Drugs in pregnancy and lactation

Abstract

Medical or surgical interventions, requiring anaesthesia and/or analgesia, are frequent during various stages of pregnancy and lactation when the mother, the embryo/fetus, and the breastfeeding infant are vulnerable. Many physiological alterations occur during pregnancy, which might result in modified pharmacokinetic/pharmacodynamic drug profiles. These are often challenging situations for the treating physician who has to rely on scarce clinical or epidemiological data to support their prescriptions. This chapter reviews the underlying principles of pharmacology and related toxicity during pregnancy and lactation. It outlines current recommendations for most commonly used drugs in anaesthesia (i.e. local anaesthetics, hypnotics, opioids, and muscle relaxants) and pain relief (i.e. analgesics and anti-inflammatory drugs). It should not be considered as an exhaustive description of the potential side effects nor should it be used as a prescription guide for specific clinical situations. When administering drugs to pregnant or lactating women, one should always refer to up-to-date best standard of care and review references, which should be clearly documented in the patient’s medical record, especially with respect to newly marketed compounds.