Drug use during pregnancy and lactation

Evidence-based treatment of schistosomiasis in pregnancy

Schistosomiasis is a parasitic infection that causes significant morbidity and mortality, especially in pregnant women originating from developing countries. Prompt diagnosis and treatment can improve pregnancy and infant outcomes. Currently, there are no formal guidelines for treatment in this population, which makes schistosomiasis in pregnancy a challenge to treat.

Antiparasitic drugs and lactation: focus on anthelmintics, scabicides, and pediculicides

Infections involving helminths or parasitic worms affect more than 25% of the population worldwide. Because lactating women and their infants are often affected by the complications of these infections such as iron deficiency anemia and malnutrition, they benefit the most from drug therapy. However, scientific literature offers little information regarding transfer of anthelmintics in breast milk and its effects in lactating infants. Scabies and pediculosis, or lice, are common skin infections affecting school-aged children. Close contacts of infected children, which often include lactating mothers, need treatment with one of the several topical products available in the market. This article will review the physicochemical properties and use of anthelmintics, pediculicides, and scabicides while breastfeeding.

Antibiotics and breast-feeding: a critical review of the literature

Continuous breast-feeding, an integral component of the postpartum period, is often threatened upon maternal initiation of antibiotics. The real risk of antibiotic use while breast-feeding must be carefully analysed with regard to all the variables that influence the extent of antibiotic distribution into breast milk, including breast milk composition, physicochemical properties of the antibiotic (molecular weight, lipid solubility, pH, protein binding), length of feeding, and maternal disposition. In addition, infant disposition, including ability to absorb, metabolize, eliminate, and tolerate any amounts of antibiotic, must also be considered prior to maternal administration of antibiotic. The milk to plasma (M/P) ratio is a frequently quoted parameter used to predict drug distribution into breast milk. However, its utility is questionable and often fraught with misinterpretation. An alternative approach when the amount of antibiotic concentration in breast milk is known (through clinical trials) is to calculate an estimated or expected infant drug exposure factoring in known/expected milk consumption, drug concentration and bioavailability. In this review, the following antibiotic classes and current literature regarding their distribution into breast milk are critically reviewed: beta-lactam antibiotics, fluoroquinolones, sulfonamides, macrolides, aminoglycosides, tetracyclines, nitrofurantoin, metronidazole, vancomycin, clindamycin and chloramphenicol. In the majority of instances, these antibiotics do not distribute into breast milk in sufficient concentrations to be of any clinical consequence in the breast-feeding infant.

Inflammatory thyroid disorders

Inflammatory thyroid disorders encompass a broad spectrum of diseases that are generally self-limited, and relatively easy to diagnose and manage. Autoimmune subtypes are by far the most commonly encountered diagnoses and create the most confusion because of simultaneous overlap and the potential for interconversion among the subtypes. The otolaryngologist will frequently see these disorders and provide valued consultative care and surgical intervention as needed.

Steroid use during pregnancy

Health care providers and pregnant women share a concern for protecting the fetus from unnecessary and potentially teratogenic influences. Since the introduction of steroids for the induction of fetal surfactant production, there has been considerable experience in the use of corticosteroids during pregnancy. While the use of corticosteroids for surfactant induction in the preterm fetus has become commonplace, steroids are used for other obstetric and medical indications during pregnancy. Thus, finding a balance between drug benefits and possible side effects remains a critical issue.