Drug Maternal Considerations Fetal Considerations Breast-Feeding Considerations

Analgesics Lack of consensus regarding

Whole category management of women who have both ----------------------------------------------------------------
(aspirin, antiphospholipid antibodies and a
acetaminophen, history of recurrent pregnancy loss
ibuprofen) reflects the wide range of clinical
manifestations.
A large cohort study concluded the
antenatal use of nonsteroidal
antiinflammatory drugs such as
ibuprofen, naproxen, and aspirin but
not acetaminophen increased the risk
of spontaneous abortion.
Aspirin
Collectively, large trials demonstrate Crosses human placenta. Compatible with breast-feeding.
low-dose aspirins relative safety Associated with an increased risk Some experts suggest breast-
during pregnancy and generally of fetal vascular disruptions, feeding mothers use the lowest
positive effects on reproductive particularly gastroschisis, small effective dose and for the shortest
outcomes. intestine atresia, and possibly duration taken after feeding.
Understanding the mechanism of premature closure of the ductus Women requiring high doses
action still incomplete. arteriosus. such as that used for arthritis or
Gastrointestinal lesions, renal or Should be avoided in the first rheumatic fever should avoid
hepatic dysfunction, asthma, trimester to prevent gastroschisis. breastfeeding because neonatal
hypoprothrombinemia, tachypnea, salicylate levels may reach toxic
hyperthermia, and lethargy are the levels.
most significant risks.
Has small but significant effect on
reducing the rate of preterm delivery
but not perinatal death.
 Used to improve pregnancy outcomes
in women who have both
antiphospholipid antibodies and a
history of recurrent pregnancy loss:
- theorized that aspirin interferes
with the potential of these
antibodies to compromise
implantation and placental
angiogenesis.
- aspirin plus heparin remains the
most efficacious treatment8 for
women with a history of at least
two spontaneous miscarriages or
one intrauterine fetal death without
apparent cause other than inherited
or acquired thrombophilias.
- however, in a 2002 randomized
trial, a high success rate was
achieved when low-dose aspirin
alone was used for the treatment of
antiphospholipid syndrome; the
addition of low molecular weight
heparin did not improve outcome.
Prescribed to reduce the risk of
maternal thrombosis:
alone is not sufficient to prevent
thrombosis.
not without risk: may contribute to
maternal bleeding due to its effect
 on platelet cyclooxygenase
enzymes, and clinicians often
avoid recommending it during the
third trimester.
Use for prevention of preeclampsia
also remains controversial:
several meta-analyses suggest a
modest reduction in preeclampsia
and intrauterine growth restriction.
but most recent meta-analysis
indicates that antiplatelet agents
are associated with moderate but
consistent reductions in the
relative risk of preeclampsia.
Acetaminophen
(Tylenol, Apacet) One of the most widely used Used to treat the fever of Compatible with breast-feeding.
medications during pregnancy. chorioamnionitis during labor and Some experts suggest breast-
Most common maternal problems associated with improved feeding mothers use the lowest
relate to chronic abuse and overdose: umbilical blood gases effective dose and for the shortest
damage appears secondary to free (improvements in the umbilical duration taken after feeding.
radical toxicity with the cord bicarbonate concentration and
consumption of glutathione during base deficit) apparently by
the acetaminophen metabolism. reducing fetal oxygen demand as
N-acetylcysteine is the treatment the maternal core temperature
of choice for an acute overdose. declines.
Former suggestion that first
trimester exposure in combination
with propoxyphene is associated
with clubfoot and digital
 abnormalities is not sustained by
large series tests.
Possible link between
acetaminophen, gastroschisis, and
small bowel atresia in the offspring
of genetically predisposed mothers
exposed to the drug early in
pregnancy.
The drug has no antiplatelet
activity and does not pose a
hemorrhagic risk to the fetus.
Ibuprofen
(Advil, Alaxan, Drug of choice for management of Crosses human placenta. Compatible with breast-feeding.
Brofen, Motrin, postabortal pain, acute postoperative Fetal levels are dependent on Some experts suggest breast-
Paduden) pain, and postpartum pain. maternal because nonsteroidal feeding mothers use the lowest
antiinflammatory drugs are not effective dose and for the shortest
efficiently metabolized by the fetal duration taken after feeding.
kidney.
As effective as indomethacin in
closing the ductus arteriosus but
possibly with less adverse effect on
renal function.
Chronic exposure of the fetus to
the drug requires close follow-up
because of its potentially
lifethreatening effect (fetal right
heart decompensation after critical
constriction of the ductus
arteriosus).
Sumber: S. Buhimschi, Catalin. Weiner, Carl P. 2009. Medications in Pregnancy and Lactation Part 2. Drugs With Minimal or Unknown Human
Teratogenic Effect. VOL. 113, NO. 2. http://journals.lww.com/greenjournal/pages/default.aspx. Di akses pada tanggal 14 Maret 2017.