SAN DIEGO, Calif. – Pregnant women with psoriasis may be at increased risk for adverse pregnancy outcomes, according to research just published in the British Journal of Dermatology.

The Organization of Teratology Information Specialists (OTIS) Autoimmune Diseases in Pregnancy Project compared the prevalence of selected risk factors between 170 pregnant women with psoriasis and 158 non-diseased pregnant women. The research study was coordinated at the University of California, San Diego.

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Last month, CTIS received questions from callers about new mothers taking antidepressants and possibly encountering a delay in the initiation of optimum milk production in the early postpartum period. These questions were generated by an article published in the February 2010 issue of the Journal of Clinical Endocrinology & Metabolism suggesting that the selective serotonin reuptake inhibitors (SSRIs), which include citalopram (Celexa®), fluoxetine (Prozac®), paroxetine (Paxil®) and sertraline (Zoloft®), might cause this effect.

CTIS reviewed the article...

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Oral contraceptives (OCs), also known as birth control pills, have been around for over 40 years. When they were initially introduced into the market, OCs were prescribed in high dosage and in varying formulation. Lo-Ovral®, Ortho-novum®, and Triphasil® are just a few of a variety of OCs on the market. To date, OCs generally consists of two synthetic hormones, an estrogen and a progestin. Since the early 60’s, case reports and small-scale studies have suggested an increased risk for major structural birth defects, such as heart, limb and genitourinary tract defects, when taken in early pregnancy (i.e., continued exposure early in an unrecognized pregnancy). However, there are also published studies that have not suggested an increased risk for major structural birth defects when OC exposure occurs in early pregnancy. As OC dosages are now much lower, are they still a concern when inadvertent exposures occur during pregnancy?

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During pregnancy, a woman’s estrogen level increases. High levels of estrogen have been suspected as one cause of nausea and vomiting during pregnancy (NVP). It has been estimated that as many as 80% of pregnant women develop NVP. Since Bendectin was removed from the market in the U.S. many years ago, clinicians have had to find alternative strategies to treat NVP. Metoclopramide enhances GI motility and is an effective antinauseant. Although, it is not FDA-approved for NVP, it was originally developed to treat nausea during pregnancy. At least six countries in Europe and Israel use metoclopramide as an antiemetic treatment for NVP. To date, available data on metoclopramide use in pregnancy, based on small-scale studies, is not suggestive of an increased risk for major birth defects.

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by Gerald G. Briggs, BPharm, FCCP

Diabetes mellitus can be classified into three types:

type 1: autoimmune disease that results in β-cell destruction, usually leading to absolute insulin deficiency; ketoacidosis prone; may have a late onset and slow progression of disease; pregestational diabetes

type 2: non-autoimmune disease that results in progressive insulin secretory defect on the background of insulin resistance; ketoacidosis resistant; pregestational diabetes

type 3: diabetes diagnosed during pregnancy, called gestational diabetes.

Diabetes mellitus is the most common medical complication of pregnancy, occurring in 2%-3% of all pregnancies. Approximately 90% of these represent gestational diabetes mellitus (GDM; type 3) where the onset or recognition of glucose intolerance occurs during pregnancy. Most of these cases represent true GDM in which glucose intolerance disappears after delivery, but a significant number are newly diagnosed type 2 diabetics. The distinction is important because poorly controlled pregestational diabetes can cause all aspects of developmental toxicity (growth alteration, structural anomalies, functional/neurobehavioral defects, and death), whereas true GDM does not cause structural anomalies because its onset is after organogenesis. Suboptimal treatment of this disease, indicated by a hemoglobulin A1c (HbA1c) above (>6%) the normal, is associated with significant maternal, embryo, fetal, neonatal, childhood and adolescent morbidity and mortality. Thus, tight control of the blood glucose level in pregnant diabetic patients is a primary therapeutic goal.

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by Philip O. Anderson, Pharm.D., FASHP, FCSHP

Breastfeeding is acknowledged as the standard against which other methods of infant feeding are judged. No artificial feeding method comes close to providing the benefits of breastfeeding in terms of infant and maternal health. All major national and international healthcare organizations with policy statements on breastfeeding recommend exclusive breastfeeding for 6 months with continued breastfeeding thereafter.

Sometimes nursing mothers need a medication. Almost any medication will reach the breastmilk in some quantity. However, the amount that appears in milk is usually not great enough to harm a nursing infant.

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First developed in the 1930s, antihistamines are currently the most commonly used drugs for seasonal allergies. They have been used clinically in the general population and are available over-the counter or through prescription. In pregnancy, antihistamines are also sometimes used to treat nausea and vomiting of pregnancy. The prevalence of antihistamine use, anytime during pregnancy, ranges from 8 – 15%. First-generation antihistamines include clemastine fumarate, dimenhydrinate, diphenhydramine, doxylamine, hydroxyzine, meclizine, pheniramine, promethazine, and triprolidine. Whereas, second-generation anithistamines include cetirizine, fexofenadine, and loratadine. When used as suggested or prescribed, these medications can minimize symptoms of allergy by blocking the histamine reaction to allergens, thereby preventing other potential complications from untreated allergies. But how safe are antihistamines during pregnancy?

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By David Schatz, MD

Treatment of medical illness during pregnancy is often complicated. Though the common medications used to treat illness can do wonderful things, a certain number can have negative effects on the unborn child. Thus, a mother and her doctor are left with the difficult decision of deciding if a treatment during pregnancy is worth the possible risk to the baby. Nowhere are these facts truer than in the treatment of Major Depressive Disorder (MDD) during pregnancy.

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Numerous studies over two decades have associated use of sodium valproate or valproic acid (VPA) during pregnancy with a characteristic pattern of major and minor malformations...

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