during the first week, when the male infant was not breastfeeding, was 92. Successful pregnancy outcome in paroxysmal nocturnal haemoglobinuria on long term eculizumab. Exposure of rats throughout gestation and lactation was associated with decreased pup weights and increased pup deaths during the first 4 days of lactation. In rats, however, there was a decrease in pup weight and an increase in pup deaths during lactation. Moreover, ergotamine is a member of the same chemical family as bromocriptine, an agent that is used to suppress lactation. Steady-state cord and amniotic fluid ceftizoxime levels continuously surpass maternal levels. A 1998 noninterventional observational cohort study described the outcomes of pregnancies in women who had been prescribed one or more of 34 newly marketed drugs by general practitioners in England (3). Prevention of the first occurrence of neural-tube defects by periconceptional vitamin supplementation. The data were adequate to suggest that citalopram, fluoxetine, sertraline, and venlafaxine were not associated with an increased risk of congenital defects. She developed well-compensated Heinzbody hemolytic anemia 6 days after starting dapsone. The authors attributed the hyperbilirubinemia to flecainide because no other cause of the toxicity could be found and the drug is known to produce a similar condition in adults. Gabapentin exposure in human pregnancy: results from the gabapentin pregnancy registry. The cases were divided into five mutually exclusive treatment groups: nonsterilizing surgery, chemotherapy with alkylating agents, abdominal­pelvic radiation, alkylating agents plus abdominal­pelvic radiation, and all other treatments. A thorough macroscopic and microscopic examination of the male fetus revealed no evidence of malformation. The mutagenic effects of colchicine and the possible relationship of this drug to sperm abnormalities and congenital malformations were the subjects of several publications (25­32). A malformed fetus was discovered after voluntary abortion in a patient with renovascular hypertension (9). Neonatal withdrawal consisting of severe tremulousness and irritability has been attributed to maternal use of chlordiazepoxide (10). Bendamustine is indicated for the treatment of patients with chronic lymphocytic leukemia. Four weeks later, the woman gave birth to a 2950-g normal male infant who was doing well at 1 year of age (23). Citing previously published data, a 1999 study listed the concentrations of the quinolizidine alkaloids found in some blue-cohosh-containing dietary supplements: N-methylcytisine 5­850 ppm, anagyrine 2­390 ppm, and baptifoline 9­900 ppm (the lower concentrations were found in liquid-extract products) (6). No effects were observed on the progression of labor and none of the women had nausea or vomiting.

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Because the infants were not hospitalized, the authors could not determine if either infant experienced an adverse reaction. Of the 11 children, 2 were dead, 1 was lost to follow-up, 4 had borderline intelligence with continued growth deficiency and were dysmorphic, and 4 had severe intelligence deficiency as well as growth deficiency and dysmorphic appearance. A 1992 review of tuberculosis and pregnancy stated that the safety of capreomycin in pregnancy was not established, but cited no references of its use (1). Drug abuse patterns in both groups were determined by interview, which may have introduced classification error into the results, but the authors reasoned that any error would have underestimated the actual effect of the cocaine exposure (21). The effect of glucocorticoids on the maturation of premature lung membranes: preventing the respiratory distress syndrome by glucocorticoids. There were 16 birth defects (14 exposures in the 1st trimester and 2 in the 2nd/3rd trimesters). Oral clefts, transforming growth factor alpha gene variants, and maternal smoking: a population-based case-control study in Denmark, 1991­1994. Progestational agents to prevent preterm births: a metaanalysis of randomized controlled trials. Carbamazepine: placental transport, tissue concentrations in the foetus and newborns, and level in milk. Although it has weak partial agonist activity in some animals, flumazenil has little or no agonist action in humans. Studies for carcinogenicity have not been conducted with decitabine, but the drug was mutagenic and caused chromosomal rearrangements in larvae of fruit flies. Other publications have described the successful use of flecainide for the treatment of fetal tachycardia (8­14), and in one of these, flecainide and digoxin were considered the drugs of choice for this condition (8). Among these cases, 31 were still pregnant, 572 were lost to follow-up, and there were 1005 known outcomes (includes 9 sets of twins and 1 set of triplets). A healthy 3100-g male infant was delivered, without evidence of hematologic abnormalities, whose growth and development remain normal at 32 months of age (6). The American Academy of Pediatrics classifies antidepressants as drugs for which the effect on nursing infants is unknown but may be of concern (10). In this 1998 case report, a 32-year-old woman with bipolar disorder took buspirone (45 mg/day), fluoxetine (20 mg/day), and carbamazepine (600 mg/day) throughout pregnancy and during the first 3 weeks postpartum (4). The authors of the above report cited knowledge of 27 other pregnancies in which danazol had been accidentally used (6). Captopril and acebutolol were used throughout pregnancy to treat a woman with nephrotic syndrome and arterial hypertension (15). The effect of ginger root on postoperative nausea and vomiting after major gynaecological surgery. Plasma and milk concentrations of dicyclomine 2 hours after the dose were 59 ng/mL and 131 ng/mL (milk:plasma ratio 2. In a 2000 case report, a 27-year-old woman at 38 1/7 weeks was bitten by a black widow spider (6). The American Academy of Pediatrics classifies ceftriaxone as compatible with breastfeeding (11). Cyclophosphamide is one of the most common causes of chemotherapyinduced menstrual difficulties and azoospermia (37­45). The drug is extensively protein bound (about 96%) in the plasma, primarily to albumin (about 75%) and 1-acid glycoprotein. Data from one review indicated that 40% of the infants exposed to anticancer drugs were of low birth weight (20). Anaesthesia for caesarean section in the presence of multivalvular heart disease and severe pulmonary hypertension: a case report. Sued O, Lattner J, Patterson P, Abusamra L, Cesar C, Fink V, Krolewiecki A, Cahn P. Reversible inhibition of lung cell number after glucocorticoid injection into fetal rabbits to enhance surfactant appearance. The two mothers on chronic therapy observed no adverse effects in their nursing infants.