Additional Points

The Use of Medication in Pregnancy by PD Dr. med. Katarina Dathe and Prof. Dr. med. Christof Schaefer in issue 46/2019

The article summarizes important medications that are used in pregnancy. Fondaparinux has been found to be a good substitute if heparins are not tolerated (positive experiences in more than 1000 pregnant women). In iron deficiency, oral iron preparations are often prescribed, which can cause gastrointestinal problems. For this reason, the preferred option should be intravenous administration of 500 mg ferric carboxymaltose (1). Administration of vitamin D preparations is also required in most cases. For analgesia, paracetamol or metamizole should be preferred to ibuprofen, as miscarriages, cardiac malformations, and gastroschisis have been observed after intake of ibuprofen (2).

Citalopram should be avoided (at least in the third trimester), as it may cause neonatal dyspnea, apnea, seizures, hypoglycemia, and hypotension (2). Sertraline should be preferred to citalopram, although if given in the third trimester, it may result in pulmonary hypertension in the neonate (2). High doses of amitriptyline were found to be associated with reproductive toxicity in animal experiments. If the mother takes amitriptyline for longer than three years, dementia may develop (2, 3). The most elegant approach to treating depression is administration of tryptophan, if the pregnant woman is deficient in tryptophan.

Hydrochlorothiazide can lead to disrupted fetoplacental perfusion and therefore negative effects on the fetus, such as icterus/jaundice, electrolyte imbalance, or thrombocytopenia (2).

Furosemide/frusemide should only be given temporarily, since animal experiments showed embryotoxic, teratogenic effects (2). Good quality compression treatment is the preferred option.

DOI: 10.3238/arztebl.2020.0220b

Prof. Dr. Dr. med. Holger Kiesewetter
Hämostaseologicum Berlin

References

1. Kiesewetter H, Hoppe B: Behandlung von Risikoschwangerschaften mit Ferinject. Berlin: 29. Kongress der DPMG 2019; Abstract

2. Rote Liste 2019, 59. Edition. ISBN-13:978–3–946057–42–0.

3. Der Arzneimittelbrief. Jahrgang 53. Berlin: Westkreuz-Verlag 2019.

4. Dathe K, Schaefer C: The use of medication in pregnancy. Dtsch Arztebl Int 2019; 116: 783–90