1. Scottish Neonatal and Paediatric Pharmacists Group DRUGS IN PREGNANCY AND LACTATION

2. Scottish Neonatal and Paediatric Pharmacists Group AIMS To update pharmacists on current opinion relating to the prescribing of drugs in pregnancy and breastfeeding.

3. Scottish Neonatal and Paediatric Pharmacists Group OBJECTIVES To be aware of the background and relevance of this specialised area of prescribing To be able to find information regarding current drug use in pregnancy - and breast feeding To be able to interpret this in day to day cases encountered in working - practice.

4. Scottish Neonatal and Paediatric Pharmacists Group INTRODUCTION Thalidomide Foetal malformations occur in 2% of population 65% - 70% of malformations are of unknown cause

5. Scottish Neonatal and Paediatric Pharmacists Group PRINCIPLES OF TERATO GENESIS Placental barrier does not exist Teratogenicity is usually dose dependent Teratogenic agents may be synergistic. A teratogen may be harmless to the mother but devastating to the embryo. Timing and exposure is critical Susceptibility to teratogenesis is genetically determined.

6. Scottish Neonatal and Paediatric Pharmacists Group PRINCIPLES OF PRESCRIBING Evaluate every drug prescribed Use drugs which have been widely used in pregnancy Medico-legal

7. Scottish Neonatal and Paediatric Pharmacists Group PROBLEMS ENCOUNTERED 1. Anxious and emotional patients 2. Medico legal implications 3. Defensive Pharmaceutical Companies 4. Poor quality data 5. Media Scares

8. Scottish Neonatal and Paediatric Pharmacists Group FACTORS TO TAKE INTO CONSIDERATION Pregnant, planning pregnancy Script needed Consider period of gestation Medicate only if benefits outweigh the risks Avoid new drugs Use a single drug if possible Use lowest effective dose Involve and counsel patient

9. Scottish Neonatal and Paediatric Pharmacists Group INADVERTENT DRUG EXPOSURE Identify medicines taken Go to the SPC Either contact the local medicines information unit or Contact the National Teratology Information Service at Newcastle