Conditions prevalent in pregnancy and lactation Nausea and Vomiting

As many as 80% of pregnant women suffer from nausea or vomiting.16

Nonpharmacologic measures, such as lifestyle (rest, avoidance of nausea triggers such as strong odors) and dietary changes (small and frequent meals, fluid restriction during meals) should be used as first-line management. Acupuncture and acupressure can be also helpful.16

The combination of pyridoxine (vitamin B6) and doxylamine is well studied during pregnancy and is the first-line pharmacologic treatment of nausea and vomiting during pregnancy (Table 47-8).1 ,17 This combination is not available in the United States, and the ingredients have to be administered separately. When the combination of pyridoxine/doxylamine is insufficient, other drugs such as metoclopramide or diphenhydramine can be prescribed; ondansetron is another alternative.1 ,17

Table 47-7 Drugs of Concern During Breast-Feeding

Drug or Class_Comments

Acebutolol Amiodarone

Antineoplastics

Atenolol

Bromocriptine

Cabergoline

Ergotamine

Illicit drugs Larnotrigine

Lithium

Radioactive iodine-131 Tetracyclines

Neonatal (3-blockade reported May accumulate be:ause of long half-life; possible neonatal thyroid and cardiovascular tox city Neonatal myetosuppression possible Neonatal /3-blockade reported Lactation suppression Lactation suppression Symptoms of ergotism (vomiting and diarrhea) reported; inhibition of prolactin secretion possible Unknown contents and effects A breast-fed infant will receive a dose estimated between 10% and 50% of the lowest pediatric dose; serum concentrations reported in breast-fed infants were between 3% and 50% of maternal serum levels; potential for rash aid CNS side effects Up to 50% of material serum levels have been measured in infants; cases of infant toxicity have beer reported Long radioactive half-life (21-42 days)

Chronic use may lead to dental staining or decreased epiphyseal bone growth

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