Medical Diseases in Pregnancy

Priyanka Sharma

RAPID BOARD REVIEW—KEY POINTS TO REMEMBER:

Most medications used in pregnancy are category B or C.
Examples of category D and X drugs and their potential effects include the following:

CATEGORY D	EFFECTS	CATEGORY X	EFFECTS
Angiotensin-converting enzyme inhibitors	Unsafe after the first trimester; renal failure and death in neonate	Measles, mumps, rubella, varicella live-attenuated vaccines	Congenital viral syndromes
Anticholinergic drugs	Neonatal meconium ileus	Danazol	Ambiguous genitalia
Antithyroid drugs	Neonatal goiter and hypothyroidism, aplasia cutis (methimazole)	Warfarin	Embryopathy: hypoplastic nose, epiphyseal stippling, optic atrophy, microcephaly, and growth restriction
Carbamazepine	Neural tube defects (NTDs)	Diethylstilbestrol	Vaginal adenosis and clear cell carcinoma in offspring
Lithium	Ebstein’s anomaly	Vitamin A	Spontaneous abortions and fetal malformations
Nonsteroidal anti-inflammatory drugs	Constriction of the ductus arteriosus in third trimester	Isotretinoin	Isotretinoin syndrome
Phenytoin	Fetal hydantoin syndrome	Triazolam	Cleft palate
Psychoactive drugs	Fetal withdrawal syndrome	Lovastatin	Bone malformation
Tetracycline	Tooth discoloration, bone malformation	Thalidomide	Limb-shortening defects
Valproic acid	NTDs	Ribavirin	Embryocidal
		Lead, methyl mercury, polychlorinated and polybrominated biphenyls, organic solvents	Assorted mental, physical, and metabolic effects
		Ionizing radiation	Miscarriage