Drug Therapy in Pregnant and Nursing Women

Catherine S. Stika*, Marilynn C. Frederiksen

*Corresponding author for this work

Research output: Chapter in Book/Report/Conference proceedingChapter

1 Scopus citations

Abstract

This chapter describes drug therapy in pregnant and nursing women. There are two compelling reasons for studying drugs and drug therapy during pregnancy. The first relates to the changing age of reproduction. The second relates to the physiologic changes that occur with gestation. To accommodate fetal growth and development and provide a measure of safety for the woman, pregnancy alters a woman's underlying physiology. Regional blood-flow changes also occur in pregnant women and can affect drug distribution and elimination. Blood flow increases to the uterus, kidneys, skin, and mammary glands, with a compensatory decrease in skeletal muscle blood flow. Pregnancy is also associated with a partially compensated respiratory alkalosis that may affect the protein binding of some drugs. The clearances of drugs metabolized by cytochrome P450 3A4 (CYP3A4) have been shown to be consistently increased in multiple studies of pregnant women. The hepatic clearance (CLH) of phenytoin, a restrictively eliminated drug that is predominantly a CYP2C9 substrate, increases during pregnancy, thereby resulting in correspondingly lower total plasma concentrations.

Original languageEnglish (US)
Title of host publicationPrinciples of Clinical Pharmacology
PublisherElsevier Inc
Pages339-357
Number of pages19
ISBN (Print)9780123694171
DOIs
StatePublished - 2007

ASJC Scopus subject areas

  • Dentistry(all)
  • Medicine(all)

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    Stika, C. S., & Frederiksen, M. C. (2007). Drug Therapy in Pregnant and Nursing Women. In Principles of Clinical Pharmacology (pp. 339-357). Elsevier Inc. https://doi.org/10.1016/B978-012369417-1/50062-6