Key Points
Preconception Counseling: Educate women on optimizing health before
pregnancy, such as folic acid supplementation, managing chronic
conditions, and avoiding teratogenic medications.2. Medication Factors:
Consider medication safety for both mother and fetus/lactating infant.3.
Educational
Pregnancy and Lactation Labeling Rule (PLLR): Emphasizes narrative
Objectives
sections over simple letter grades for more nuanced risk assessment.4.
Over the Counter (OTC) Guidance: Safe OTC medications during
pregnancy, such as acetaminophen for fever.
For a woman trying to conceive:
- Supplementation: Recommend folic acid (400–800 mcg daily) to
prevent neural tube defects.
Case 1: - Chronic Conditions: Optimize management of conditions like diabetes
Preconception and hypertension.
Counseling - Medication Review: Evaluate current medications for teratogenic risks
and adjust as necessary.
The PLLR replaces the outdated A-B-C-D-X system. It includes three
narrative sections:
Pregnancy and - Pregnancy (including labor/delivery): Risks to the fetus.
Lactation Labeling -Lactation: Effects on breastfed infants and milk production.
Rule -Reproductive potential: Guidance for women and men of childbearing
age (e.g., contraception recommendations). This system allows more
detailed and individualized risk assessments compared to broad categories.
- Risk-Benefit Analysis: Weigh potential maternal benefits against
fetal/lactation risks.
- Gestational Age: Certain medications (e.g., NSAIDs) are safer or more
Factors Influencing dangerous depending on pregnancy stage.
Medication - Resources: Use evidence-based tools like LactMed, the FDA PLLR, or
Prescribing guidelines from ACOG (American College of Obstetricians and
Gynecologists).
- Symptom Relief: Use non-pharmacological measures like hydration,
saline nasal sprays, and rest.
URI Management - Safe Medications: Acetaminophen for fever and discomfort. Avoid
in Pregnancy NSAIDs (risk of miscarriage or ductus arteriosus closure). Decongestants
like pseudoephedrine should be avoided in the first trimester.
Nausea and - First-Line Treatments: Ginger capsules, pyridoxine (vitamin B6), and
Key Points
doxylamine (an antihistamine). These are safe and well-studied.-
Vomiting in Refractory Cases: Ondansetron is considered, but it is reserved for severe
Pregnancy cases due to potential safety concerns in early pregnancy.
- Management: Prescribe antibiotics safe for breastfeeding, such as
cephalexin or dicloxacillin. Recommend continuing breastfeeding to
Lactational
prevent milk stasis, which can worsen the condition.- Pain Management:
Mastitis
Use acetaminophen or ibuprofen (compatible with lactation).
- Treatment Options: SSRIs like sertraline or paroxetine are first-line due
to their safety profiles during lactation.- Non-Pharmacological Options:
Postpartum Cognitive behavioral therapy (CBT) or other forms of psychotherapy can
Depression be offered.- Screening: Regularly screen postpartum women for
depression using tools like the PHQ-9.
- UTI in Lactating Women: Recommend antibiotics compatible with
breastfeeding, such as nitrofurantoin or cephalexin. Use LactMed to
confirm safety.- Nausea in Pregnancy: First-line treatment is ginger or
Knowledge Check
pyridoxine/doxylamine; diphenhydramine and ondansetron are second-
Questions
line.- Preconception Medication Adjustments: Atenolol (beta-blocker)
should be switched due to fetal growth restriction risks; consider labetalol
or methyldopa instead.
