PENGGUNAAN OBAT

PADA IBU HAMIL DAN

MENYUSUI
Changes in pregnancy
CARDIOVASCU
LAR

GASTROINTES
GYNECOLOGI
TINAL

KIDNEY
 Cardiovascular
> Increased blood volume by 30-50%
> Increased cardiac output by 30-50%
> Decreased systemic vascular resistance
 Gastrointestinal
> IncreasedpH of intestinal secretion
> Increased gastric emptying time
> Decreased gastric acid secretion
> Decreased intestinal motility
 KIDNEY
> Increased renal blood flow rate
> Increased glomerular filtration rate
 GYNECOLOGI
• > Increased uterine blood flow
FDA DRUGS CATEGORIES IN
PREGNANCY
CATEGORY
A

CATEGORY CATEGORY
X B

CATEGORY CATEGORY
D C
 CATEGORY A
• Adequate and well-controlled studies
have failed to demonstrate a risk to the
fetus in the first trimester of pregnancy (no
risk in the later trimester)
Example: levothyroxine, folic acid,
MgSO4, liothyronine
 CATEGORY B
• Animal reproductive studies have failed
to demonstrate a risk to the fetus and
there are no adequate and well-
controlled studies in pregnant women
Example: metformin, hydrocholorthiazide,
amoxicillin, pantoprazole
 CATEGORY C
• Animal reproduction studies have shown
an adverse effect on the fetus and there
are no adequate and well-controlled
studies in humans, but potential benefits
may warrant use of the drug in pregnant
women despite potential risks.
Example: tramadol, gabapentin,
amlodipine, prednisone
 CATEGORY D
• Positive evidence of human fetal risk
based on adverse reaction data from
investigational or marketing experience
studies in humans but potential benefits
may warrant use of the drug in pregnant
women despite potential risks
Example: lisinopril, alprazolam, losartan,
clonazepam, lorazepam
 CATEGORY X
• Studies in animals or humans have
demonstrated fetal abnormalities and/or
there is positive evidence of human fetal
risk based on adverse reaction data
from investigational or marketing
experience and the risks involved in use
of the drug in pregnant women clearlu
outweigh potential benefits
Example: atorvastatin, simvastatin,
warfarin, methothrexate, finasteride.
 EFEK PENGGUNAAN OBAT
PADA KEHAMIAN
Drug Trimester Effect
ACEI All Renal damage
Barbiturates All Chronic use: neonatal
dependence
Carbamazepine First Neural tube defects
Cocaine, tamoxifen All Risk of spontaneous abortion
Ethanol All Fetal alcohol syndrome
Tobacco All Intrauterine growth retardation
Tetracycline All Discolorisation of teeth and
altered bone growth
Thalidomide First Limb malformation
Warfarin First Alter respiratory tract formation
Second CNS malformation
Third Risk of bleeding
Antiemetics drugs in pregnancy
• Metoclopramide – B
• Ondancentron – B
• Domperidon – B
• Phenothiazine – C
 Analgesics drugs in pregnancy
• Paracetamol – B
• Aspirin – C
• NSAID – C & D
 Dyspepsia in pregnancy
• Antasida – safe in 2nd and 3rd trimester
• H2 antagonist (cimetidine/ranitidine) – safe
in sectio
• Sucralfat – safe in pregnancy because no
absorptions
 Antihypertensive drugs in
pregnancy
• ACEI (captopril, lisinopril) – C & D
• Beta blockers (propanolol, bisoprolol) – C
&D
• Diuretics (Furosemide) – C & D
• ARB (candesartan) – C & D
 Antibiotics in pregnancy

AMAN TIDAK AMAN

Penicillin Tetracyclin

Ampicillin Aminoglicoside

Amoxicillin Gentamycin

Cephalosporin Quinolon

Cotrimoxazole Vancomycin

Erithromycin

Antifungal

* Beware of allergic reaction in some antibiotics

EFEK PENGGUNAAN OBAT
PADA IBU MENYUSUI
Drug Comments
Tetracycline Risk of Permanent tooth staining in
infant

Isoniazide Risk of Pyridoxine deficiency in infant

Barbiturate Lethargy, sedation and Poor suck
reflexes

Diazepam Drug accumulation and sedation

Methadone Risk of withdrawal if breast feeding stop
Iodine Thyroid suppression and risk of cancer
Propylthiouracil Can suppress thyroid function in infant