Book of Medical Disorders in Pregnancy - Tintash

effects or malformations have been reported.
Theophylline pharmacokinetics
are unaffected by pregnancy, and this
drug also appears in breast milk.
Betagonists:
These have little systemic absorption
and a more potent bronchodilatory effect
via inhalation. Data on the use of inhaled
beta-agonists showed no difference in
perinatal mortality, congenital malformations,
birth weight, or Apgar scores.
Corticosteroids:
The use of corticosteroids during
pregnancy continues to be controversial,
although numerous reports confirm their
use without adverse fetal effects. In 3
reports on human pregnancies, no congenital
malformations or adverse fetal
effects were found from inhaled corticosteroids.
Prednisone has been used extensively
during pregnancy for a variety of
conditions. It is associated with an
increased incidence of cleft palates in
animals but not in humans.
Ipratropium and bromide:
Neither of these medications has been
associated with adverse fetal outcomes.
Antihistamines and decongestants:
Patients frequently request these
medications for nasal symptoms,
mucosal edema, and hyperemia that
accompany normal pregnancy. The
available data does not indicate safety of
antihist-amines in pregnancy.
Brompheniramine is associated with
congenital malformations.
102
Common antibiotics used for
respiratory infections:
The major antibiotics considered safe
during pregnancy are penicillin, cephalosporins,
and erythromycin. Although
penicillin and ampicillin readily cross
the placenta, no adverse effects to the
fetus are reported. Cephalosporins also
traverse the placenta to a moderate
degree, but no adverse fetal effects
occur. Erythromycin crosses the placenta
to a low degree but achieves high levels
in breast milk. The estolate formulation
is contraindicated due to potential
hepatic toxicity in the mother. Antibiotics
that have relative contrain-dications
include sulfonamides, trime-thoprim,
aminoglycosides, nitrofuran-toin,
antituberculosis drugs, tetracyc-lines,
and quinolones.
Teratogens used in pulmonary
disease:
These drugs include iodine-containing
compounds. Brompheniramine, antihistamine,
coumarin, and anticoagulants cause
various teratogenic effects. Ciprofloxacin,
sulfonamides, tetracyclines, chloramphenicol,
streptomycin, and rifampin
have been associated with various
effects. Ionizing radiation exposure to
the fetus is associated with growth
retardation, CNS effects, microcephaly,
and eye malformations.
Maternal radiation exposure of less than
0.05 Gy is associated with no adverse
effects, a dose of 0.05-0.1 Gy is
considered the gray zone, and exposure
to more than 0.1 Gy is associated with
significant fetal effects. Fetal ionizing
radiation might cause increases in
childhood leukemia. A chest radiograph
results in 0.002-Gy exposure; perfusion
lung scan, 0.002 Gy; ventilation lung