Friday, February 26, 2010

Presciptions in Pregnancy

It’s a common fear: a woman becomes pregnant and starts worrying about the medications she is taking.

According to Michael Carson, M.D., who presented at Sinai Hospital Grand Rounds yesterday, internists need to become more familiar with the impact of disease on a pregnancy, and what medicines are safe. Carson is an assistant clinical professor in the Departments of Medicine and Obstetrics at the UMNDJ – Robert Wood Medical School and the director of research and outcomes at the Jersey Shore University Medical Center.

“Women of childbearing age bear children. You need to address pregnancy with your patient before she becomes pregnant,” he told the group of Sinai physicians. “Fifty percent of pregnancies are unplanned.”

It’s estimated that anywhere from 14 to 45 percent of women beginning prenatal care in the United States have medical problems. Physicians should talk about resources and options available for the patient, Carson said. According to a study published in the International Journal of Gynecology and Obstetrics, pregnant women ingest an average of three difference prescription medications during pregnancy. The most common are antimicrobial (to treat infections), antiemetics (to treat nausea), tranquilizers (to treat stress) and analgesics (to treat pain).

“Medication use is not a yes/no issue,” Carson said. “You have to weigh the risks and benefits.”

Patients and physicians also need to discuss what is realistic. For example, a smoker may not be able to go cold turkey, but she can use a nicotine patch. A woman who is depressed may be able to cut back on her medication, but needs to be able to function.

There's a tendency to undermedicate during pregnancy, Carson says. The bottom line is internists need to make sure they're looking at the whole picture.

“The best thing for a healthy kid is a healthy mom,” Carson says.

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