Every pregnant woman should be aware that any medication she takes will have an effect on the fetus, since many chemicals can cross the placenta to the developing baby. Their embryotoxic and fetotoxic effects often lead to embryonic death, delayed skeletal development, reduced body weight gain or increased perinatal pathologies.

Relevance of the problem

According to the study, approximately 1% of the development of fetal abnormalities is associated with uncontrolled use of medications by the mother. Therefore, doctors and scientists around the world make it a priority to study medications and their effect on the child’s body in the womb and on the pregnant woman’s body itself. must be taken into account different terms pregnancy.

Many research centers are conducting research into the embryotoxic and teratogenic effects of drugs on the embryo and fetus. They also have a fetotoxic effect on its development.

Thus, the embryotoxic effect in pharmacology is the ability of a drug, when it enters the mother’s body, to have a detrimental effect on the fetus, which leads to its death or developmental abnormalities.

What is embolic action

Embryotoxicity is the damage to a non-implanted blastocyst, which often leads to its death. This effect is caused by medications such as barbiturates, salicylates, atimetabolites, sulfonamides, nicotine and other similar substances.

Embryotoxicity means the effect of medicinal substances coming from the maternal body on the embryo and fetus, which lead to its death or developmental abnormalities.

Teratogenic effect is the effect on the fetus of medications or biological substances, which causes disturbances in the development of the fetus, and subsequently the child suffers from congenital deformities.

How do medications affect the baby's body in the womb?

Depending on the mechanism of action of medications on the fetus, three directions can be distinguished:

The first is those that penetrate the placenta and are not able to have a direct effect on the developing fetus.
The second is through transplacental transition, which means they have a direct effect on the fetus.
Third, those that, penetrating the placenta, tend to accumulate in the body of the unborn child.

It is worth noting that the toxicity of the drug does not affect the ways it penetrates the fetus.

A teratogenic embryotoxic effect on the fetus can be caused not only by drugs that a woman takes during pregnancy, but also by drugs that were used before conception. As an example, we can take retinoids, which are teratogens with a long latent period. Accumulating in a woman’s body, they can further affect the development of the fetus.

And even the reception medicines the father of the child can influence the congenital pathologies of the baby. Most often these are the following medications:

substances intended for anesthesia;
antiepileptic drugs;
"Diazepam";
"Spironolactone";
"Cimetidine"

Classification of drugs by risk category during pregnancy

The American Food and Drug Administration - FDA has developed a special classification of drugs that are the most and least dangerous for the fetus during pregnancy:

A - these include medications that are not able to affect the body of the mother and child. Conducted studies have eliminated this risk. B - drugs that can be taken in limited quantities, and no anomalies in fetal development were subsequently observed. Experiments on animals have ruled out any effect of these medications on the growing organism inside the mother.
C - these medications, when conducting experiments on animals, had a teratogenic or embryotoxic effect on the embryo. They harm the child’s body, but have reversible consequences. Often, the development of abnormalities in the fetus was not observed.
D - drugs from this group lead to irreversible consequences and congenital anomalies in the child. When prescribing such drugs, the doctor must weigh their benefits and subsequent risks for the child.
X - this category of medications can cause persistent fetal developmental anomalies and congenital deformities, since they have a proven teratogenic or embryotoxic effect on both animals and humans. Their use during pregnancy is strictly contraindicated.

What are the consequences of using different groups of drugs during pregnancy?

Here is the embryotoxic effect that various medications can cause in the fetus:

Aminopterin - the fetus can die in the womb. If this does not happen, then multiple anomalies of its development occur, mainly affecting the facial part of the skull.
Androgens - limbs grow poorly. The trachea, esophagus and cardiovascular system are damaged.
Diethylstilbestrol - changes in the sexual plane in a child, in girls it is adenocarcinoma of the vagina and changes in the cervix, in boys it is pathological conditions of the penis and testicles.
Disulfiram - the medicine leads to miscarriages, club feet and split limbs in the child.
Estrogens cause congenital heart defects, feminization in boys, and vascular disorders.
Quinine - if fetal death does not occur, then the subsequent development of glaucoma, mental retardation, ototoxicity, and abnormalities in the development of the genitourinary system is possible.
Trimethadione - mental retardation, anomalies in the development of the heart and blood vessels, trachea and esophagus.
Raloxifene - disorders in the reproductive system.

These are just examples of embryotoxic effects; in fact, the list can be continued for a long time, since there are a lot of drugs.

Medicines with teratogenic effects

These include:

"Streptomycin" - the medicine leads to deafness.
"Lithium" - leads to heart ailments, the development of goiter, hypotension, cyanosis.
"Imipramine" - neonatal distress syndrome, leg defects, breathing problems, tachycardia, problems with urination.
"Aspirin" - persistent pulmonary artery hypertension, various bleedings. Including intracranial ones.
"Warfarin" - convulsions and bleeding, which often lead to fetal death, embryopathy, optic nerve atrophy, developmental delay.
"Ethosuximide" - the child's appearance changes, his forehead is set low. Appearance acquires Mongoloid features, dermoid fistula, mental retardation and physical development, presence of an extra nipple.
"Reserpine" - ototoxicity.
"Busulfan" - development occurs with a delay, as in the womb. So, in the future, clouding of the cornea is observed.

The effect of alcohol on fetal development

In addition to the fact that there is a concept of the teratogenic and embryotoxic effects of drugs on the embryo and fetus, one can note the negative effects of alcohol, tobacco and narcotic drugs.

A woman who drinks alcohol during pregnancy, even in small doses, risks not only her health, but also the health of her child.

The most common complications include:

Miscarriages occur 2 times more often.
A slow birth process, which brings various complications in the future.
Other complications during childbirth.

Subsequently, the child may experience the following negative manifestations:

1/3 of children have;
in 1/3 of cases toxic prenatal changes are observed;
and only a third of children born will develop without any visible complications.

Fetal alcohol syndrome

It is characterized by three main qualities:

delay in physical development;
mental retardation;
a specific appearance, characterized by a narrow forehead, narrow palpebral fissure, short nose, microcephaly.

These consequences can be prevented if you do not drink alcohol during pregnancy.

The consequences of alcohol syndrome in a child may become dull as he grows, but will not completely disappear. Such a child can be hyperactive, his attention is impaired, which affects his social adaptation.

Also, characteristic features of such a child may be aggressiveness, stubbornness, and poor night sleep.

Embryotic effect of tobacco (nicotine)

Tobacco negatively affects the development of the fetus, and not only when the woman smokes herself. If she is a passive smoker, that is, she is in a room next to people who smoke and inhales the smell of nicotine, she is already harming her unborn child.

Complications of this behavior include:

Bleeding from the vagina.
Poor placental circulation.
The risk of delayed labor also increases.
Risk of spontaneous abortion and premature birth.
Risk of placental abruption.

Smoking can affect the fetus in the following ways:

Slow fetal development; at birth, such children have low height and weight.
There is a risk of developing congenital anomalies.
The possibility of sudden death of a newborn doubles.
Subsequent developmental risks, this can manifest itself in delayed mental and physical development, a tendency to respiratory diseases, and unpredictability in the child’s behavior.

Conclusion

The embryotoxic effect of many medicinal and non-medicinal substances can lead to severe irreversible consequences. You need to know before taking medications that they will negatively affect the embryo or fetus. Therefore, doctors recommend that young women take a responsible approach to the birth of a child and prepare for birth process, read relevant literature, undergo regular examinations, conduct healthy image life.

Only under such conditions is there a chance to give birth to a healthy baby, without any abnormalities. Every time you try to take any drug, remember the embryotoxic effect of the drugs, this can affect your unborn baby. Therefore, discuss every step you take with your doctor.

What medications should you avoid during pregnancy?

If during pregnancy women still try to avoid taking certain medications, then when they start breastfeeding, they stop being careful. Meanwhile, many drugs taken by a nursing mother enter the newborn’s body through breast milk and can harm him. Let's give a few examples.

Known to everyone, it can cause worsening of blood clotting in a child.

Leads to depression, as well as bleeding in the newborn.

Hormonal contraceptives will cause a mother's breast milk supply to decrease.

Gentamicin - hearing impairment; tetracyclines - damage to teeth; biseptol, etc. - severe jaundice; quinine - a violation of blood composition; theophylline moodiness, sleep disturbances.

Caution must be exercised when prescribing delagil, caffeine, atropine, cemetidine, analgin, baralgin, aminazine, phenolphthalein (purgen), senna and other laxatives, soda, metronidazole (trichopol).

Absolutely contraindicated - lithium salts, diazepam, thiouracil, seduxen.

This is an incomplete list of medications that have a bad effect on a newborn when passed through mother's milk. Both doctors and mothers who abuse self-medication should be aware of the possibility of adverse effects of medications.

After reading this article, parents may become frightened and, if they become ill, not receive proper treatment. This behavior will cause even more harm to the child. You can almost always find a high-quality replacement for “dangerous” drugs without panicking, without rushing to extremes, and without resorting to advertised, but insufficiently studied, treatment methods.

The health of the child must be taken care of even before his birth. The fetus is affected not only by alcohol, tobacco and poor diet, but also by medications. A third of pregnant women take at least six medications during pregnancy. Almost all drugs can accumulate in fetal tissue, so many “harmless” drugs can become dangerous during pregnancy.

Listed below are the medications that are most often used for self-medication, and the possibility of their adverse effects on fetal development is indicated.

Hormonal contraceptive drugs can cause disturbances in the structure of some organs in the unborn child.

The use of indomethacin will increase the risk of fetal death.

When taken by a pregnant woman, it accumulates in the tissues of the fetus and can cause vomiting, diarrhea, and convulsions in the newborn.

If blood pressure rises during pregnancy, a woman may be prescribed clonidine, which will cause drowsiness, depression, and liver damage in the newborn.

Despite its low toxicity, it can lead to delayed fetal development, jaundice, difficulty breathing and cardiac activity in the newborn.

Taking diphenhydramine by a pregnant woman can cause anxiety, cramps, and diarrhea in the unborn child.

The use of aspirin can lead to late labor.

Even the safest antibiotics for the fetus - penicillin, ampicillin, kefzol - can cause diathesis in newborns. Of the other antimicrobial drugs, the most dangerous are sulfadimethoxine, biseptol, trichopolum, furagin, furazolidone, levomecitin, tetracycline, erythromycin, gentamicin, streptomycin.

In 1979, in the United States, all drugs were divided into several groups depending on the danger of their effects on the fetus. The risk of complications in newborns, according to this table, is very high when pregnant women use castor oil, phenobarbital, amidopyrine, delagil, diazepam, etc.

According to domestic data, in addition to all of the above, great harm is caused to the fetus and newborn by the use of atropine, aminazine, analgin, theophylline, lincomycin, and boric acid by expectant mothers.

With correct dosages and short-term use of medications prescribed by a competent doctor, undesirable effects of their action can be minimized. In each specific case, you can choose an effective and safe replacement for a “dangerous” drug.

When self-medicating, which, unfortunately, can rarely be avoided, it is important to pay attention to the inserts for medications (annotations), which usually indicate the danger of their use during pregnancy. It is best to consult a doctor. No matter how afraid you are of medications, remember - an untreated or poorly treated illness will cause more harm to your child than medications.

I want to get pregnant. But I remembered that a week ago I took one abactal tablet (I had pharyngitis). Will this somehow affect the unborn child. If yes, how long should you wait?

If you took the pill during this menstrual cycle, then wait for the next one. And 10 days after menstruation you can start conceiving. If the pill was in the previous cycle, it cannot harm you in any way.

Pregnancy 26 weeks. To relieve local hypertonicity of the uterus, the drug Ginipral was prescribed, 1/4 tablet 4 times a day. The annotation states that the drug cannot be used together with drugs containing calcium and vitamin D. Is it possible to continue taking multivitamins for pregnant women (Vitrum Prenatal), since they contain both calcium and vitamin D?

It's better to follow the instructions. Calcium preparations negate the relaxing effect of ginipral on the uterine muscles and increase its side effects.

I was diagnosed with a slight inflammation in the vagina and was prescribed treatment with drugs: Unidox, nystatin, douching with furatsilin, suppositories with syntomycin and acylact in suppositories. Many of them are contraindicated during pregnancy. I follow my husband and do not always use protection during sexual relations. What do i do? Should I start treatment immediately before my period? And how will this affect pregnancy (what if I got pregnant during the previous 2 weeks) Or should I wait until my menstruation and then start treatment.

In your case, it is better to wait for menstruation and start treatment, protecting yourself with a condom during this cycle (the entire cycle). Even without connection with conception, it is better to start antibiotics with menstruation, because it aggravates existing infections, and they are easier to treat.

I took Doxycycline, and now it turns out that I’ve been pregnant for a month and a half. What to do? Is it really an abortion?

In general, tetracycline drugs during pregnancy are dangerous because they are deposited in the skeletal system of the fetus, causing skeletal abnormalities. Such a small one does not yet have a skeleton. This is the first. Secondly, if the fetus is damaged in the early stages, for example, by antibiotics, it is not retained in the body and a miscarriage occurs. If everything is in order, there is no threat of miscarriage, then theoretically you can continue the pregnancy. Also consult a geneticist and let him calculate the exact risk. You can do an ultrasound and monitor the child's development. In this case, the decision is up to you, weighing all the pros and cons. If a child has been desired for a long time, if you have been planning a pregnancy for a long time and have undergone treatment, that’s one thing. If this is an accidental and unwanted pregnancy, then it’s different... There is a danger. But the dangers of abortion are also well known. Consult a geneticist and make a decision.

She underwent a course of treatment for thrush. In this cycle, on the sixth day, I took the final tablet of Diflucan 150 mg. My husband works far away and his visit for the purpose of conception has long been planned for this month. Please tell me, is Diflucan very dangerous in this regard?

Yes, it's dangerous. In this cycle you need to protect yourself. The drug had an effect on this egg.

In the second half of pregnancy, I have colpitis and doctors threaten miscarriage. In this regard, it is prescribed a large number of medications (even before receiving test results): bricanil, curantin, isoptin, methionine, polygenax. I read the annotations: something cordial, something to improve liver function. Is their use dangerous for a child?

Polizhenaks, other drugs are aimed at relaxing the uterus and improving utero-placental-fetal circulation, which almost always suffers with increased tone uterus. These drugs have been widely used in obstetrics for a long time and do not affect the development of the fetus.

I have been making love to my husband for 5 months about once a week, sometimes more often. I haven't had my period for 3 months now. But the pregnancy test says that I am not pregnant. Please answer why I don’t have my period? And why can’t I get pregnant even though we don’t use any contraceptives? I suffer from epilepsy, I take the medicine "Depakine Enterik"

Pregnancy tests sold over the counter may not be accurate. If in doubt, you need to do an ultrasound. 5 months is not a reason to say that pregnancy is not occurring. The diagnosis of infertility is made after 1 year of non-pregnancy with regular sexual activity without a condom. If, nevertheless, there is no pregnancy, you need to undergo an examination to find out the reason for the absence of menstruation. Most likely, this is a sign of hormonal disorders. If epilepsy is compensated (that is, there are no seizures while taking medications), it is not a contraindication to pregnancy. Taking Depakine (sodium valproate) is contraindicated during pregnancy; it can cause malformations of the fetal nervous system. While taking the drug, you must observe careful contraception. You need to consult your doctor and change your anticonvulsant drug. If pregnancy does occur, the issue of maintaining it must be decided.

Please advise. Having become pregnant, I took Materna for more than 2 months and all this time I had a sore throat (difficult to swallow, small abscesses). I tried to heal folk remedies, nothing helped. I took a break from taking Materna for a month, and immediately after stopping taking it my throat went away. 2 days ago I started taking it again - and again problems - the neck on the left side was swollen (lymph node?) and it was difficult to swallow. What should I do? I'm worried that I may have harmed my baby by taking these vitamins during his formative years. And where can I go for advice?

Most likely, we are talking about a rare type of drug intolerance, perhaps an allergy to some component, fortunately there are many of them in Materna. But maybe this is just a coincidence. Just in case, in the future, refrain from taking this drug and warn your doctor about such a reaction - so that, in the future, if you need to prescribe vitamin preparations, the doctor knows about the possibility of such an allergy. Allergies do not affect the development of pregnancy, but chronic tonsillitis is an unfavorable factor. For advice, the most logical thing to do is contact an ENT doctor.

I was diagnosed with chlamydia at a titer of 1:20, I started taking ATRICAN on my own before I found out that I was pregnant. How dangerous is the infection for the fetus and is this drug teratogenic?

During the first 12 days after conception, the embryo is resistant to any influences (or rather, the pregnancy is either terminated or develops further normally). If the drug was taken after this period, it could have a damaging effect on the developing pregnancy, because is a teratogen. By the way, Atrican does not have any therapeutic effect on chlamydia. Chlamydia during pregnancy can cause miscarriage, provoke inflammatory diseases of the kidneys and genital organs in a pregnant woman; chlamydia does not directly affect the fetus, with rare exceptions.

I am 30 years old, I have never had an abortion and have never been sick. I am in the 5th week of my desired pregnancy (cycle 23 days, last menstruation began on January 4; conception occurred on January 12-17), which I would really like to keep. But the fact is that on January 18 (i.e., about 7-8 days after ovulation) I had an acute attack of cystitis (from hypothermia) and the doctor prescribed me doxycycline 10 tablets of 0.1 and nitroxaline. I, not knowing about pregnancy, took these medications for 10 days. In addition, after a visit to the gynecologist, I know that I have erosion due to gardnerella. Please rate my risk. My doctor says it's very dangerous, but I don't want to have an abortion! I read that the first 11 days are a period of resistance, and then (I took the pills for another 4 days) it can affect the development of bone tissue. According to some American classification, risk class D i.e. very undesirable. And how to treat erosion if I decide to continue the pregnancy? I need to assess the risk between possible fetal development problems and my own health problems (1st abortion at 30 years old with a strong desire to give birth).

Indeed, no one can say for sure. There is such a pattern: if the damaging agent acts in the first weeks, the fetus reacts according to the “all or nothing” law: either it is damaged, and then a miscarriage occurs; or everything is fine, and then he stays. This may justify continuing the pregnancy. Tetracyclines, forming insoluble compounds, are deposited in tooth enamel and bones. The child does not yet have bones and teeth. But this is a theory, although it is often confirmed by practice. And in each specific case, of course, it is scary to leave a pregnancy during which you took a tetracycline drug in a large dose. A medical geneticist can tell you the exact figures for the likelihood of developing fetal defects. can also adversely affect pregnancy, but is not an indication for its termination. In the first trimester, it is not treated; the only thing you can do is treat the vagina with antiseptics: furacillin, chlorophyllipt, so that the discharge is not so painful. Cervical erosion is not treated during pregnancy; you will deal with this later. The risk of a first abortion is always high, especially in the presence of infection and erosion. If there are any abnormalities in the fetus now, they are not yet visible either on ultrasound or in tests. Therefore, only probable risk can be assessed. You probably need to get advice from a geneticist and decide for yourself. always proceeds more favorably. But taking doxycycline is one of the indications for interruption.

The period of resistance means that if damage to the fetus occurred before implantation (implementation and fixation of the fetus in the wall of the uterus), then a miscarriage simply occurs at an extremely early stage, even before the delay of menstruation. Implantation occurs approximately on day 6-7. If no damage occurs, the fetus develops normally. The fetus has increased sensitivity to the effects of drugs from 8 to 10 weeks of pregnancy. So the opportunity to give birth to a healthy baby is quite likely.

I'm 10 weeks pregnant. Ureaplasma was found in the smear. From your encyclopedia I understand that the child is, in principle, reliably protected from this infection. The doctor said that we will treat at a later date. And at my term, she advised me to undergo treatment with suppositories. Is it possible that treatment with suppositories will be enough? Or ureaplasma is found not only locally (in the genital tract), but in the blood in general. And therefore requires tablet treatment.?

Ureaplasma during pregnancy must be treated from the 14th week of pregnancy: Dalatsin-C cream in the vagina, Erythromycin orally or another antibiotic + Viferon rectally.

I'm 33 weeks pregnant.

1. I have been undergoing treatment for thrush and gardnerellosis for a very long time. Now the doctor has prescribed Ginalgin suppositories, but the annotation says that it is contraindicated during pregnancy and its use should be dictated by vital indications. Can it be used in my situation?

2. Recently the child has been knocking at regular intervals (like the second hand is moving), this can last for about an hour. The doctor at the residential complex said that he was the one hiccupping. Can this happen and how to avoid it.

At the end of pregnancy, in principle, many things are possible that are not possible at the beginning. But metronidazole, which is included in Ginalgin, cannot be used for sure. and gardnerellosis during pregnancy are indicators of reduced immunity. Try changing your diet, eating more vegetables and fruits, taking multivitamins. And use it topically: douching with 3% hydrogen peroxide every other day, only three times. Alternate with douching with a weak solution of furacillin. Wrap gauze around your finger, dip it in regular brilliant green and carefully treat the vagina. Use all these antiseptics, alternating, for 7-10 days. It should help. It will be possible to finally recover after pregnancy and the end of breastfeeding. The baby may actually hiccup. But for peace of mind, it would be good to go to a qualified institution such as a medical institute, or at least to a regular maternity hospital and be examined. First, do a qualified ultrasound, cardiotocography, a study of cardiac activity, which allows you to judge the condition of the fetus.

My friend is 32 years old, she really wanted a second child, but she had not been pregnant for 4 years. Now she is still pregnant, but at 2-3 weeks she was given a mandatory flu shot (in the shoulder). Now one doctor claims that it is necessary to have an abortion, because... Irreversible negative effects of vaccination on a child are possible, another doctor claims that the vaccination is weak, nothing bad will happen. She herself wants to keep the child, but if something happens, she cannot raise a disabled child due to her difficult financial situation.

There is no need to terminate the pregnancy. The vaccine contains inactivated split viruses that cannot harm the fetus. Pregnancy is not a contraindication for vaccination. So there is nothing to worry about. You just need, as with any pregnancy, to regularly monitor the child’s condition: do an ultrasound scan at the prescribed time (12, 18-20 weeks, then more often), take tests for hCG and estriol, the main markers of developmental defects (15-20 weeks), monitor to ensure that placental insufficiency does not develop (proper nutrition, multivitamins).

I am 22 weeks pregnant, the doctor (gynecologist) prescribed chimes, telling me not to read the annotation for it, that the data in it is old (meaning that it is contraindicated for pregnant women), but I read about it on the Internet and in annotations, I quote verbatim: “During pregnancy, dipyridamole is recommended to be used only after the doctor has carefully weighed the possible risks and expected benefits of using this drug. Fetotoxic risk occurs especially during the second and third three months of pregnancy. Please inform your doctor about pregnancy occurring during period of treatment with this drug." And it was prescribed to improve the oxygen supply to the fetus. I would like to know your opinion on this matter, is it worth taking this drug, or can it be done without it. And the doctor also said that chimes is prescribed to all pregnant women, so it was not prescribed for me according to individual indications, but the dosage is as follows - 1 t. 3 times a day, 3 weeks. And another question, I took 2 tons of Karsil 3 times a day (I have chronic cholecystitis and biliary dyskinesia), and then I bought new packaging from another manufacturer and read that this drug is contraindicated during pregnancy. Is this very dangerous?

Indeed, it is often prescribed for pregnant women. Practitioners do not see any adverse reactions from it, and during pregnancy there are conditions that make its use necessary. Increased blood coagulation is fraught with the occurrence of gestosis, fetal hypoxia, placental insufficiency, and miscarriage. Therefore, the annotation rightly states that it is necessary to weigh all the pros and cons. But it is also known that a person, especially a pregnant one, should not use medications that he does not trust, and, moreover, considers harmful. Therefore, you can refuse chimes, but not examination and treatment in general. After all, it was assigned to you for a reason. Maybe you need to go to an obstetric hospital for examination. There is the possibility of using other anticoagulants. In any case, the doctor must decide. Find a professional you trust. What happened cannot be returned. To protect the liver, essentiale, eicanol, and fish oil are recommended for pregnant women. These drugs are indicated not only for the liver, but also for pregnancy itself. The normal development of the child should be monitored using regular ultrasound and studying the blood flow in the placenta (Doppler study).

Pregnancy 24 weeks, when analyzing smears for infections, ureaplasma was found. All other tests are good. The doctor prescribed to take for 10 days: rovamycin, hilak, terzhinan. Is it necessary to take so many medications and will they harm the baby?

Rovamycin is a special antibiotic against ureaplasma, created for pregnant women. The issue of harm must be considered from two sides: undoubtedly, ureaplasmosis is more dangerous for a child than its treatment. Terzhinan is not necessary; these are suppositories; they reach the ureaplasma living in the uterus. they won't get it. And Hilak - for better absorption of rovamycin, so that there are no adverse reactions. So there is only one strong drug. No harm

I am pregnant (34 weeks), my husband has undergone treatment for ureaplasma. Nothing was found in my tests. Now rovamycin has been prescribed as a preventive course. How necessary is this prevention? Can its absence affect the health of the unborn child and how? If a prophylactic course is necessary, is there a similar drug (this one is too expensive)?

Before starting unnecessary antibiotic treatment, we recommend that you determine the presence of ureaplasma using the polymerase chain reaction method. If the pathogen is detected, you can undergo a course of treatment with a cheaper and approved antibiotic during pregnancy - erythromycin.

I was prescribed intravenous immunoglobulin against ureaplasmosis. Is there any risk to the fetus or my body? Can this drug have a negative effect on immune system, the body as a whole? I'm currently about 18 weeks pregnant.

I have the following problem. Ureaplasma was found to be sensitive to lincomycin and sulfamethoxazone. The gestational age is 15 weeks. I know from previous questions that you recommend treatment after 30 weeks, but I also have the possibility of isthmic-cervical insufficiency (so far there are no manifestations, but in previous pregnancies (there were miscarriages) it was (the first time the cervix was not sutured, but the second time they were sutured , and ascending inflammation began (the doctor said that the inflammation could just be from this ureaplasma))). So far I have not been prescribed any treatment, but I am very nervous, since my cervix was stitched up the last time with a dilation of 1 cm at 18 weeks. that is, there are 3 weeks left. If this disease cannot be treated, then it will probably take time to cure it. What is your opinion on this matter? Should I start a course of treatment or not?

You can take antibacterial drugs starting from 12 weeks of pregnancy. However, only drugs approved for use in pregnant women. Unfortunately, they are not one of them. You should discuss this issue with your doctor.

I'm 23-24 weeks pregnant. An ultrasound (at 21 weeks) revealed a defect in the aorta of the child’s left atrium (but not a heart defect), allegedly caused by some kind of infection (flu), but I did not have the flu. Analyzes showed the presence of ureaplasma and mycoplasma. My gynecologist prescribed me gentle treatment: vitamins, hofitol, Vagilak (10 days), Terzhinan suppositories (10 days), vilprafen (josemycin) - 8 days. I don't know anything about these medications. How harmful are they to me and most importantly to my baby? How likely is it to give birth to a healthy child? Or will there definitely be a sick baby? How will these antibiotics affect the child’s body? If infections remain after treatment, then what to do next: to be treated or not before giving birth? Is the baby infected before birth? And could this heart defect be caused by these infections? What is the treatment for the baby after birth? Will these infections affect its development? Will I be able to carry my baby to term?

Your gynecologist prescribed you competent treatment against urea and mycoplasmosis. Josamycin (vilprafen) is an effective antibiotic specially created for the treatment of these diseases in pregnant women. He cannot harm the child. Terzhinan suppositories are a local drug, also indicated for use during pregnancy. It does not affect myco- and ureaplasmas, but apparently you have a violation of the vaginal flora, which can be detected by a regular smear. Terzhinan is the first stage of flora restoration, the second vagilak (a set of lactic bacteria that should normally be in a woman’s vagina. Instead, you can douche with whey; it is just as harmless). Hofitol is a herbal preparation that restores and protects liver cells. During pregnancy, there is already an increased load on the liver, and while taking an antibiotic, the use of hepatoprotectors (drugs that protect the liver) is very desirable. Vitamins are always useful and necessary during pregnancy, reducing the likelihood of fetal malformations. So you have nothing to worry about regarding treatment. The main thing is to treat your husband at the same time. Instead of vilprafen, he can take a more potent drug like Rulid, etc. If you are sexually active, be sure to use a condom. After treatment, its effectiveness should be checked no earlier than a month later. If urea or mycoplasma remain, then it will be necessary to periodically determine the titer (amount) of antibodies to them in the blood. The appearance of antibodies indicating an exacerbation (immunoglobulins M), or an increase in the titer (in small quantities they will remain forever. This is good, a sharp increase in their number is bad) of protective antibodies (immunoglobulins G) will be an indication for a second course of treatment. Myco- and ureaplasmas are very rarely transmitted to the child, most often during the birth itself. After birth, it will be possible to examine the child and, if necessary, begin treatment. Now it is difficult to say what caused the development of an aortic defect in your child. It could be a cold, suffered at the very beginning of pregnancy, when you did not yet know about it, taking aspirin or antibiotics at the same time; smoking, alcohol, harmful working conditions, lack of vitamins. Now you need to regularly do ultrasounds, monitor the child’s condition (infections much more often cause insufficiency of placental function and malnutrition (malnutrition) of the fetus), take vitamins, so-called. metabolic therapy. Today, malformations of the vascular system are successfully operated on. You need to obtain a report from a qualified heart ultrasound specialist indicating the exact diagnosis and attached photographs and contact a cardiac surgeon. They will tell you how life-threatening this defect is and at what age it is best to operate on it. You will be able to carry your baby if you are not in confusion. You need to pull yourself together and start solving the problem that has arisen.

My wife, who is 7 months pregnant, has a low hemoglobin level. The doctor prescribed Essential Iron from VitaLine Inc. I found out on the Internet that this is a food supplement from the Cambridge nutrition system, which is more similar (judging by the sites through which it is distributed) to pyramids like Herbolife. Can I trust this drug?

As already noted in the articles on our website www..p. You shouldn't trust your health.

1 Dietary supplements are not medicines, but foods that cannot be used to treat people.

2 Nutritional supplements, for a number of legal reasons, do not undergo many examinations that drugs or food undergo, and if they are distributed “from hand to hand”, network, multi-level marketing, in a doctor’s office, and not in a pharmacy, then they do not passed no control.

3 If a doctor offers to buy something in his office, run away from this doctor.
4 To increase the hemoglobin content, which can be reduced normally, there are diets, for example with pomegranate, hematogen and other methods and preparations.

(abstract).

1. Mechanisms of action of medicinal substances on the fetus

and newborn 3

2. Medicines and the fetus 6

3. Medicines and feeding breast milk 12

4. List of sources used 17

1. Mechanisms of action of medicinal substances on the fetus and newborn

To date, considerable experience has been accumulated indicating that many drugs can have adverse effects on the developing fetus and newborn. The balance between the degree of risk and the potential benefit of prescribing drugs is the main problem of pharmacotherapy during pregnancy.

Most drugs penetrate the fetus fairly quickly. At the end of the gestational period, the main biological systems begin to function in the fetus, and the drug can cause its characteristic pharmacological effect. There are three pathological variants of the effect of drugs on the fetus:

1.embryotoxic;

2.teratogenic;

3.fetotoxic.

The embryotoxic effect is the negative effect of the substance on the zygote and blastocyst located in the lumen of the fallopian tubes or in the uterine cavity. Most often, the result is the formation of gross malformations, which leads to termination of pregnancy. I.I. Ivanov and O.S. Sevostyanov note that the teratogenic (teratos - freak) effect of drugs poses the greatest danger, as they lead to the development of congenital anomalies in the fetus. The fetotoxic effect is manifested in the closure of the natural openings of the fetus, the development of hydrogenation, hydrocephalus and specific organ damage.

It has been established that during pregnancy there are a number of metabolic features that affect both the mother and the fetus and can affect the pharmacokinetics of drugs. Pregnant women are characterized by “physiological hypervolemia”, reaching a maximum at 29-32 weeks. The concentration of drugs per unit volume decreases, and the beneficial effect decreases, and increasing the dose of drugs taken increases the risk of fetal pathologies. G.F. Sultanov, as well as O.I. Karpov and A.A. Zaitsev indicate that during pregnancy the absorption of drugs slows down. Due to a decrease in intestinal motility, there is a decrease in the bioavailability of substances inactivated in the gastrointestinal tract. At the same time, the adsorption of medicinal substances administered by inhalation increases due to changes in the volume of inhaled air and pulmonary blood flow in pregnant women. An increase in the formation of hepatic microsomal enzymes (hydrolases) leads to an acceleration of the metabolism of xenobiotics. The excretion of drugs during pregnancy increases due to an increase in renal blood flow and glomerular filtration, and at the beginning of labor, all indicators of the mother’s kidney activity decrease, the reverse transplacental flow of substances decreases, which leads to their accumulation in the child’s body.

1.simple diffusion;

2.facilitated diffusion;

3. active transport;

4. entry through membrane pores;

5. pinocytosis.

Simple diffusion is the most common route of drug transfer that occurs without energy consumption. It depends on the concentration gradient of the substance in the blood of the pregnant woman and the fetus, the transfer surface area, the thickness of the membrane, as well as the physicochemical characteristics of the drugs (molecular weight, lipid solubility, degree of ionization). Active transport requires energy, does not depend on the concentration gradient, and obeys the laws of competitive inhibition. S.I. Ignatov found that fluorouracil penetrates the placenta in this way. Diaplacental passage of drugs occurs through pores in the chorionic membrane. Their diameter is 1 nm, which corresponds to the diameter of the pores in the intestinal tract and the blood-brain barrier. Pinocetosis is one of the possible ways of transporting drugs with a predominantly protein structure, the absorption of droplets of maternal plasma by the microvilli of the syncytium along with the substances they contain.

2. Medicines and the fetus

There are many drugs that are potentially dangerous from the point of view of teratogenesis, and their effect can occur in the presence of certain favorable factors. Medicines can affect the fetus at all stages of pregnancy, but the most reliable data were obtained by studying their effects during the period of organogenesis (18-55 days) and the period of fetal growth and development (over 56 days). In this regard, when prescribing medication to women of the childbearing period, it is important to take very seriously the assessment of the benefit-risk ratio of the prescribed device during pregnancy. It is also equally important to exclude pregnancy when prescribing devices with teratogenic properties.

Based on data obtained in humans or animals, drugs are currently classified according to the degree of risk to the fetus in a number of countries (USA, Australia) into categories from A (safe) to D (contraindicated during pregnancy), as indicated by O.S. . Sevostyanova. There is also category X, which includes drugs that are absolutely contraindicated for pregnant women. V.A. Tabolin and A.D. Tsaregorodtseva argue that category X drugs do not have a sufficient therapeutic effect, and the risk of their use outweighs the benefit.

A - drugs that have been taken by a large number of pregnant women and women of childbearing age without any evidence of their effect on the incidence of congenital anomalies or damaging effects on the fetus.

B - drugs that have been taken by a limited number of pregnant women and women of childbearing age without any evidence of their effect on the incidence of congenital anomalies or harm to the fetus.

C-drugs that have demonstrated teratogenic or embryotoxic effects in animal studies. It is suspected that they may cause reversible damage to the fetus or newborn, but not cause the development of congenital anomalies. Control studies have not been conducted in humans.

D - drugs that cause or are suspected of causing congenital anomalies or permanent damage to the fetus.

X – drugs with high risk congenital anomalies or permanent damage to the fetus, since there is evidence of their teratogenic or embryotoxic effects in animals and humans. Br. Bratanov and I.V. Markov this group includes the following drugs:

Androgens pose a great danger due to the occurrence of hermaphroditism in female fetuses, and the possibility of congenital anomalies (shortened limbs, abnormalities of the trachea, esophagus, defects of the cardiovascular system) cannot be excluded;

Diethylstilbestrol causes serious changes. Girls whose mothers took this drug during pregnancy develop changes in the uterus and vagina. Most often, these changes occurred when the mother took the drug from the eighth to the sixteenth week of pregnancy. The effect of this substance is manifested in a negative effect on the male fetus, namely in the expansion of the ducts, wall hypotrophy and metaplasia of the prostate epithelium. Epididymal cysts were also found.

Ergotamine (belongs to the group of ergot drugs) increases the risk of spontaneous abortions and symptoms of central nervous system irritation, as indicated by N.P. Shabalov.

Progestins can cause pseudohermaphroditism in girls, precocious puberty in boys, and lumbosacral fusion in fetuses of both sexes.

Quinine leads to pronounced changes in the central nervous system (underdevelopment of the cerebral hemispheres, cerebellum, quadrigeminal tract, etc.), the formation of congenital glaucoma, abnormalities of the genitourinary system, and fetal death.

If taking medication during pregnancy cannot be avoided, then you should clearly understand the consequences of treatment with various drugs.

O.S. Sevostyanova notes that the most common manifestations early toxicosis pregnant women - nausea and vomiting, which occur in 80% of pregnant women in the first trimester and sometimes persist in the second and third, do not always require drug intervention. She also recommends primarily dietary measures. If necessary, prescribe pyridoxine (10 mg) and dicyclomine (10 mg) 2-3 times a day orally. If there is no effect, phenothiazine drugs (aminazine, promethazine, meclozine) are used, but they can cause the formation of fetal malformations.

According to V.A. Tabolin, myotropic antihypertensive drugs (diabazole, magnesium sulfate), as a rule, do not have a negative effect on the fetus, with the exception of magnesium sulfate, which can accumulate in the fetus, causing depression of the central nervous system.

Reserpine and raunatin cause retardation of fetal development. Once in the fetal body, reserpine uses MAO for its metabolism, which leads to a delay in the inactivation of histamine (also oxidized by MAO) and the appearance of rhinorrhea and bronchorrhea.

The α-adrenergic receptor antagonist methyldopa (dopegit, aldomet) acts on the receptors of the central nervous system. The fetus is also capable of accumulating the drug, which may be accompanied by a decrease in the excitability of the central nervous system. I.V. Markova considers autoimmune hemolytic anemia and liver damage (with long-term use) to be dangerous complications.

b-Adrenergic blockers cause a decrease in renal blood flow and glomerular filtration. By removing the inhibitory effect of adrenomimetics on the muscles of the uterus, they can lead to premature birth and miscarriages. The use of these drugs is fraught with delayed fetal development, as noted by A.P. Kiryushchenkov and M.L. Tarakhovsky.

Calcium antagonists are contraindicated during pregnancy due to the risk of severe cardiac dysfunction.

Taking acetylsalicylic acid in early pregnancy can have a harmful effect on the fetus. Side effects of salicylates:

Embryotoxic effect, fetal resorption;

Teratogenic effect, manifested after birth by cardiovascular anomalies, diaphragmatic hernias;

Effect on the rate of fetal growth leading to congenital malnutrition.

Antihistamines also have a teratogenic effect. In the experiment, meclizine and cyclizine caused the development of syndactyly, anal artesia, hypoplasia of the lungs, bladder, kidneys, hydrocephalus, and fetal resorption in the fetus. early dates pregnancy. According to the results of research by F.I. Komarova, B.F. Korovkina, V.V. Menshikov, the frequency of anomalies was 5% versus 1.5-1.6% in the control. Histamine quickly passes through the placental barrier, provides normal conditions for implantation and development of the embryo, promoting the transformation of endometrial stromal cells into decidual tissue, and regulates metabolic processes. Antihistamines can disrupt these processes. Taking diphenhydramine by a mother before giving birth can cause tremors and diarrhea in the baby a few days after birth, according to a brief medical encyclopedia.

Of the anticoagulants during pregnancy, only heparin can be used without fear.

Of the anti-infective drugs, sulfonamide drugs penetrate especially easily to the fetus (87% of the dose), then ampicillin, carbencillin, furadonin, gentamicin, streptomycin, tetracycline (50%) (Matsura S., 1997). Anti-infective drugs that reach the fetus can be excreted by its kidneys in amniotic fluid, from which they again reach the fetus, thereby maintaining their concentration in its blood and tissues. N.P. Shabalov and I.V. Markov found that penicillin, ampicillin, and cephalosporins are the safest for the fetus. Penicillin easily passes through the placenta and quickly penetrates the organs and tissues of the fetus. The patency of the placenta is higher for him at the end of pregnancy than at the beginning. This makes it possible to use penicillin to treat intrauterine infections of the fetus. If ampicillin is used at the end of pregnancy, jaundice in the newborn may increase. Tetracyclines form complex compounds with calcium and accumulate in bone tissue and teeth, disrupting their development. In addition, they cause fatty hepatosis and disrupt protein synthesis. Aminoglycoside antibiotics (streptomycin, kanamycin) can disrupt the function of the auditory and vestibular nerves in the fetus, leading to hearing loss. Erythromycin, due to accumulation in the fetal liver, may increase the risk of hyperbilirubinemia.

Of the synthetic anti-infective agents, sulfonamide drugs are contraindicated for pregnant women, since there is a high risk of hyperbilirubinemia in both the fetus and the newborn, followed by bilirubin encephalopathy. Biseptol and other drugs with trimethoprim are completely contraindicated, which disrupts the use of folic acid, inhibiting the formation of tetrahydrofolic acid, and, consequently, the synthesis of nucleic acids and proteins in developing tissues.

Nitrofuran drugs (furadonin, ffuragin, furazolidone) easily pass through the placenta and accumulate in the amniotic fluid. May cause hemolysis in the fetus. V.A. Tabolin concluded that their use at the end of pregnancy is undesirable.

3. Medicines and breastfeeding

O.I. Karpov, A.A. Hares found that the effect of drugs on the fetus is also possible if the drug is ingested into the baby's breast milk during feeding. Many drugs pass into mother's milk to one degree or another. Therefore, breastfeeding women should never take medications without a doctor’s prescription! This is especially true for antibiotics and sulfonamides, since they can penetrate into milk and have an adverse effect on the child’s body: the liver and kidneys may be damaged, the balance of intestinal microflora and the process of sexual development may be disrupted.

The penetration of drugs into milk depends on a number of factors (Gardner d., 1987): high doses of the substance and its frequent administration, especially parenteral administration, contribute to the passage into milk; limit – rapid elimination of a substance from the mother’s body, binding it to blood plasma proteins.

It was found that the substance can enter milk only in a free state, not bound to plasma proteins. In the vast majority of cases, penetration occurs by passive diffusion. Only non-ionized, low-polar molecules characterized by good solubility in lipids have the ability for such penetration.

A.P. Viktorov, A.P. Fishermen note that only a small amount of medicinal substances, such as lithium and amidopyrine, are actively secreted by the mammary gland into milk. Metabolites of sibazon, chloramphenicol, and isoniazid are also found in milk; most of them apparently penetrate into it from the blood plasma, but some can be formed directly in the gland. Ionized molecules and/or small molecules with a molecular weight less than 200 can pass through water-filled pores in the basement membrane. The non-ionized fraction of substances not associated with milk proteins can be reabsorbed back into the blood (sulfonamide drugs).

The concentration of most minerals in milk changes little when additionally, in addition to food, they are prescribed to a woman. This also applies to iron and fluorine. Lithium is an important exception.

Not always all the substance that enters the child’s gastrointestinal tract is absorbed. Both the physicochemical properties of the substance and the functional state of the intestine are important. Therefore, some drugs contained in milk in high concentrations, for example aminoglycoside antibiotics, are poorly absorbed (in the normal state of the mucous membrane; if it is inflamed, they can be absorbed). On the contrary, even small amounts of certain substances in milk, once reaching a child, can cause undesirable effects, often very dangerous.

The following drugs are considered contraindicated for nursing women: chloramphenicol, tetracyclines, metronidazole, nalidixic acid, iodine, reserpine, lithium preparations. It is undesirable to prescribe to nursing women: bromides (the child may have rashes, weakness), phenyline (hemorrhages), meprotane (central nervous system depression, decreased skeletal muscle tone), ergot alkaloids - ergotamine (vomiting, diarrhea, convulsions), butamide, chlorpropamide (hypoglycemia, jaundice, oliguria), amantadine (urinary retention, vomiting, rash).

The remaining substances should be prescribed with caution, the occurrence of complications should be monitored by warning the mother about them, and the drug should be immediately discontinued at the first signs of their occurrence. Otherwise, if the substance comes into contact with the child again, it may accumulate and a serious complication may develop.

Still, a number of medications can be prescribed to a nursing woman, since they either penetrate little into the milk, are poorly absorbed from the child’s gastrointestinal tract, or cause minor effects in the child.

Medicines that can be prescribed to a nursing woman: penicillins, cephalosporins, erythromycin, oleandomycin, lincomycin, furadonin, salbutamol, fenoterol, orciprenaline, dicoumarin, heparin, digoxin, strophanthin, anaprilin, octadin, insulin, caffeine, vitamins, diuretics, anticalcium drugs.

V.A. Shileiko points out that medications affect not only the child’s body, but also the secretion of milk. Milk secretion is regulated by the pituitary hormone prolactin, the formation of which is influenced by the neurosecretory structures of the hypothalamus. The latter produce special hormones that inhibit or stimulate the release of prolactin. The synthesis and release of hypothalamic hormones with the help of neurotransmitters is influenced by other parts of the central nervous system, as well as the trophism and blood supply of the mammary gland. As a result of the action of any drugs on the central structures, trophism and blood flow of the gland, various changes in milk secretion may be observed, for example hypogalactia (decreased amount of secretion).

Hypogalactias can be early (in the first 2 weeks after birth) and late, primary and secondary (developing against the background of some disease). In the treatment of hypogalactia, it is very important for the mother to observe the correct daily regimen, including a balanced diet. Late toxicosis of pregnancy (nephropathy, eclampsia) and complications during childbirth can also lead to a delay in the appearance of milk and a decrease in its quantity. Severe toxicosis in most women leads to the development of hypogalactia. Anemia, both post-hemorrhagic and recorded throughout pregnancy, often causes a decrease in the amount of milk produced. Methylergometrine, used to prevent bleeding in the early postpartum period, often leads to the development of hypogalactia.

Medications that enhance milk secretion: lactin, prolactin, oxytocin, mammophysin, nicotinic acid, ascorbic acid, vitamin A, thiamine, pyridoxine, glutamic acid, pyrroxane, methyldopa, metoclopromide, theophylline.

Substances that inhibit milk secretion: estrogens, progesterone, oral contraceptives, levodopa, bromocriptine, ergocryptine, furosemide, adrenoline, norepinephrine, ephedrine, pyridoxine.

In medicine, there are often phenomena that cannot be considered unambiguous in all cases. So it is with the release of drugs into milk. It has been established that too many different factors influence the excretion of the drug in milk, its absorption from the child’s intestines, and the child’s reaction to the substance.

Based on all of the above, we must draw the following conclusions. Medicines can be prescribed to a nursing woman only if they are truly needed. When choosing a drug, you should take into account the possibility of their negative effect on the child. Do not prescribe medications that are contraindicated for a nursing woman. If the doctor is forced for any reason to prescribe such substances, then the child must be transferred to donor milk or artificial feeding.

4. List of sources used

Berezov T.T., Korovkin B.F.. Biochemistry.-M.: Medicine, 1990.

Beutler E. Disorders of erythrocyte metabolism and hemolytic anemia. - M.: Medicine, 1981.

Clinical Pediatrics /Ed. Br. Bratanova. – Sofia: Medicine and Physical Education, 1983.Vol.1.

Clinical pediatrics / A. Anadoliyska, A. Angelov, V. Antonova, etc. / Ed. Br. Bratanova. – 2nd ed. – Sofia: Medicine and Physical Education, 1987.T.1.

Bryazgunov I.P. Jaundice associated with breastfeeding// Issues of maternal health. 1989. No. 3. pp. 54-58.

Viktorov A.P., Rybak A.T. Excretion of drugs during lactation. – Kyiv: Health, 1989.

Golzand I.V. Diseases of the liver and gall bladder in children. – L.: Medicine, Leningrad branch, 1975. – 198 p.

Neonatology / Ed. T.L. Gomelly, M.D. Cunnigum. Per. from English – M.: Medicine, 1995. – 636 p.

Grishchenko I.I. Hypogalactia. - Kyiv. 1957. – pp. 161-165.

Ermolaev M.V. Biochemistry. – M.: Medicine, 1983.

Introduction to Clinical Biochemistry / Ed. I.I. Ivanova - L.: Medicine, Leningrad branch, 1969.

Ignatov S.I. Pharmacotherapy. (Guide for pediatricians) – 3rd ed. – M.: Medgiz, 1960.

Karpov O.I., Zaitsev A.A. Risk of using medications during pregnancy and lactation. Ref. leadership – St. Petersburg: Iz-vo BHV, 1998. - 352 p.

Kiryutsenkov M.V., Tarakhovsky I.S. The effect of drugs on the fetus. – M.: Medicine, 1983. – 278 p.

Klimanov V.V., Sadykov F.G. Clinical pathophysiology childhood: diagnosis of pathological conditions in children from the position of pathological physiology. – St. Petersburg: Sotis: Lan, 1997. – 153 p.

The effect of drugs on the fetus and newborn

(abstract).

1. Mechanisms of action of medicinal substances on the fetus

and newborn 3

2. Medicines and the fetus 6

3. Medicines and breastfeeding 12

4. List of sources used 17

1. Mechanisms of action of medicinal substances on the fetus and newborn

1.embryotoxic;

2.teratogenic;

3.fetotoxic.

1.simple diffusion;

2.facilitated diffusion;

3. active transport;

4. entry through membrane pores;

5. pinocytosis.

2. Medicines and the fetus

A - medications that were taken big amount pregnant women and women of childbearing age without any evidence of their influence on the incidence of congenital anomalies or damaging effects on the fetus.

B - drugs that have been taken by a limited number of pregnant women and women of childbearing age without any evidence of their effect on the incidence of congenital anomalies or harm to the fetus.

D - drugs that cause or are suspected of causing congenital anomalies or permanent damage to the fetus.

X - drugs with a high risk of congenital anomalies or permanent damage to the fetus, since there is evidence of their teratogenic or embryotoxic effects in animals and humans. Br. Bratanov and I.V. Markov this group includes the following drugs:

- androgens pose a great danger due to the occurrence of hermaphroditism in female fetuses, and the possibility of congenital anomalies cannot be excluded (shortening of the limbs, anomalies of the trachea, esophagus, defects of the cardiovascular system);

- diethylstilbestrol causes major changes. Girls whose mothers took this drug during pregnancy develop changes in the uterus and vagina. Most often, these changes occurred when the mother took the drug from the eighth to the sixteenth week of pregnancy. The effect of this substance is manifested in a negative effect on the male fetus, namely in the expansion of the ducts, wall hypotrophy and metaplasia of the prostate epithelium. Epididymal cysts were also found.

-ergotamine ( belongs to the group of ergot drugs) increases the risk of spontaneous abortions and symptoms of central nervous system irritation, as indicated by N.P. Shabalov.

- progestins can cause pseudohermaphroditism in girls, premature puberty in boys, and lumbosacral fusion in fetuses of both sexes.

- quinine leads to pronounced changes in the central nervous system (underdevelopment of the cerebral hemispheres, cerebellum, quadrigeminal tract, etc.), the formation of congenital glaucoma, abnormalities of the genitourinary system, and fetal death.

If taking medication during pregnancy cannot be avoided, then you should clearly understand the consequences of treatment with various drugs.

O.S. Sevostyanova notes that the most common manifestations of early toxicosis in pregnant women - nausea and vomiting, which occur in 80% of pregnant women in the first trimester and sometimes persist in the second and third - do not always require drug intervention. She also recommends primarily dietary measures. If necessary, prescribe pyridoxine (10 mg) and dicyclomine (10 mg) 2-3 times a day orally. If there is no effect, phenothiazine drugs (aminazine, promethazine, meclozine) are used, but they can cause the formation of fetal malformations.

Calcium antagonists are contraindicated during pregnancy due to the risk of severe cardiac dysfunction.

Taking acetylsalicylic acid in early pregnancy can have a harmful effect on the fetus. Side effects of salicylates:

Embryotoxic effect, fetal resorption;

Teratogenic effect, manifested after birth by cardiovascular anomalies, diaphragmatic hernias;

Effect on the rate of fetal growth leading to congenital malnutrition.

Antihistamines also have a teratogenic effect. In the experiment, meclizine and cyclizine caused the development of syndactyly, anal artesia, hypoplasia of the lungs, bladder, kidneys, hydrocephalus, and fetal resorption in the early stages of pregnancy in the fetus. According to the results of research by F.I. Komarova, B.F. Korovkina, V.V. Menshikov, the frequency of anomalies was 5% versus 1.5-1.6% in the control. Histamine quickly passes through the placental barrier, provides normal conditions for implantation and development of the embryo, promoting the transformation of endometrial stromal cells into decidual tissue, and regulates metabolic processes. Antihistamines can disrupt these processes. Taking diphenhydramine by a mother before giving birth can cause tremors and diarrhea in the baby a few days after birth, according to a brief medical encyclopedia.

Of the anticoagulants during pregnancy, only heparin can be used without fear.

Nitrofuran drugs (furadonin, ffuragin, furazolidone) easily pass through the placenta and accumulate in amniotic fluid. May cause hemolysis in the fetus. V.A. Tabolin concluded that their use at the end of pregnancy is undesirable.

3. Medicines and breastfeeding

Not always all the substance that enters the child’s gastrointestinal tract is absorbed. They also matter physicochemical characteristics substances, and the functional state of the intestine. Therefore, some drugs contained in milk in high concentrations, for example aminoglycoside antibiotics, are poorly absorbed (in the normal state of the mucous membrane; if it is inflamed, they can be absorbed). On the contrary, even small amounts of certain substances in milk, once reaching a child, can cause undesirable effects, often very dangerous.

Medications that enhance milk secretion: lactin, prolactin, oxytocin, mammophysin, a nicotinic acid, ascorbic acid, vitamin A, thiamine, pyridoxine, glutamic acid, pyrroxane, methyldopa, metoclopromide, theophylline.

Substances that inhibit milk secretion: estrogens, progesterone, oral contraceptives, levodopa, bromocriptine, ergocryptine, furosemide, adrenoline, norepinephrine, ephedrine, pyridoxine.

4. List of sources used

1. Berezov T.T., Korovkin B.F.. Biochemistry.-M.: Medicine, 1990.

2. Beutler E. Disorders of erythrocyte metabolism and hemolytic anemia. - M.: Medicine, 1981.

3. Clinical pediatrics / Ed. Br. Bratanova. – Sofia: Medicine and Physical Education, 1983.Vol.1.

4. Clinical pediatrics / A. Anadoliyska, A. Angelov, V. Antonova, etc. / Ed. Br. Bratanova. – 2nd ed. – Sofia: Medicine and Physical Education, 1987.T.1.

5. Bryazgunov I.P. Jaundice associated with breastfeeding // Issues of maternal health. 1989. No. 3. pp. 54-58.

6. Viktorov A.P., Rybak A.T. Excretion of drugs during lactation. – Kyiv: Health, 1989.

7. Gonzand I.V. Diseases of the liver and gall bladder in children. – L.: Medicine, Leningrad branch, 1975. – 198 p.

8. Neonatology / Ed. T.L. Gomelly, M.D. Cunnigum. Per. from English – M.: Medicine, 1995. – 636 p.

9. Grishchenko I.I. Hypogalactia. - Kyiv. 1957. – pp. 161-165.

10. Ermolaev M.V. Biochemistry. – M.: Medicine, 1983.

11. Introduction to clinical biochemistry / Ed. I.I. Ivanova - L.: Medicine, Leningrad branch, 1969.

12. Ignatov S.I. Pharmacotherapy. (Guide for pediatricians) – 3rd ed. – M.: Medgiz, 1960.

13. Karpov O.I., Zaitsev A.A. Risk of using medications during pregnancy and lactation. Ref. leadership – St. Petersburg: Iz-vo BHV, 1998. - 352 p.

14. Kiryutsenkov M.V., Tarakhovsky I.S. The effect of drugs on the fetus. – M.: Medicine, 1983. – 278 p.

15. Klimanov V.V., Sadykov F.G. Clinical pathophysiology of childhood: diagnosis pathological conditions in children from the position of pathological physiology. – St. Petersburg: Sotis: Lan, 1997. – 153 p.

In the early 60s of the 20th century, when almost 10,000 children with phocomelia were born in Europe, the relationship of this developmental malformation with taking the tranquilizer thalidomide during pregnancy was proven, that is, the fact of drug teratogenesis was established. It is characteristic that preclinical studies of this drug, performed on several species of rodents, did not reveal a teratogenic effect. In this regard, at present, most developers of new drugs, in the absence of embryotoxic, embryonic and teratogenic effects of the substance in the experiment, still prefer not to recommend use during pregnancy until the complete safety of such a drug is confirmed after a statistical analysis of its use by pregnant women,

At the end of the 60s, the fact of drug teratogenesis, which was of a different nature, was established. It was determined that many cases of squamous cell carcinoma of the vagina at puberty and young age are registered in girls whose mothers took diethylstilbestrol during pregnancy, a synthetic drug with a non-steroidal structure with a pronounced estrogen-like effect. It was later revealed that in addition to tumors, such girls were more likely to have various developmental anomalies of the genital organs (saddle or T-shaped uterus, uterine hypoplasia, cervical stenosis), and in male fetuses the drug caused the development of epididymal cysts, their hypoplasia and cryptorchidism in postnatal period. In other words, it has been proven that side effects the use of drugs during pregnancy can be recorded not only in the fetus and newborn, but also develop over a fairly long period of time.

In the late 80s - early 90s, during an experimental study of the effects of a number of hormonal drugs on the fetus (first synthetic progestins, and then some glucocorticoids) prescribed to pregnant women, the fact of so-called behavioral teratogenesis was established. Its essence lies in the fact that until the 13-14th week of pregnancy there are no gender differences in the structure, metabolic and physiological parameters of the fetal brain. Only after this period do the characteristics characteristic of male or female individuals begin to appear, which further determine the differences between them in behavior, aggressiveness, cyclicality (for women) or acyclicity (for men) of the production of sex hormones, which is obviously associated with the sequential inclusion of hereditary deterministic mechanisms that determine the sexual, including psychological differentiation of the subsequently emerging male or female organism.

Thus, if at first drug teratogenesis was understood literally (teratos - freak, genesis - development) and associated with the ability of drugs used during pregnancy to cause gross anatomical developmental abnormalities, then in recent years, with the accumulation of factual material, the meaning of the term significantly expanded and currently teratogens are substances whose use before or during pregnancy causes the development of structural disorders, metabolic or physiological dysfunction, changes in psychological or behavioral reactions in the newborn at the time of birth or in the postnatal period.

The cause of teratogenesis in some cases may be mutations in the germ cells of the parents. In other words, the teratogenic effect in this case is indirect (through mutations) and delayed (the effect on the parents’ body occurs long before pregnancy). In such cases, the fertilized egg may be defective, which automatically leads to either the impossibility of its fertilization, or to its abnormal development after fertilization, which, in turn, may result in either spontaneous cessation of embryo development, or the formation of certain anomalies in the fetus. An example is the use of methotrexate in women for the purpose of conservative treatment ectopic pregnancy. Like other cytostatics, the drug suppresses mitosis and inhibits the growth of actively proliferating cells, including germ cells. Pregnancy in such women is at high risk of fetal developmental abnormalities. Due to the peculiarities of the pharmacodynamics of antitumor drugs, after their use in women of reproductive age, the risk of having a child with developmental anomalies will remain, which should be taken into account when planning pregnancy in such patients. After antineoplastic therapy, women of childbearing age should be considered at risk of developing fetal abnormalities, which subsequently requires prenatal diagnosis, starting in early pregnancy.

Long-acting drugs also pose a certain danger, which, when administered to a non-pregnant woman, remain in the blood for a long time and can have a negative effect on the fetus if pregnancy occurs during this period. For example, etretinate, one of the metabolites of acitretin, a synthetic analogue of retinoic acid, widely used in recent years for the treatment of psoriasis and congenital ichthyosis, has a half-life of 120 days and in experiments has a teratogenic effect. Like other synthetic retinoids, it belongs to a class of substances that are absolutely contraindicated for use during pregnancy, as it causes abnormalities in the development of the limbs, bones of the face and skull, heart, central nervous, urinary and reproductive systems, and underdevelopment of the ears.

The synthetic progestin medroxyprogesterone in depot form is used for contraception. A single injection provides a contraceptive effect for 3 months, but later, when the drug no longer has such an effect, its traces are detected in the blood for 9-12 months. Synthetic progestins also belong to the group of drugs that are absolutely contraindicated during pregnancy. In case of refusal to use the drug before the onset of a safe pregnancy, patients should use other methods of contraception for 2 years.

How do medications affect the fetus?

Most often, fetal developmental anomalies are the result of improper development of a fertilized egg due to the effect of unfavorable factors on it, in particular medications. In this case, the duration of influence of this factor is important. Applicable to humans, there are three such periods:

up to 3 weeks pregnancy (period of blastogenesis). It is characterized by rapid segmentation of the zygote, the formation of blastomeres and blastocysts. Due to the fact that during this period there is still no differentiation of individual organs and systems of the embryo, for a long time it was believed that at this stage the embryo is insensitive to drugs. Subsequently, it was proven that the effect of drugs in the very early stages of pregnancy, although not accompanied by the development of gross anomalies in the development of the embryo, usually leads to its death (embryolethal effect) and spontaneous abortion. Since the medicinal effect in such cases is carried out even before the fact of pregnancy is established, often the fact of termination of pregnancy goes unnoticed by the woman or is regarded as a delay in the onset of the next menstruation. A detailed histological and embryological analysis of abortion material showed that the effect of drugs during this period is characterized primarily by a general toxic effect. It has also been proven that a number of substances are active teratogens during this period (cyclophosphamide, estrogens);
The 4th-9th weeks of pregnancy (the period of organogenesis) are considered the most critical period for inducing birth defects in humans. During this period, intensive fragmentation of germ cells, their migration and differentiation into various organs occurs. By the 56th day (10 weeks) of pregnancy, the main organs and systems are formed, except for the nervous, genital and sensory organs, the histogenesis of which continues up to 150 days. During this period, almost all drugs are transferred from the mother's blood to the embryo and their concentration in the blood of the mother and fetus is almost the same. At the same time, the cellular structures of the fetus are more sensitive to the effects of drugs than the cells of the maternal body, as a result of which normal morphogenesis may be disrupted and congenital malformations may form;
the fetal period, by the beginning of which differentiation of the main organs has already occurred, is characterized by histogenesis and fetal growth. During this period, the biotransformation of drugs in the mother-placenta-fetus system is already taking place. The formed placenta begins to perform a barrier function, and therefore the concentration of the drug in the fetus’s body is usually lower than in the mother’s body. The negative effect of drugs during this period usually does not cause gross structural or specific developmental anomalies and is characterized by a slowdown in fetal growth. At the same time, their possible influence on the development of the nervous system, organs of hearing, vision, the reproductive system, especially the female system, as well as the metabolic and functional systems developing in the fetus remains. Thus, atrophy of the optic nerves, deafness, hydrocephalus and mental retardation are observed in newborns whose mothers used the coumarin derivative warfarin in the second and even third trimesters of pregnancy. During the same period, the above-described phenomenon of “behavioral” teratogenesis is formed, which is obviously associated with disruption of the processes of fine differentiation of metabolic processes in brain tissue and functional connections of neurons under the influence of sex steroid hormones.

In addition to the duration of exposure, the dose of the drug, the specific sensitivity of the organism to the action of the drug, and the hereditarily determined sensitivity of the individual to the action of a particular drug are important for drug teratogenesis. Thus, the thalidomide tragedy largely occurred because the effect of this drug was experimentally studied in rats, hamsters and dogs, which, as it later turned out, unlike humans, are not sensitive to the action of thalidomide. At the same time, mouse fetuses turned out to be sensitive to the action of acetylsalicylic acid and highly sensitive to glucocorticosteroids. The latter, when used in early pregnancy in humans, lead to cleft palate in no more than 1% of cases. It is important to assess the degree of risk of using certain classes of drugs during pregnancy. According to the recommendations of the US Food and Drug Administration (FDA), all drugs, depending on the degree of risk and the level of adverse, primarily teratogenic, effects on the fetus, are divided into five groups.

Category X - drugs whose teratogenic effect has been proven experimentally and clinically. The risk of their use during pregnancy outweighs the possible benefits, and therefore they are strictly contraindicated for pregnant women.
Category D - drugs whose teratogenic or other adverse effects on the fetus have been established. Their use during pregnancy is associated with risk, but it is lower than the expected benefit.
Category C - drugs whose teratogenic or embryotoxic effects have been established experimentally, but clinical trials have not been conducted. The benefit of the application outweighs the risk.
Category B - drugs, the teratogenic effect of which was not detected in the experiment, and the embryotoxic effect was not detected in children whose mothers used this drug.
Category A: experiments and controlled clinical trials did not reveal any negative effect of the drug on the fetus.

Medicines absolutely contraindicated during pregnancy (category X)

Medicines	Consequences for the fetus
Aminopterin	Multiple anomalies, postnatal growth restriction, facial anomalies, fetal death
Androgens	Masculinization of the female fetus, shortening of the limbs, anomalies of the trachea, esophagus, defects of the cardiovascular system
Diethylstilbestrol	Adenocarcinoma of the vagina, pathology of the cervix, pathology of the penis and testicles
Streptomycin
Dieulfiram	Spontaneous abortions, cleft limbs, club feet
Ergotamine	Spontaneous abortions, symptoms of central nervous system irritation
Estrogens	Congenital heart defects, feminization of the male fetus, vascular anomalies
Inhalational anesthetics	Spontaneous abortions, developmental defects
Iodides, iodine 131	Goiter, hypothyroidism, cretinism
	Delay mental development, ototoxicity, congenital glaucoma, abnormalities of the urinary and reproductive systems, fetal death
Thalidomide	Limb defects, heart, kidney and digestive tract abnormalities
Trimethadione	Characteristic face (Y-shaped eyebrows, epicanthus, underdevelopment and low position auricles, sparse teeth, cleft palate, low-set eyes), abnormalities of the heart, esophagus, trachea, mental retardation
Synthetic retinoids (isotretinoin, etretinate)	Anomalies of the limbs, facial part of the skull, heart defects, central nervous system (hydrocephalus, deafness), urinary and reproductive systems, underdevelopment of the ears. Mental retardation (>50%)
Raloxifene	Developmental disorders of the reproductive system
Progestins (19-norsteroids)	Masculinization of the female fetus, clitoral enlargement, lumbosacral fusion

Medicines whose use during pregnancy is associated with a high risk (category B)

Medicines	Consequences for the fetus and newborn
Antibiotics Tetracyclines (doxycycline, demeclopicline, minocycline) Aminoglycosides (amikacin, kanamycin, neomycin, netilmicin, tobramycin) Fluoroquinolones Chloramphenicol (chloramphenicol)	Safe during the first 18 weeks of pregnancy. In more late dates cause discoloration of teeth (brown discoloration), hypoplasia of tooth enamel, impaired bone growth Congenital deafness, nephrotoxic effect Affects cartilage tissue (chondrotoxicity) Agranulocytosis, aplastic anemia, gray syndrome in the neonatal period
Nitrofurintoin	Hemolysis, yellow discoloration of teeth, hyperbilirubinemia in the neonatal period
Antiviral agents Ganciclovir Ribavirin Zalcitabine	In experiments, it has a teratogenic and embryotoxic effect. Has teratogenic and/or embryo-lethal effects in almost all animal species Teratogenic effects have been described in two animal species
Antifungal agents Griseofulvin Fluconazole	Arthropathy A single dose of 150 mg does not lead to a negative effect on the course of pregnancy. Regular intake of 400-800 mg/day causes intrauterine developmental defects
	A teratogenic effect was recorded in an experiment on some animal species.
Antidepressants Lithium carbonate Tricyclic MAO inhibitors	Congenital heart defects (1:150), especially Ebstein's anomaly, cardiac arrhythmias, goiter, central nervous system depression, arterial hypotension, neonatal cyanosis Respiratory disorders, tachycardia, urinary retention, neonatal distress syndrome Slow development of the fetus and newborn, behavioral disorders
Coumarin derivatives	Warfarin (coumarin) embryopathy in the form of nasal hypoplasia, choanal atresia, chondrodysplasia, blindness, deafness, hydrocephalus, macrocephaly, mental retardation
Indomethacin	Premature closure of the ductus arteriosus, pulmonary hypertension, with long-term use - growth retardation, impaired cardiopulmonary adaptation (more dangerous in the third trimester of pregnancy)
Anticonvulsants Phenytoin (diphenin) Valproic acid Phenobarbital	Hydantoin fetal syndrome (widened flat and low-lying nose, short nose, ptosis, hypertelorism, maxillary hypoplasia, large mouth, protruding lips, cleft upper lip etc.) Spina bifida, palate, often additional minor anomalies - hemangiomas, inguinal hernia, separation of the rectus abdominis muscles, telangiectasia, hypertelorism, deformation of the auricles, delayed development. Central nervous system depression, hearing loss, anemia, tremor, withdrawal syndrome, arterial hypertension
ACE inhibitors	Oligohydramnios, hypotrophy, contractures of the limbs, deformation of the facial part of the skull, pulmonary hypoplasia, sometimes antenatal death (more dangerous in the second half of pregnancy)
Reserpine	Hyperemia of the nasal mucosa, hypothermia, bradycardia, central nervous system depression, lethargy
Chloroquine	Nervous disorders, hearing, balance, vision disorders
Antitumor agents	Multiple deformities, frozen pregnancy, intrauterine growth restriction
Antithyroid drugs (thiamazole)	Goiter, ulceration of the middle part of the scalp
Pituitary hormone inhibitors Danazol Gesterinone	When taken after 8 weeks, from the moment of conception, it can cause virilization of the female fetus. May cause masculinization of female fetuses
Benzodiazepine derivatives (diazepam, chlozepid)	Depression, drowsiness in the neonatal period (due to very slow elimination), Rarely - malformations reminiscent of fetal alcohol syndrome, congenital heart and vascular defects (not proven)
Vitamin D in high dose	Organ calcification
Penicillamine	Possible developmental defects connective tissue- developmental delay, skin pathology, varicose veins veins, fragility of venous vessels, hernias

In conclusion, I would like to note that despite the 40 years that have passed since the first description of cases of drug-induced teratogenesis, the study of this problem is still largely at the stage of accumulation and primary comprehension of material, which is due to a number of reasons. Only a relatively small list of drugs is systematically used and cannot always be withdrawn from a patient due to pregnancy (anti-epileptics, anti-tuberculosis drugs, tranquilizers for mental illnesses, oral hypoglycemic drugs for diabetes mellitus, anticoagulants after heart valve replacement, etc.). It is the side effects on the fetus of such drugs that have been most fully studied. Every year, a number of new drugs are introduced into medical practice, often with a fundamentally new chemical structure, and although their possible teratogenic effects are studied in accordance with international rules, there are species differences that do not allow the safety of the drug to be fully assessed at the stage of preclinical studies or clinical trials. in terms of its teratogenic effect. These data can only be obtained by conducting expensive multicenter pharmaco-epidemiological studies with analysis of the use of a particular drug by a large number of patients. Significant difficulties arise in assessing the long-term effects of drug use during pregnancy, especially when it comes to their possible impact on a person’s mental status or behavioral reactions, since their characteristics may not only be a consequence of the use of drugs, but also determined by hereditarily determined factors, social conditions life and upbringing of a person, as well as the action of other unfavorable (including chemical) factors. When registering certain deviations in the development of the fetus or child after using the drug by a pregnant woman, it is difficult to differentiate whether this is the result of the action of the drug or the effect of a pathogenic factor on the fetus , which necessitated the use of this medicine.

Taking into account the facts already accumulated by doctors of various specialties in their daily activities will allow optimizing the pharmacotherapy of diseases both before and during pregnancy and avoiding risks side effect medicines for the fetus.