Drug therapy in pregnant and nursing women

Pregnant women and nursing women remain “therapeutic orphans” and pose definite challenges in regard to both drug selection and dosing. Although unnecessary medications should be avoided in both conditions, women with epilepsy, hypertension, diabetes, and other preexisting conditions need to continue therapy. Other pregnancy-specific conditions also may arise that need to be treated with medications. Optimal therapy of these patients requires cognizance of the profound physiological and metabolic changes that occur during pregnancy. These are discussed in this chapter as are the problems of teratogenesis and milk-based transfer of drugs to nursing infants. There is a continuing need for further pharmacologic studies in these patients and current recommendations and guidances for these are cited.