Pharmacology in pregnancy

In this talk, we turn our attention to pharmacology and pregnancy, framing our discussion around managing medication safety during pregnancy, including how physiological changes alter drug absorption and elimination and how the placenta regulates fetal drug exposure. We will discuss medication choices for common conditions, highlighting drugs that are safe versus those that are contraindicated. Special attention will be given to managing chronic illnesses like hypertension, diabetes, and epilepsy during pregnancy and the importance of adjusting therapy. Finally, we'll address medication safety during breastfeeding, emphasizing risk assessment and reliable resources for clinical decision making. Managing medications during pregnancy is both delicate and essential. Approximately 90% of pregnant women will take at least one prescribed or over the counter drug, making safety a universal concern. The clinician must balance the mother's health with the fetus' well being. Unique physiological changes affect drug absorption, metabolism, distribution, and elimination, impacting medication decisions, and requiring careful consideration of safety classifications and available data. The placenta is not just a passive barrier but an active organ, managing selective transfer between maternal and fetal blood. Its structure enables passive diffusion of many drugs, active transport through proteins like BCRP and MDR, and efflux pumps that limit fetal exposure. Drug passage depends on factors like molecular weight,