The effect of drugs on the fetus. Embryotoxic effect. The effect of drugs on the embryo and fetus The effect of drugs on the fetus summary

There is no doubt that various medications can have a negative effect on the fetus. However, the degree of this influence is very diverse and depends on many factors, which will be presented in more detail below. Even widely used and approved during pregnancy medications can cause various complications in the fetus and newborn. When prescribing any treatment during pregnancy, it should be borne in mind that all medications are prescribed only according to indications. In this case, it is necessary to choose drugs with proven tolerability, giving preference to one drug rather than combination treatment. No drug is absolutely safe and harmless. Sensitivity to certain drugs may be genetically determined. The use of medications can contribute to pregnancy complications such as: spontaneous miscarriage; premature birth; stillbirth; congenital anomalies; cerebral paralysis; mental retardation or behavioral disorders, etc. Medicines that do not cause organic damage to the fetus can contribute to the development of allergic reactions in the fetus. In addition, the negative effects of medications may appear only after the birth of the child or at a later date. Often, concomitant diseases during pregnancy have a harmful effect on the fetus, which requires the use of various medications. Various medications are also prescribed to pregnant women for the purpose of specific therapeutic effects on the fetus. In these cases, first of all, the balance of benefit and harm from taking certain medications is assessed and they are prescribed only if the likelihood of a therapeutic effect for the mother outweighs the risk of developing undesirable effects on the fetus. Usually, only those drugs are prescribed for which there is already experience of their widespread use during pregnancy. It is impossible to compile an exact list of safe drugs. One can only assume that there are more or less safe drugs, but their harmlessness can never be completely ruled out.

All drugs can be divided into the following five groups:

  • 1 group. Medicines that, in controlled trials in pregnant women, have not shown a risk to the fetus in the early stages and for which there is no data on a harmful effect on the fetus in late pregnancy (most multivitamin complexes, potassium chloride, iron supplements, triiodothyronine).
  • 2nd group. Drugs whose experimental study did not reveal a teratogenic effect or complications observed in animals were not found in children whose mothers took medications included in this group (penicillin antibiotics, heparin, insulin, aspirin, metronidazole).
  • 3rd group. When testing these drugs on animals, their teratogenic or embryotoxic effect was revealed. No controlled trials have been conducted or the effect of the drug has not been studied (isoniazid, fluoroquinolones, gentamicin, antidepressants, antiparkinsonian drugs). These drugs should only be prescribed when the potential benefit outweighs the potential risk.
  • 4th group. The use of drugs in this group is associated with a certain risk to the fetus, but the benefits of their use outweigh the possible side effects (anticonvulsants, doxycycline, kanamycin, diclofenac).
  • 5 group. The teratogenic effect of drugs in this group has been proven; their use is contraindicated during pregnancy, as well as when planning pregnancy (isotretionine, carbamazepine, streptomycin).

It is advisable for pregnant women to refrain from taking any medicines in the first trimester of pregnancy, unless the drugs are specifically prescribed by a doctor, and avoid any medications other than drugs that correspond to the first group of those listed above.

In cases where any medications were used on the eve of conception or in the earliest stages of pregnancy, then, first of all, the drug should be identified from the point of view of its possible damaging effect. If, for example, it is a likely teratogen, an attempt should be made to determine the relationship between the time of exposure and the likely time of conception. If exposure to a known teratogen occurred early, then further research is necessary to clarify the risk of possible abnormalities in fetal development. To do this, it is advisable to determine the level of free hCG subunit in the blood, perform a PAPP-A test, and determine the thickness of the nuchal translucency (NT) using ultrasound. The table below identifies drugs that should be avoided during early stages pregnancy due to their damaging effects on the fetus.

Medicines that should not be used in early pregnancy

A drug Action
1. Drugs with a high risk of developing disorders (known to be teratogenic) or causing abortion.
Warfarin.
Diethylstilbestrol. Vaginal adenosis and adenocarcinoma in daughters.
Androgens. Virilization and numerous congenital developmental defects.
Antitumor agents. Numerous birth defects.
Corticosteroids (high doses). Cleft palate.
Fibrinolytic drugs. Placental abruption.
Tetracyclines. Yellow discoloration of teeth, slower bone growth.
Valproate Neural tube defect.
Vitamin A analogues. Multiple congenital developmental defects.
Cyproterone acetate. Feminization of the male fetus.
Distigmine. Increased uterine tone.
Misoprostol. Increased uterine tone.
2. Drugs with a high probability of developing abnormalities (moderately increasing risk).
Amiodarone. Gout.
Chloroquine. Deafness (not canceled in case of acute malaria).
Lithium. Gout, cardiovascular system defects.
Phenytoin. Numerous congenital defects (do not cancel if there are absolute indications for the need to control epileptic seizures).
3. Other drugs to avoid.
Calcium antagonists, griseofulvin, omeprazole, quinolone antibiotics, rifampicin, spironolactone, live vaccines, etc. Theoretical risk identified in animal and other experimental studies.

The use of anticoagulants in the first trimester of pregnancy is associated with an unfavorable pregnancy outcome in 35% of cases and is dangerous for the development of skeletal abnormalities in the fetus (especially during intrauterine development). The use of sex steroid hormones is associated with an increased risk of stillbirth, the birth of fetuses with pathologies of the cardiovascular system (tetralogy of Fallot, transposition of blood vessels), hypospadias and the development of neuroblastoma in children during adolescence. The use of oral contraceptives in early pregnancy increases the risk of chromosomal abnormalities and the risk of having children with Down syndrome by 2.8 times. The risk of developing neuroblastoma in children, especially in males, increases 1.2 times. There may be a slight increase in the risk of spontaneous abortion in pregnancies occurring during continued use of oral contraceptives.

The use of vitamin A during critical periods of development of organs and systems can lead to the formation of multiple malformations in the fetus. None of the tranquilizers or sleeping pills are completely safe. Therefore, their use, especially in, should be abandoned. In the second half of pregnancy, the drugs used, as a rule, no longer cause large anatomical defects. Some drugs, while not teratogenic, may nevertheless have side effects on the fetus when taken. In the last weeks of pregnancy or during childbirth, medications mainly affect the functions of individual organs or enzyme systems of the newborn and have a lesser effect on the fetus. When used in high doses in the last weeks of pregnancy, acetylsalicylic acid can cause jaundice in the fetus. In addition, upon admission to last week before delivery, acetylsalicylic acid can cause disruption of the blood coagulation system during childbirth in the mother and provoke bleeding in the newborn. Aminoglycoside antibiotics can be used during pregnancy only for absolute indications, as they have a damaging effect on the hearing aid and kidneys of the fetus. Tetracyclines can cause hepatocellular necrosis in the mother and impaired development of bones and teeth in the fetus. Levomycetin (chloramphenicol) may cause peripheral vascular collapse in an infant if given in inappropriate doses. Syndrome gray hair observed in newborns due to maternal treatment with chloramphenicol, causes a relative contraindication for the use of this drug in late pregnancy. Most sulfonamides should be completely avoided during. Anticoagulants prescribed orally during the second half of pregnancy can also cause microcephaly and bleeding. Heparin does not cross the placenta and is relatively safe, although it sometimes causes reversible osteoporosis and often bone demineralization. Thiazide diuretics (diuretics) can cause thrombocytopenia in newborns, probably due to direct toxic effects on the bone marrow, and should be avoided in late pregnancy. The table shows drugs that should not be used in the second half of pregnancy or, in some cases, used with great caution.

A drug Risk to the fetus or newborn
Aspirin. Kernicterus (also in mother).
Aminoglycosides.
Aminoglycosides. Damage to the VIII pair of cranial nerves.
Tetracyclines. Slow bone growth, yellow discoloration of teeth.
Levomycetin. Peripheral vascular collapse.
Sulfonamides and novobiocin. Kernicterus.
Anticoagulants. Fetal hemorrhage or retroplacental microcephaly.
Thiazide diuretics. Thrombocytopenia.
Benzodiazepines. "Lazy baby syndrome"
Sulfonylurea. Hypoglycemia.
Disopyramide. Premature birth.
Misoprostol. Premature birth.
Fibrinolytic drugs. Bleeding in the fetus and mother.
Narcotic analgesics. Respiratory depression, opiate withdrawal syndrome in a newborn.
Nitrofurantoin. Hemolysis.
Non-steroidal anti-inflammatory drugs. Closure of the ductus arteriosus; late prolonged labor.
Antithyroid drugs. Gout and hypothyroidism.
Reserpine. Bradycardia, hypothermia, nasal congestion with respiratory distress.

When assigning and selecting drug treatment During pregnancy, not only its positive sides, but also a risk to the mother and fetus.

Certain medications may be used during pregnancy. When folic acid is prescribed in an amount of 400 mcg in the first trimester, there is a decrease in the risk of developing neural tube defects in the fetus. The usual daily dose of folic acid to prevent anemia in pregnant women is 500 mcg. The use of multivitamin preparations within 3 months before pregnancy significantly reduces the risk of having children with pathologies of the heart, blood vessels and nervous system(Materna, Elevit, Vitrum-prenatal, Gendevit). However, a teratogenic effect can be observed not only with a deficiency, but also with an excess content of vitamins in the body. Thus, excess vitamin C can lead to chromosomal abnormalities. Large doses of vitamin D can help remove calcium from the fetal skeletal bones and reduce the production of parathyroid hormone. Therefore, in the absence of any diseases and complications during pregnancy, it is clear balanced diet the mother is completely sufficient for its normal course, proper development and growth of the fetus, and there is no need to prescribe multivitamin complexes, especially during gestation. It is more beneficial to eat foods rich in vitamins and microelements, in accordance with the increased needs of the body.

To prevent and treat anemia in pregnant women, drugs containing iron and folic acid are usually used (Fenuls, Sorbifer Durules, Ferrum Lek, Maltofer, Ferro-foilgamma). The main requirement for such drugs is to provide a minimum daily dose of iron and folic acid (500 mcg). Modern hormonal gestagenic drugs (Duphaston, Utrozhestan) do not have an androgenic and anabolic effect, and do not have a virilizing effect on the fetus. Prescribing glucocorticoid therapy (metipred, dexamethasone, prednisolone) without indications that a woman has autoimmune connective tissue diseases or is not justified due to the high risk of suppressing fetal adrenal function, developing osteoporosis and generalization of infection. Antispasmodics (No-spa, papaverine) are used in. Magnesium preparations - Magne B6, Magnerot can be used for a long time until the threat of miscarriage is eliminated and throughout pregnancy to replenish magnesium deficiency. They should be taken with caution in case of arterial hypotension - mimetics (Partusisten, Ginipral, Salgim) penetrate into the fetus and contribute to an increase in glucose levels, causing tachycardia. With prolonged use, newborns have manifestations similar to diabetic fetopathy. The safest antiemetic drugs are Cerucal and Reglan. However, because nausea and vomiting are more likely to occur in early pregnancy, it is important to limit the use of these antiemetic drugs to a minimum.

The use of antihistamines (Suprastin, Pipolfen, Cimetidine, Ranitidine, Tavegil) in the first trimester of pregnancy, as a rule, is not associated with an increased risk of developing congenital defects in the fetus. Antacids (Almagel, Maalox), used in the second and third trimesters of pregnancy, also do not have a negative effect on the fetus. Laxatives that are relatively safe for the fetus are Bisacodyl and senna leaves. However, frequent and systematic use of these drugs is not recommended.

The use of antibiotics during pregnancy should be regulated by strict medical indications and carried out under the supervision of a physician. Relatively safe for both mother and fetus are: penicillin, ampicillin, amoxicillin, cephalosporins (Cefazolin, Cefotaxime, Suprax), augmentin, vilprofen, erythromycin. To begin with, antimicrobial agents can be used for local treatment: terzhinan, Klion-D, miramistin, plivosept, clotrimazole. Recombinant interferon preparations (KIPferon, Viferon) are recommended to be used no earlier than with. In some cases, there is a need to correct hyperthyroidism in the mother. In this case, it is possible to prescribe low doses of carbimazole, methimazole or propylthiouracil. However, such treatment may be accompanied by a risk of hypothyroidism and gout in the fetus (10%). For hypothyroidism, levothyroxine and potassium iodide are prescribed. If you have an insulin-dependent diabetes mellitus Pregnant women are prescribed insulin after consultation with a specialist and under monitoring blood sugar levels. Heparin and low molecular weight heparins (Fraxiparin) do not pass through the placenta and do not have any adverse effects on the fetus. Long-term (more than 6 months) use of heparin in therapeutic doses during pregnancy predisposes to reversible osteoporosis and fractures. Fraxiparine has a number of advantages: the absence of hemorrhagic complications in mothers and newborns and the absence of clinical signs of osteoporosis. are not considered potentially teratogenic for the human fetus, but the fetotoxic effect of diuretics of various chemical groups cannot be excluded. With prolonged use of large doses of thiazides by pregnant women, hyponatremia and thrombocytopathy may develop in newborns. Under the influence of ethacrynic acid, weakening and hearing loss are observed in newborns. Furosemide does not have a negative effect on the fetus. Drugs that lower blood pressure (antihypertensive drugs) may have an adverse effect on the fetus, increasing its susceptibility to the effects of hypoxia. In newborns from mothers who took antihypertensive drugs, blood pressure is slightly lower over a period of time than in healthy children.

Treatment bronchial asthma the use of β-adrenergic drugs (Salbutamol) during pregnancy is not contraindicated. The side effects of medications currently used for acute asthma (including steroids and cromolyn sodium) have not been proven. In cases where pregnancy occurs after clomiphene stimulates ovulation, the risk of chromosomal abnormalities in the fetus increases. When using antiallergic drugs, the development of abnormalities of the cardiovascular system and musculoskeletal system in the fetus is often observed.

One of the most important periods in a woman’s life is the period of bearing a child. And during these few months, the expectant mother must do everything in her power to ensure that a healthy baby is born.

Of course, a pregnant woman should lead healthy image life: eat right, pay the necessary attention physical activity and try to avoid any health problems. But the pregnancy continues for nine calendar months— it is very difficult during this time not to feel any ailments or health problems.

How can a pregnant woman cope with possible ailments, or even diseases, if the number of medications that are approved for use by pregnant women is very limited?

Possible effects of medications on the fetus

It has been repeatedly proven that various medications can affect the developing fetus at any stage of pregnancy.

The most dangerous effect occurs in the first trimester of pregnancy, when all the organs and systems of the future organism are formed in the rapidly growing body, and then the fetus. The fact is that during this period the placenta is still in the stage of formation and cannot become an obstacle to a wide variety of chemicals, including those that can have an extremely negative effect on the fetus.

Attention! Even medications that are officially approved for use during pregnancy can sometimes cause various complications in the body of the fetus, and then in the newborn.

If it is necessary to use any drug during pregnancy, the expectant mother should remember:

  • Any drug during pregnancy (at any stage) can be used only in accordance with the indications and only as prescribed by the attending physician;
  • When choosing a drug, preference should be given only to those drugs that have proven tolerability;
  • During the period of bearing a child, preference should be given to monotherapy, that is, treatment should, if possible, be carried out with only one drug; combination treatment during this period is undesirable;
  • A pregnant woman should remember that completely safe and absolutely harmless medications do not exist.

Careless and/or excessive use of medications during pregnancy can cause many pregnancy complications, especially since it is almost impossible to predict the reaction of a pregnant woman’s body to a particular drug, even if it is officially approved for use in pregnant women, since sensitivity to certain substances and, accordingly, medications can be genetically predetermined, and a substance that is safe in one case can be very dangerous in another.

Careless, ill-considered and incorrect use of medications during pregnancy can cause the following undesirable and sometimes extremely dangerous consequences:

  • Spontaneous abortion, or miscarriage, which can happen at any gestational age;
  • Premature onset of the labor process (premature birth), which can result in death and/or the birth of a non-viable baby;
  • There may be cases of stillbirth;
  • The use of drugs during different periods of pregnancy can result in congenital deformities and anomalies of various organs of the fetus;
  • It is believed that one of the consequences of consumption by a pregnant woman medical supplies may become cerebral palsy (cerebral palsy);
  • The result of exposure of the fetus to various drugs can be behavioral disorders that manifest themselves over time, or delayed mental development of the child.

Attention! Even if taking medications during pregnancy does not cause organic damage to the fetus, it is very likely that the child will develop allergic reactions.

Scientists and clinicians note that the effects of taking medications during pregnancy can appear after the birth of the baby, even after several months or even several years.

Unfortunately, pregnant women also sometimes get sick, and the diseases can be both acute and chronic. And almost any disease expectant mother may have an undesirable, that is, harmful, effect on the fetus, which can lead to serious consequences. In such cases, it is necessary to use different medications to protect the unborn child.

In addition, sometimes pregnant women are prescribed medications that have a specific effect on the fetus for therapeutic purposes when it is necessary to correct the condition of the fetus during the prenatal period. And sometimes the fetus has to be treated, for which it is necessary to provide a very specific therapeutic effect.

Of course, these are very important prescriptions, therefore, when prescribing any medications to a pregnant woman, first of all, the doctor evaluates how the potential benefits and possible harm from taking any drug.

Attention! Any medications are prescribed to pregnant women only if the possible therapeutic effect on the mother’s body will undoubtedly outweigh the risk of undesirable or even harmful effects on the developing and growing fetus.

In medical practice, it is customary to prescribe to pregnant women only those medications that have been tested and have proven themselves when used during pregnancy.

Is there a list of medications that are safe for pregnant women? Unfortunately, such a list is impossible in principle, since the body of each woman is unique, as is the development of each pregnancy. In addition, as is known, some reactions to various substances in the body can be genetically determined.

Attention! Today, doctors can only assume that some medications are safer for pregnant women than others, but they cannot be considered completely harmless to the expectant mother’s body, since the possibility of potential harm to a greater or lesser extent is never excluded.

Dangers of using medications during pregnancy

The most dangerous period for the use of any medicines, both chemical and natural, is considered to be (the first 12 gestational weeks), when the fetus develops all the organs and systems that will only develop in the future. It is at this period that the fetus is considered most vulnerable to any influences, including chemical (medicinal) substances. Among other things, the danger also increases because in the first weeks of pregnancy the placenta, which will later filter substances entering the fetus’s body, is not yet formed and does not work at full capacity.

It should also be taken into account that some medications can have a negative and even damaging effect on male (sperm) and female (eggs) reproductive cells even before conception. That is, conception can occur with the participation of damaged cells, and it is completely unknown how the embryo will develop and what disorders will appear in the fetus, and then in the newborn.

Attention! Immunosuppressants, some antibacterial drugs (antibiotics), drugs for antitumor treatment, as well as psychotropic drugs and hormonal drugs with a steroid structure can damage male and/or female reproductive cells even before pregnancy.

If a man and/or woman has taken such medications, then it makes sense for them to postpone planning a pregnancy for about six months after taking such medications. The fact is that taking some medications even at the stage of pregnancy planning can cause undesirable consequences:

  • Some drugs can exhibit an embryotoxic effect, that is, an extremely negative effect on the developing embryo, and this is especially pronounced in the first, second and third gestational weeks - the development of the fertilized egg in such cases simply stops.
  • There are drugs that have a teratogenic effect on the embryo and fetus, which causes the appearance of a variety of developmental anomalies in the fetus. It is important to understand that the nature of the fetal developmental abnormality highly depends on the duration of pregnancy, since the fetus at any stage of its development reacts differently to the effects of the drug, although such a reaction is almost always negative.

The teratogenic properties of drugs, that is, their ability to provoke the formation of fetal injuries, depends on several characteristics of the drug, including:

  • The chemical structure of the drug, that is, the structure of the molecules that make up the drug, is very important;
  • Equally important is how easily the drug (drug molecules) is able to penetrate through placental barrier;
  • Of course, the dosage of the drug and the duration of its use are of great importance;
  • Metabolic features are also important, that is, at what speed the half-life products of this drug can be eliminated from the body of a pregnant woman.
Attention! The simultaneous use of certain drugs increases their teratogenic effects: if two or more drugs with a teratogenic effect, this significantly (several times) increases the risk of possible development of various congenital malformations and defects in the fetus.

Drugs that have a fetotoxic effect can have a negative effect on the developing and growing embryo, and then on the fetus, that is, these drugs can have a toxic effect on the fetus after 12 weeks of gestation and until birth. The fetotoxic effect manifests itself in different ways: delay in general fetal indicators, low indicators physical development(weight and length), dysfunction of various organs and systems of the fetus. It is very important that the fetotoxic effect of some drugs can manifest itself in an already born baby.

It must be remembered that any complications during pregnancy, including such as and/or kidney problems, lead to the fact that drugs accumulate in the mother’s body, creating higher concentrations in the blood, which increases the fetotoxic effect.

Attention! To protect the fetus from the fetotoxic effects of various drugs, the placenta and its functional state are very important, on which the possibility of manifestation of protective functions depends. It is the placenta that is the barrier that protects the body of the developing fetus from the harmful effects of any factors that could pose a danger to it.

Metabolic processes associated with the removal of harmful chemicals from the body include not only the placenta, but also the kidneys, liver, adrenal glands and pancreas, as well as other organs

Five groups of drugs that have different effects on the body of a pregnant woman and the body of the fetus

  • The first group includes those drugs that have successfully passed controlled trials, even on pregnant women. As a result of the tests, it was proven that taking these drugs does not pose any risk to the fetus and its development during the first trimester of pregnancy. Also, no data and/or evidence have been identified regarding possible harm to the fetus of these drugs at later pregnancy.
  • The first group of drugs includes potassium chloride, triiodothyronine, iron supplements, many multivitamin complexes and some other drugs.
  • The second group includes medicinal substances that have been tested. But no teratogenic effect on the fetus was detected if mothers took these drugs while carrying a child. However, when tested on animals, some deviations from the norm were observed in the offspring.
  • The second group of drugs includes aspirin, insulin, heparin, penicillin antibiotics, metronidazole and other medications.
  • The third group includes drugs that have demonstrated teratogenic and/or embryotoxic effects during animal testing. Controlled clinical trials in humans have not been conducted or the possible effects of taking such a drug have not been studied. Such drugs are prescribed to pregnant women only when the expected potential benefit outweighs the potential risk.
  • The third group of drugs includes fluoroquinolones, isoniazid, gentamicin, antidepressants, antiparkinsonian drugs, as well as other drugs.
  • The fourth group includes medications, the use of which during pregnancy carries some risk for the growing and developing fetus, but it has been proven that the benefits of using these drugs outweigh the possible harm from side effects.
  • The fourth group of drugs includes diclofenac, doxycycline, kanamycin, anticonvulsants and other drugs.
  • The fifth group includes drugs whose teratogenic effect has been proven, therefore their use during pregnancy and even during pregnancy planning is contraindicated. If taking such drugs is necessary for absolute reasons, for example, to save the life of the mother, then the pregnancy cannot be saved and must be terminated
Attention! At any gestational stage, a decision on whether a pregnant woman needs to take any medication can be made only by the attending gynecologist or specialist and only after a detailed study of the pregnant woman’s medical history, the results of all studies and clinical tests.During the first trimester of pregnancy, taking any medications is extremely undesirable. Only drugs that belong to the first group can be safe during this period..

Attention! If conception occurs spontaneously while taking oral contraceptives, and if oral contraceptives are not stopped until pregnancy is known for certain, then this almost triples the likelihood of chromosomal abnormalities in the fetus, and the risk of having a child with Down syndrome increases by 2 ,8 times. In addition, the risk of developing neuroblastoma in newborns, especially boys, increases (at least 1.2 times).

For reference: Neuroblastoma is a malignant tumor that affects the sympathetic nervous system.

conclusions

It is very important that every pregnant woman remembers that any drug during pregnancy can bring not only benefit, but also considerable harm, therefore any self-prescription during this period is unacceptable, since their consequences are unpredictable and in many cases can cause irreparable harm to the developing fetus.

Teratogenicity. Embryotoxicity.

A teratogenic effect can occur in the first trimester of pregnancy, i.e. during organogenesis. During this period, some medications can cause deformities, malformations, or death of the fetus. This effect can be observed even when a woman uses medications in therapeutic doses. Embryotoxicity is observed in the second and third trimester of pregnancy when a pregnant woman uses drugs in a large (toxic) dose. In this case, death or metabolic disorders of the fetus (embryo) may develop with a delay in its development.

The basic principle of drug therapy for pregnant women: proven effectiveness and proven safety of drugs for the fetus. There are problems with the evidence base on the safety of drugs for the fetus:

· conducting controlled clinical trials LS is difficult for ethical reasons;

· there are no adequate, strictly controlled clinical studies of the effectiveness and safety of drugs;

· the research carried out is short-term.

In the Republic of Belarus, risk categories for medicinal products for the fetus have not been developed; therefore, in practice, the American classification of risk categories for medicinal products for the fetus is used (FDA):

A– absolutely harmless to the fetus;

B– there is no evidence of risk to the fetus;

C– the risk to the fetus cannot be excluded;

D– there is convincing evidence of harm to the fetus;

In order to reduce the risk of side effects, you should consider:

1. Pharmacological effects of the drug.

2. Patient's age. In elderly people, the dose is reduced by 30-50%; for children, the dose is set based on weight and age.

3. Functional state of organs and systems involved in the biotransformation of drugs.

4. Functional state of excretory organs. In patients with severe chronic renal failure, the excretion of drugs and their metabolites is reduced, their connection with plasma proteins is disrupted, which leads to an increase in the concentration of active substances in the blood plasma and the likelihood of side effects.



5. Presence of concomitant diseases. Prescribing, for example, NSAIDs can cause exacerbation of gastritis, gastroduodenitis, and peptic ulcers.

6. Lifestyle (with intense physical activity the rate of elimination of drugs is increased), the nature of nutrition (in vegetarians the rate of biotransformation of drugs is reduced), bad habits (smoking helps to accelerate the metabolism of some drugs).

In the Republic of Belarus, there are documents regulating the procedure for organizing control over side effects of medicines: Law of the Republic of Belarus No. 161-3 dated June 20, 2006 “On Medicines”, Order of the Ministry of Health of the Republic of Belarus No. 254 dated August 13, 1999 “On approval of the rules for conducting clinical trials of medicines” funds”, Resolution of the Ministry of Health of the Republic of Belarus No. 52 dated 03.20.2008 “On approval of instructions on the procedure for submitting information about identified adverse reactions to drugs and monitoring adverse reactions to drugs”, Resolution of the Ministry of Health of the Republic of Belarus No. 50 dated 05.07.2009 “On Certain Issues of Conducting Clinical Trials of Medicines”, which approved the code of established practice “Good Clinical Practice”.

DRUG DAMAGES TO ORGANS AND SYSTEMS

Drug-induced liver damage. Among the side effects of pharmacotherapy, drug-induced liver damage makes up a small proportion, but is characterized by a high probability of adverse outcomes. The mechanisms of drug-induced damage to hepatocytes are different, however, in most cases these are acute lesions with cytolysis and (or) cholestasis. At the same time there is large group chronic forms of liver damage of drug origin, and among them – cirrhosis. In these cases, cirrhosis is the result of fatty degeneration and chronic hepatitis, which can be caused by methyldopa, nitrofurans, tetracyclines, amiodarone, valproate and many other drugs. In 1992, the number of drugs that cause liver damage totaled more than eight hundred items.

Drug-induced kidney damage. The kidneys, due to their large role in removing drugs from the body, are also susceptible to their side effects. In the interstitium and lymphatic spaces of the kidneys, the concentration of many drugs exceeds their content in the blood plasma. Intense blood circulation and the participation of the kidneys in the biotransformation of drugs also create conditions for prolonged contact of drugs and their metabolites with kidney tissue. Often the cause of kidney damage can be an immune reaction, leading to denaturation of the protein structures of the basement membrane. Some drugs (aminoglycosides, cephalosporins, cytostatics) are active inhibitors of complex enzyme systems in the kidneys, which can cause severe disorders of their functions. In some cases, there is deposition of drugs and their metabolites in the structures of the nephron - the basement membrane, mesangium, interstitium, and around the vessels. Deposits of drugs in the pelvis can lead to drug-induced nephropathy, which most often occurs during treatment with sulfonamides, gold preparations, and non-steroidal anti-inflammatory drugs.

Clinical manifestations Most drug-induced nephropathies are similar to those in kidney diseases. This may be glomerulonephritis, acute interstitial nephritis, urate crystalluria, calculous pyelonephritis (with long-term use of drugs containing calcium).

Drug-induced lung lesions. Although the respiratory system is thought to be resistant to the adverse effects of drugs, lung lesions do occur. There are several types of drug-induced lung lesions: asthma, alveolitis, pulmonary eosinophilia, respiratory distress syndrome.

Bronchospasm is one of the most common allergic reactions to medications. Beta-blockers, cholinomimetics, and sympatholytics have a bronchospastic effect.

The cause of alveolitis can be both increased sensitivity to drugs and their toxic effect on lung tissue. Drugs that have a cytotoxic effect (methotrexate, azathioprine, bleomycin) more often cause fibrosing alveolitis. Pathogenetically, it does not differ from idiopathic fibrosing alveolitis.

The pathogenesis of pulmonary phospholipidosis caused by amiodarone is based on the ability of amiodarone to bind the lipids of the lysosomes of alveolar macrophages, which disrupts the catabolism of their phospholipids, which are then deposited in the alveoli. Against this background, pulmonary fibrosis may develop. Eosinophilic infiltrates in the lungs can form when taking antibiotics, sulfonamides, etc. An extremely rare lung injury is respiratory distress syndrome, which can be caused by acetylsalicylic acid and nitrofurans.

Drug-induced damage to the cardiovascular system. Many medications have side effects on the cardiovascular system, causing rhythm and/or conduction disturbances, impaired myocardial contractility, and an increase or decrease in blood pressure. Adverse side effects are especially pronounced in the presence of cardiovascular diseases and combinations of drugs. Some medications (such as the ergot alkaloid ergotamine) can cause fibrous thickening of the heart valve leaflets.

Drug-induced vascular lesions often manifest as phlebitis, vasculitis, and phlebosclerosis as a consequence of connective tissue hyperreactivity to the administered drug.

Drug-induced skin lesions. Skin lesions can develop both from direct external contact with the drug and from systemic use of drugs. They appear in the form of rashes of various types: erythematous, vesicular, bullous, pustular, urticaria, purpura, erythema nodosum. Most of them are of allergic origin, appear on the 8-10th day of treatment and subsequently disappear without a trace.

Pustular rashes are a consequence of infection of the follicles of the sweat glands. Vesicular rashes with significant spread are manifested by erythroderma. Widespread bullous rashes can lead to hemodynamic disorders and hypotension. A severe form of exudative erythema multiforme (Stevens-Johnson syndrome) is fatal in a third of patients.

Drug-induced damage to connective, bone and muscle tissues. Atrophic changes in connective tissue occur under the influence of glucocorticosteroids due to inhibition of the activity of fibroblasts, a decrease in the synthesis of connective tissue fibers and the main substance of connective tissue. At the same time, striae form on the body, and wound healing worsens. On the contrary, as a result of proliferation of connective tissue in various organs and parts of the body - mediastinum, lungs, endo- and pericardium - fibrosis can develop. The development of fibrosis has been described during treatment with ganglion blockers and b-blockers.

Drug-induced systemic lupus erythematosus can be provoked by procainamide, chlorpromazine, D-penicillamine, methyldopa, and anticonvulsants. When the drugs are discontinued, symptoms may reverse, at least partially.

Side effects Many medications include arthralgia and arthritis, which are based on allergic reactions.

Drug-induced bone lesions are most often observed in the form of osteoporosis, osteomalacia and rickets. Osteoporosis develops with long-term treatment with glucocorticosteroids, and rarely with heparin. Osteomalacia and rickets are the result of decreased bone mineralization due to a lack of vitamin D. The breakdown of vitamin D can be caused by phenobarbital and phenytoin. Glucocorticosteroids inhibit the absorption of vitamin D.

An unfavorable side effect that occurs as a result of taking many medications is muscle weakness. Muscle weakness can be caused by myopathy, which is based on damage to myocytes, or myasthenia gravis, a disorder of the transmission of excitation at neuromuscular synapses. In therapeutic practice, myasthenia gravis can be expected when treated with aminoglycosides, tetracyclines, macrolides, chloroquine, quinidine, and b-blockers. Damage to the muscle cells themselves can be the result of rhabdomyolysis, necrotizing myopathy, and muscle fiber atrophy. There is also a vacuolating or hypokalemic form of myopathy, which can develop as a result of intensive therapy with diuretics or laxatives.

Rhabdomyolysis is an extremely rare but often fatal complication of drug therapy with cytostatics and statins. Rhabdomyolysis is characterized by swelling of large proximal muscles with transition to flaccid paralysis, development of fibrosis, compaction with contracture. Necrotizing myopathy can be considered a mild form of rhabdomyolysis caused by the same drugs. In addition, necrotizing myopathy can be provoked by vincristine, clofibrate, and beta-blockers.

Drug-induced polymyositis is usually one of the manifestations of drug-induced lupus erythematosus.

Lesions affecting connective tissue, muscles, skin and bones include algodystrophy - trophic changes in bones, muscles, joints and skin, accompanied by severe pain. Clinically, algodystrophy can manifest itself as glenohumeral syndrome due to fibrosis of the tissues of the capsules of the upper extremities. This complication may sometimes occur during treatment with phenobarbital.

Drug-induced damage to hematopoiesis. Blood changes are among the most common adverse reactions. Their development has been described using more than a thousand drugs. Thrombocytopenia, granulocytopenia, aplastic and hemolytic anemia are of greatest clinical importance.

Thrombocytopenia most often caused by cytostatics, gold drugs, penicillins, cephalosporins, tetracyclines, furosemide, quinidine. Its development is a consequence of toxic inhibition of megakaryocytes in the bone marrow.

Granulocytopenia– rare, but very dangerous complication drug treatment, sometimes leading to agranulocytosis, the mortality rate of which reaches 50%. Granulocytopenia is often caused by analgin, phenacetin, and less commonly phenylbutazone, indomethacin and other non-steroidal anti-inflammatory drugs.

The most dangerous drugs that cause aplastic anemia include chloramphenicol, sulfonamide drugs, gold drugs, butadione. As a rule, aplastic anemia is an idiosyncratic reaction.

Hemolytic anemia develops as a result of the formation of antibodies during pharmacotherapy that react with erythrocyte antigens. Penicillins, cephalosporins, insulin, levodopa, and quinidine can induce the formation of erythrocyte antibodies.

Hemolytic anemia can also develop with a deficiency of the enzyme glucose-6-phosphate dehydrogenase in red blood cells. In these cases, red blood cells are not protected from the action of oxidants. As a result, when treated with drugs that have oxidant properties, idiosyncrasy develops and, as a consequence, hemolytic anemia. This mechanism of hemolytic anemia is observed during treatment with sulfonamides, nitrofurans, chloroquine, primaquine, phenacetin, acetylsalicylic acid and other antipyretics, ascorbic acid.

It is impossible to avoid the occurrence of side effects when using modern medicines. However, adverse reactions should be prevented whenever possible, which can be facilitated by adherence to the following recommendations:

Never use medications unless there are clear indications for their use; the use of medications in pregnant women is advisable only when there is an urgent need for the prescribed medications;

When prescribing a specific medicine, you should clarify what other medicines, including self-medication drugs, herbs, nutritional supplements, accepted by the patient; this is necessary to know, since their interaction is possible, leading to undesirable consequences;

Allergic and idiosyncratic reactions are common adverse reactions to drugs, so it is necessary to check with patients whether they have had any such reactions in the past;

You should pay attention to the age of the patient, the presence of liver and kidney diseases, since under these conditions the metabolism and excretion of drugs from the body may change, which, in turn, leads to the need to select the dose of the drug; it is also necessary to take into account that genetic factors may also be responsible for variability in the biotransformation of drugs;

If possible, simultaneous administration of multiple medications should be avoided; if necessary, limit the number of drugs used to the minimum required (no more than 3 in an outpatient setting);

Patients, especially the elderly, should be clearly instructed on how to take medications and should be directed to strictly follow the instructions for use of medications;

The patient must be warned about the possibility of serious adverse reactions, about which there is information in the instructions for use of the drugs;

When prescribing new drugs Special attention Patients should be alerted to possible and unexpected adverse reactions.

LITERATURE

1. Vdovichenko V.P. Pharmacology and pharmacotherapy. // Minsk, 2006.

2. Khapalyuk A.V. General issues of clinical pharmacology and evidence-based medicine. // Minsk, 2003.

3. Khapalyuk A.V. The importance of the paradigm of evidence-based medicine in the practice of a doctor of the 21st century.// Recipe. - 2003. - No. 1.

4. Chuchalin A.G., Tsoi A.N., Arkhipov V.V. Diagnosis and treatment of pneumonia from the standpoint of medical evidence. // Consilium-Medicum. - 2002. - T.4. - No. 12.

The external environment of the fetus during its intrauterine development is the mother’s body. It serves as a protective barrier for the unborn child from harmful factors, which at this time are very dangerous for him.

Unfortunately, the protective capabilities of a pregnant woman’s body are very limited; they are depleted over time and cannot counteract enormous power harmful factors, which are divided into two groups:

  1. Those that come from a pregnant woman;
  2. External factors affecting the embryo or fetus through the mother’s body.

What you need to know : how the fetus will develop depends largely on the health of the mother and her environment, which to one degree or another affects the unborn child through the body of a pregnant woman.

Whether the development of the fetus will be accelerated or slowed down, whether it will completely stop, depends on what month of pregnancy the woman is in, what the dose is, the duration and strength of the harmful effects.

The following teratogenic agents can cause abnormal fetal development:

  • medicinal and chemical substances;
  • radioactive radiation;
  • and etc.

Their impact entails not only anatomical defects, but also genetic ones.

Harmful factors that have a detrimental effect on the fetus include:


Why you shouldn't drink alcohol during pregnancy

Alcoholic drinks consumed by a woman during pregnancy are a biological poison for her unborn child, which he receives along with the mother’s blood.

This applies not only to strong drinks, but also to light wines and beer. Even in small quantities and only once, an alcoholic drink consumed by the mother can cause enormous harm to the fetus, since it does not have an enzyme (alcohol dehydrogenase) that would destroy ethanol. Alcohol easily crosses the placental barrier, affecting the placenta. As a result, the conditions for the development of the fetus worsen and its nutrition is disrupted. Alcohol also has a detrimental effect on a pregnant woman, reducing the resistance of her body and making it vulnerable to various infections.

Children born to drinking mothers, as a rule, lag behind in physical, psychomotor, and often mental development. They often have congenital deformities and defects that appear as they grow older.

Thus, disorders of the central nervous system (CNS) can manifest themselves:

  • reduction in the size of the skull and brain (microcephaly);
  • ataxia (impaired coordination of movements);
  • decreased intelligence;
  • motor disinhibition;
  • dementia.

Such a child may be stunted or have abnormalities internal organs, facial skull, limbs. With alcohol syndrome, fetal mortality in the perinatal period is very high.

What you need to know: It is strictly prohibited to drink alcohol in the first trimester of pregnancy, when the main organs and systems of the child’s body are laid and formed.

There are often cases when alcohol provoked the development of hereditary diseases, the occurrence of which might not have occurred during a normal, healthy pregnancy.

How does nicotine affect the fetus?

Smoking is harmful, especially during pregnancy! All doctors in the world came to this conclusion. The fact is that after a pregnant woman smokes just one cigarette, after about half an hour, a spasm of the uterine vessels occurs. Nicotine and other toxic substances entering the blood of the fetus cause inhibition of its respiratory movements.

Babies of smoking mothers are born with low body weight. Risk sudden death in such children in the perinatal and neonatal periods it is very high. Often newborns experience:

  • development of pulmonary failure,
  • encephalopathy,
  • delayed psychomotor development.

What you need to know: Nicotine is present in breast milk, so a smoking mother who breastfeeds her baby poisons her baby every day. Nicotine negatively affects a child's growing body. The baby becomes vulnerable to various diseases, grows weakened, and often lags behind in development.

How do drugs affect pregnancy and the fetus?

Drug use by a pregnant woman complicates the course of pregnancy, adversely affects the intrauterine development of the child, and leads to difficult childbirth.

Pregnant women who use narcotic drugs experience frequent miscarriages, hemorrhages, premature births, spontaneous abortions, premature placental abruption, and intrauterine fetal death.

It should be noted that the fetus, like the mother, experiences drug addiction, which threatens the newborn with withdrawal syndrome, leading in 5% of cases to death or the development of postpartum drug withdrawal.

This pathological condition manifested by hyperactivity, irritability (the child constantly screams), frequent sneezing, yawning, decreased muscle tone, and increased body temperature.

Intrauterine fetal hypoxia, which develops when a pregnant woman uses drugs, leads to the development of the following anomalies in the unborn child:

  • underdevelopment of the respiratory apparatus;
  • impairment of external respiration;
  • developmental defects of the limbs and genitourinary system;
  • intrauterine growth retardation.

Such children are often born with defects of the cardiovascular and nervous systems, and mental disorders. There are frequent cases of cerebral stroke in the perinatal period.

Effect of drugs on the fetus

Approximately 80% of women use certain medications during pregnancy, but few people know that various changes occurring in the physiological state of the body at this time affect the pharmacokinetics of medications used by a pregnant woman.

What you need to know: the harm that drugs cause depends on the stage of intrauterine development of the fetus, the dose used and the pharmacological action of the drug facilities.

There are five critical moments when a drug can cause significant harm to the embryo/fetus:

  1. Time preceding conception;
  2. Time from conception to the eleventh day of pregnancy;
  3. From the eleventh day to three weeks;
  4. From the fourth to the ninth week;
  5. The period from the ninth week until birth.

It is believed that the teratogenic effect of drugs is greatest between 31 and 81 days from the last menstruation. The most vulnerable parts of the embryo at this time are the central nervous and cardiovascular systems, ears, and palatine plate.

Therefore, in the first trimester of pregnancy it is better not to use medications at all. refuse. Well, if such a need arises, the benefits of the medications prescribed to the pregnant woman should be many times greater than the possible harm.

The strength of the teratogenic effect of drugs is determined by the degree of their penetration through the placental barrier, which depends on the molecular weight of the drug, fat solubility and its other properties.

Low molecular weight drugs easily cross the placental barrier and enter the bloodstream of the embryo/fetus.

What you need to know: Not a single drug used orally during pregnancy can be considered absolutely harmless..

The most dangerous drugs with a high degree of penetration and teratogenic effect include:

  • antiepileptic drugs (phenytoin, diphenin, finlepsin, valproic acid, etc.);
  • psychotropic drugs (lithium, etc.);
  • antithrombotic agents (warfarin, etc.);
  • retinoids (adaclin, differin, etc.);
  • antigonadotropic drugs (danazol, danoval, etc.).

Based on embryotoxic and teratogenic effects, drugs are divided into three groups.

The first group includes the most dangerous drugs with a high risk:

  • cytostatic drugs (methotrexate, melphalan, vincristine, etc.);
  • antibiotics with antitumor and antimycotic effects (dactinomycin, daunorubicin, exifin, etc.);
  • immunosuppressants (batridene, azathioprine, etc.).

The second group includes drugs that have a significant degree of risk:

  • (tetracyclines, rifamycins, etc.);
  • antiprotozoal (plaquenil, diloxanide, quinidine, etc.);
  • anticonvulsants (finlepsin, etc.);
  • antipsychotic drugs;
  • antiparkinsonian;
  • antithyroid;
  • antidiabetic;
  • antipsychotics (antidepressants, antipsychotics);
  • indirect anticoagulants.

The third group includes drugs of moderate risk:

  • psychotropic drugs (tranquilizers);
  • sulfa drugs;
  • antiprotozoal drugs (metronidazole, etc.);
  • estrogens.

What you need to know : the effects in the fetus and newborn from medications taken by a pregnant woman can be very diverse and can be expressed by anomalies in the development of organs and systems, deformities, functional pathologies, and long-term consequences.

Conclusion

In order for a child to be born healthy, develop and grow normally, you need to give up cigarettes, alcohol, and drugs even before the baby is conceived. If the resulting pregnancy was not planned, but the decision was made to give birth, say goodbye to bad habits necessary not only for the entire nine months, but also for the period of breastfeeding.

During pregnancy, you should never self-medicate. All medications are prescribed by a doctor for specific indications and in the most necessary cases.

Video information about the dangers of smoking during pregnancy

Statistics show that about 92% of women use some kind of medication at different stages of pregnancy. The reasons for this may be the low level of health of the modern population, the incompetence of doctors, the availability of almost any drug and the pathological tendency of some people to self-medicate.

Any of the medications, entering the body, changes its biochemical state, affecting certain organs and systems. Unfortunately, almost all medications have side effects, which are often ignored in order to cure diseases. In addition, their impact on the adult body is minimal. As for the developing fetus, it is not always able to cope with changes in its biochemical balance, which can lead to disruption of the transfer of genetic information, causing a slowdown in intrauterine and postnatal development, various pathologies and defects, and even premature birth, miscarriages or death of the newborn.

The fetus is especially susceptible to the effects of drugs in the first three months of pregnancy. Taking potent medications shortly before conception can also change the genetic apparatus and other structures of the egg, reduce the speed of its movement through the fallopian tube, which can cause degradation of the development of the embryo. Medicines can also be dangerous for the future father, increasing the number of pathological sperm, but not reducing their motility. Thus, the danger of conceiving a obviously defective child increases.

Statistics show that up to 70% of embryos die from the effects of medications in 1 - 2 weeks of development, and the woman does not even know that she was pregnant. In cases where the fetus still survives, it is necessary thorough examination and tests, since there is a high risk that the medications have caused him irreparable harm, and the appearance of deformities is guaranteed.

Since the side effects of many medications have not yet been fully studied, it is recommended to avoid taking them altogether during pregnancy.
Or, as a last resort, exclude the following medications:

Antibiotics destroy a large percentage of the cells that produce the protein necessary for the formation of embryonic tissue. The consequences of taking them can be stillbirth or fetal deformities;
- cyclofsatin causes a change in the structure of the child’s bone tissue, namely, its softening;
- aminoglucosides damage bones and teeth. About 50% of people whose mothers took these drugs during pregnancy have to have false teeth inserted by the age of 30;
- streptomycin, kanaicin and gentamicin affect brain function, slowing down the appearance of speech or causing hearing impairment;
- tetracycline can cause a child to develop underdeveloped jaws and palate, shortened limbs, cataracts, and stains on teeth;
- chloramphenocol changes the composition of the blood;
- chloramphenicol has a destructive effect on the child’s liver and his hematopoietic system;
- if fusidine does not kill the embryo, it provokes chromosomal abnormalities;
- sulfonamides cause kernicterus in an infant;
- aspirin reduces the child’s blood clotting and can affect the functioning of the heart.
Also, its use increases the possibility of intracranial hemorrhage in the baby, the development of pulmonary failure and a decrease in platelet aggregation;
- thalidomide can cause defects in the limbs, outer, middle and inner ears, eyes;
- diazepam inhibits the breathing and sucking reflexes of the newborn;
- meprobamate and phenazepam lead to subsequent mental disorders in the child;
- reserpine and its analogues cause difficulty in nasal breathing in newborns due to copious mucus secretion, low heart rate, low blood pressure and muscle tone;
- imipramine can cause pathologies of the muscular system;
- Lithium salts mainly cause heart defects. If this drug is taken during lactation, the child may experience cyanosis, hypotension and dysfunction of the cerebral cortex;
- nialamide, especially in the first three months of pregnancy, harms the structures of the fetal brain;
- diphenin, phenytin and hydantoin contribute to the inhibition of mental development, and are also the cause of deformities: deformations of the skull, nose, upper lip and the sky;
- trimethine, tridione and trimethadione cause delayed brain function, heart defects, skeletal pathologies, abnormalities of the eyes, palate, nose, ears;
- valproic acid leads to congenital deformities;
- narcotic analgesics: morphine hydrochloride, omnopon, codeine, ethylmorphine hydrochloride, promedol, fentanyl, estocin, dipidolor, pentazocine inhibit respiratory function baby on the first day after birth.
And long-term use of these drugs leads to mental disorders, developmental delays and drug addiction with withdrawal syndrome;
- salicylates inhibit the intrauterine development of the child, that is, they lead to an extension of the pregnancy period;
- indomethacin narrows the lumen of the arteries and promotes the proliferation of connective tissue, which can lead to suffocation of the child;
- diethylstilbestrol - a drug of female sex hormones causes disruption of the formation of the genital organs. In girls, neoplasms of the vagina and cervix are observed, and in boys, underdeveloped appendages and the absence of one or both testicles in the scrotum;
- ethisterone causes pseudohermaphroditism in girls whose mothers took it during pregnancy;
- androgens: testosterone propionate, methyltestosterone and other preparations of male sex hormones cause the development of hermaphroditism in born girls;
- antiandrogenic drugs, for example, cyproterone acetate, promote a change in sexual orientation in boys, and on a subconscious level instill in them a tendency towards homosexuality;
- contraceptive drugs taken in the first weeks of pregnancy, when the woman is not yet aware of it, can cause defects in the internal organs, limbs and spine;
- antiemetics, often taken by women during toxicosis, cause deformities of the upper jaw in children;
- Bendictine disrupts the development of the genital organs, and also contributes to the appearance of defects of the upper lip and palate;
- cimetidine complicates the course of pregnancy;
- quinidine sulfate causes thrombocytopenia, optic neuritis, myasthenia, and in the worst case, paralysis;
- disopyramide, like laxatives, stimulates uterine contractions and can cause premature birth;
- synthetic anticoagulants, coumarin or warfarin derivatives, when taken in the first three months of pregnancy, cause various malformations in 15-20% of cases;
- diuretics: diacarb, ammonium chloride, spironolactone or veroshpiron change the composition of the blood, resulting in sodium deficiency in the plasma, decreased platelet concentration, and jaundice;
- ethacrynic acid has a negative effect on the hearing aid. Causes potassium deficiency in the pregnant mother, which increases the risk fatal outcome from paralysis of the respiratory muscles;
- mercury diuretics: Promeran, Novurit have a toxic effect on the fetus;
- sodium bicarbonate prevents the removal of fluid from the body of the mother and child;
- Mercalil negatively affects the formation of the central nervous system and gastrointestinal tract. A certain percentage of children subsequently develop mental retardation;
- griseofulvin causes the development of defects of the central nervous system, bone tissue, and genitourinary organs;
- antitumor and immunotropic drugs are the cause of deformities.

Considering the above information, it should be said that the use of any medications during pregnancy is not recommended at all. If a woman planning to conceive a child has chronic diseases, she should undergo preventive treatment, which will avoid illness, and, consequently, taking medications. If a woman used hormonal contraceptives as a means of contraception, then their use must be stopped at least three months before pregnancy, and preferably six.

It is recommended to be suspicious of any drugs prescribed by a doctor during pregnancy, especially in the early stages. It is advisable to consult a geneticist about each medication. Negligence should not be allowed when it comes to the health of the unborn child.