-
Tx of pre-term labor
Before 37 weeks
- Tocolytic therapy:
- goal is to postpone delivery long enough to decrease chances of probs with prematurity esp pulmonary underdevelopment
- doesn't decr # of preterm deliveries
- Allows for time to give corticosteroids to enhance fetal lung maturity
- Ca+2 is needed for m. contractions to occur
- Drugs:
- Mg sulfate - antagonizes Ca to decr uterine activity
- nifedipine - blocks Ca channels
- terbutaline - reduces intracellular Ca and reduces uterus sensitivity to Ca - not 1st line! - BBW do not use longer than 48-72 h d/t CV issues and death in mother
- Indomethacin - prevents arachadonic acid conversion to prostaglandins - Cat D if used for > 48 h or after 34 wks of gestation
-
Tx of Group B strep infx
Abx throughout labor and delivery
- recommendation is Penicillin IV
- OR
- ampicillin
- if Pen allergic, can use cefazolin
- if Pen allergic with anaphylaxis risk, use clindamycin
-
Tx of post-partum depression
- SSRIs or TCAs are 1st line (paroxetine is ok in breastfeeding)
- other options: venlafaxine, bupropion
-
Maternal and infant benefits of breastfeeding
- Maternal:
- faster recovery from pregnancy
- faster wt reduction
- decr chance of breast and ovarian cancer and osteoporosis
- postpone menstrual periods
- economic benefit
- Infant:
- optimal nutrition source
- complete composition of nutrients, growth factors, enzymes, immune factors, hormones
- may decr infx rate
- decr allergies, otitis media, lymphoma, gastroenteritis
- decr incidence of constipation
- may improve cognitive fxn in later life
- enhanced maternal bonding
-
Factors affecting drug therapy during lactation
- Mother:
- drug dose and duration of tx
- route and freq of admin
- metabolism
- renal clearance
- blood flow to breasts
- milk pH (less than blood pH, so traps basic drugs more)
- Milk composition (lipids)
- plasma level
- Drug:
- PO bioavail
- molecular weight
- pKa
- lipid solubility
- protein binding
- Infant:
- age (newborns more likely affected)
- feeding pattern
- amount of milk ingested
- drug abs, distrib, metab, excr
-
Ways to reduce infant exposure to medications via breast mild
always consider if drug is necessary
- Drug Selection:
- safety of drug
- choose meds that are well studied in infants
- avoid long-acting meds
- determine shortest length of therapy
- avoid long-term drug use
- use topicals if available to lower systemic abs
- choose meds with poorest oral absorption
- choose meds with lowest lipid solubility
- Feeding Pattern:
- avoid nursing during peak drug conc
- plan feeding before admin of next dose
- take once daily meds at night
- Consider:
- avoid drug therapy if possible
- observe infant for s/s of drug tox
- d/c drugs if benefits don't outweigh infant risk
- meds that are safe for infants usually safe for breastfeeding mom
- meds safe in preg are not always safe in breastfeeding
- give pt info regarding risk of drug ingestion and breastfeeding from reliable resources
-
Best resources for determining recommendations for drug use in lactation
- Medications and Mothers' Milk (book) by Dr. Hale and the website
- Phone advice from Yale-New Haven Hospital Lactation Center
- Drugs in Pregnancy and Lactation (book) by Briggs
- breastfeedingbasics.org
- ibreastfeeding.com
- perinatology.com
- LactMed - peer reviewed database
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