The objective of this article is to discuss the most updated data on the safety and efficacy of some psychotropic medications during pregnancy, specifically antipsychotic medications, anxiolytic and sedative hypnotics, stimulant medications, and medications for treatment of substance use disorders (SUDs). The common disorders and the risks of not receiving treatment for certain psychiatric conditions, including SUDs, are also discussed.
Neurodevelopmental impairments follow both term and preterm birth, and include cerebral palsy (CP), cognitive dysfunction, and sensory impairment (blindness and deafness). Proven neuroprotective strategies include antepartum magnesium sulfate (MgSO4) administration prior to anticipated preterm delivery, delayed cord clamping, and therapeutic hypothermia for term and late preterm infants. MgSO4 administration prior to anticipated preterm delivery has been shown to reduce the risk of death, cerebral palsy and major neurodevelopmental disorders, whereas therapeutic hypothermia in term and later preterm infants has been shown to prevent or reduce sequelae associated with hypoxic-ischemic encephalopathy (HIE).
Preterm birth refers to the delivery of a live fetus between 20 0/7 and 36 6/7 weeks' gestation. Tocolytics are used to inhibit myometrial contractions and subsequently, preterm labor/birth. The mainstay of tocolysis is to delay delivery for 48 hours to give adequate timing for the administration of antenatal corticosteroids that are proven to enhance fetal lung maturity and/or to transfer a patient to a tertiary care center. Vaginal progesterone is used to prevent spontaneous PTB (sPTB) in women with a shortened cervical length of 20 mm or less on transvaginal ultrasound without a history of a prior sPTB.
The objective of this article is to discuss the most updated data on the safety and efficacy of some psychotropic medications during pregnancy, specifically antidepressants and mood-stabilizing medications. The common disorders and the risks of not receiving treatment of certain psychiatric conditions are discussed.
Pregnancy profoundly impacts normal physiology. When combined with the growth of the developing fetus and placenta, these changes result in multiple alterations in drug absorption, distribution, metabolism, and elimination. In this context, physiology-based pharmacokinetics modeling provides a powerful tool that can anticipate altered pharmacokinetics in pregnant women and predict maternal and fetal drug exposure in clinical scenarios that are untested or untestable, thereby contributing to an evidence-based approach to pharmacotherapy in pregnant patients. Although concerns about fetal safety have historically limited pharmacokinetic studies, many medications are clinically indicated for various maternal or fetal conditions and need further study.
This overview provides a summary of the commonly used vasoactive agents and the various clinical scenarios in which they are used in the neonatal intensive care unit (NICU). The lack of well-designed clinical trials in this vulnerable population means that these agents continue to be administered without sufficient evidence-based knowledge on their dosing, safety, efficacy and long-term effects. The lack of age appropriate cardiotonic formulations remains an ongoing challenge. Future trials of cardiotonic drugs need to incorporate echocardiography and other objective monitoring tools in their design with robust assessments of short and longer-term outcomes.
Hypertensive disorders affect 15% of US pregnancies, significantly contributing to maternal and neonatal morbidity. This paper explores the profound hemodynamic adaptations of pregnancy and how their failure leads to conditions like preeclampsia and gestational hypertension. Diagnosis relies on blood pressure thresholds (≥140/90 mm Hg), with management focusing on preventing severe sequelae. Labetalol and nifedipine are established as first-line treatments due to their safety and efficacy, while angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers are strictly contraindicated due to fetotoxicity. Low-dose aspirin is recommended for high-risk patients. Ultimately, early recognition and evidence-based pharmacologic intervention are critical for improving obstetric outcomes.
Breast milk is the most beneficial nutrition for an infant. Most medications are suitable for use in breastfeeding mothers and the dose of most drugs transferred into milk is often subclinical and the mother should frequently be advised to continue breastfeeding. An improved understanding of the relationship between maternal and infant exposure to medications would provide a more enlightened understanding of risk-benefit analysis. The Drugs and Lactation Database, published by the National Library of Medicine and National Institutes of Health, is available online and is the most comprehensive source of information regarding the safety of maternal medications during breastfeeding.
Until recently, pregnant or lactating women were systematically excluded from drug development. Currently, the ethical consensus is that women who are pregnant or lactating need to be involved in drug development. The rich experience of drug development in HIV/AIDS can be generalized. This article reviews contemporary, integrated, multidisciplinary best practice in the design and conduct of clinical trials that recruit women who are pregnant or lactating and shows how contemporary preclinical methods facilitate clinical studies while minimizing the use of nonhuman animal species. Community engagement is essential for drug development particularly with the rise of multiple sources of misinformation.
Antibiotics are among the most commonly prescribed medications in neonatal intensive care units. Preterm and term infants are commonly exposed to antibiotics: before birth via transplacental intrapartum maternal exposures, at birth due to suspected early-onset sepsis, or due to suspected late-onset sepsis in the first weeks to months of a neonatal intensive care unit hospitalization. Antibiotic selection requires assessment of infection timing and associated microbiology patterns, patient-specific factors (eg, colonization status, source of infection), and antibiotic resistance concerns. In this article, we summarize basic concepts relevant to neonatal antimicrobial pharmacology and available neonatal-specific pharmacokinetic/pharmacodynamic data for commonly-used antibiotic agents.
Diabetes is a common complication of pregnancy associated with both short-term and long-term adverse effects on the mother and offspring. All types of diabetes in pregnancy are increasing in prevalence in parallel with the increase in overweight and obesity in women of reproductive age. Despite ongoing research on the treatment of diabetes and pregnancy for decades, changes in the characteristics of the patient population and increasing evidence of heterogeneous pathophysiology have highlighted the limited effectiveness of several therapies. Further research is needed to develop novel and individualized treatment strategies to address the increasing frequency and complexity of diabetes during pregnancy.
