Journal Article Adderall Use During Pregnancy Side Effects on Baby

Perception of benefits and risks by clinical pharmacists regarding utilization of drugs during pregnancy: A narrative review

Department of Pharmacy Practice, P Rami Reddy Memorial College of Pharmacy, Kadapa, Andhra Pradesh, India

Engagement of Submission	07-May-2020
Date of Decision	28-May-2020
Engagement of Acceptance	27-Jun-2020
Date of Web Publication	23-Dec-2020

Correspondence Address:
Miss Mohammad Ahmadi Tabassum
Department of Chemist's shop Practice, P Rami Reddy Memorial College of Chemist's, Kadapa, Andhra Pradesh
Bharat

Source of Back up: None, Conflict of Interest: None

DOI: x.4103/amhs.amhs_88_20

Pregnancy is a happy and positive experience for women considering pregnancy in add-on, having a baby is a life-irresolute event: the torso undergoes major changes. There may be considerable discomfort or ill health takes place during pregnancy. Therefore, they face problems about taking medicines. All the illicit drugs are associated with medical complications, but some may pb to severe damage and increases the gamble of serious harm to both fetus and for the mother. Drugs take shown to laissez passer into breast milk, so advice the mothers to avert breastfeeding when using information technology. There is a need to exist cautious in using medication during pregnancy. Notwithstanding, women with lower levels of teaching tend to utilize more prescription or illicit drugs, as they practice non empathize the proper use of medications, which were associated with several adverse teratogenic outcomes. According to Globe Wellness Arrangement, therapeutic employ of medication does not cause developmental abnormalities in the fetus or newborns, only corruption does pose risks to the fetus. The provision of health education during pregnancy to be an of import attribute of prenatal intendance. Indulging constructive knowledge and counseling impact of clinical pharmacist activities tends to be promoting awareness to all patients receiving drugs during pregnancy every bit well equally providing information on the consequences and potential harm or furnishings for mothers and for foetuses based on their need. Communicate with the nearby pharmacists, while using medications to avoid adventitious impairment during pregnancy.

Keywords: Clinical pharmacist, educational activity and counseling, illicit drugs, pregnancy

How to cite this commodity:
Tabassum MA, Alishar S, Kumar S N, Subbiah MV. Perception of benefits and risks past clinical pharmacists regarding utilization of drugs during pregnancy: A narrative review. Curvation Med Health Sci 2020;8:247-54

How to cite this URL:
Tabassum MA, Alishar Southward, Kumar S N, Subbiah MV. Perception of benefits and risks by clinical pharmacists regarding utilization of drugs during pregnancy: A narrative review. Arch Med Health Sci [serial online] 2020 [cited 2022 Mar 12];8:247-54. Available from: https://www.amhsjournal.org/text.asp?2020/8/2/247/304731

Introduction

Pregnancy

Pregnancy is known equally gestation. Pregnancy is a dynamic process, which involves a series of changes that take place from fertilization to nascence in woman's organs, which takes an average of 270 days, or about ix months, from the starting time of last menstrual period.^[ane]

Clinical chemist

Clinical pharmacists are licensed practitioners with avant-garde education and training who practice in all types of patient intendance settings with a focus on achieving optimal employ of medications, emphasizing dosing, monitoring, identification of agin furnishings, and economical efficiency to reach optimal patient outcomes.^[2]

Clinical pharmacist activities

A clinical pharmacist typically provides the following pharmaceutical care:

• Providing information to patients, which may include the data leaflet, proper name of the medicine, its purpose, potential interactions, and side effects, as well equally correct usage and storage^[3]
• Educating the patients on medication (past focusing on the drug administration and precautions) taken during hospitalization and upon discharge^[4]
• Providing and sharing full general as well equally specific medicine-related necessary information to the physicians and advice to the public and health-intendance practitioners regarding the concerned drug use that general practitioners are not familiar with a focus on off-label drug employ and the interactions associated between herbal and ayurvedic medications with allopathic medicines^[4],[5]
• Performing medication reconciliation in order to avert duplication and interactions then as to confirm the prophylactic transition of care among the patients^[four]
• Participating in multi-disciplinary teams concerning complex pharmacological handling in collaboration with physicians and other wellness-care providers, typically in a hospital setting
• Reporting adverse reactions to medicines and then discussing with the prescribing physician and health authorities in accord with national legislation
• Maintaining a high level of knowledge of pharmacological treatment through continuing professional development^[iv]
• Ensuring rubber procurement, adequate storage, and dispensing of medicines in compliance with the relevant regulations
• Reviewing prescriptions to find allergic reactions, contraindications, and therapeutic duplications that should be discussed with the prescribing physician, just the pharmacist should not change the prescription without consulting the prescriber^[3]
• Pharmacists should also aid the physicians in monitoring the patient's mental health well-existence when in that location is a severe shortage of front end-line physicians
• Providing effective counseling to patients and follow sure precautions on the spread of infection such as not to use unnecessary medications equally information technology may atomic number 82 to further infections. Avoid unnecessary visits to the infirmary every bit it may increase the chances of cross-infection. Consult the physician only when the person is suspected with the symptoms of fever, cough, cold, and breathlessness.

Retraining Knowledge on Utilize of Stimulant

Stimulant is the virtually common type of medication prescribed for attention deficit hyperactivity disorder^[half-dozen] used in children and adults. This is usually a type of medication that has been used for a long fourth dimension and helps the encephalon command impulses, behavior, and attending^[7] by increasing dopamine levels in the encephalon. Dopamine is a neurotransmitter associated with motivation, pleasure, attending, and movement.^[6]

Instance includes: Amphetamine, dextroamphetamine, dexmethylphenidate, lisdexamfetamine, and methylphenidate.^[7]

Effect on the usage of stimulants in pregnancy

The stimulant used in tardily pregnancy, which has the potential to negatively bear on fetal growth, could touch infant growth after believable exposure via breast milk and take adverse effects on ambition and sleep.^[8] Stimulant furnishings are likely related to placental abruption. These are associated with higher risk of preterm commitment, premature birth, low nascency weight, growth retardation, neonatal withdrawal symptoms, and increased maternal and fetal morbidity and neonatal mortality.^[9] Several adverse teratogenic outcomes were associated while using the stimulants, which include higher rates of preterm birth, placental vasoconstriction, cardiac anomalies, smaller caput circumference, fetal distress, and fetal growth restriction.^[ten]

Epidemiology of stimulants

In the U.s.a., pregnant women consistently increment the using of stimulant nationwide. In 2015, 1.38 1000000 women used stimulant. The lifetime prevalence amongst adults for stimulant employ is 29.ii%, 2nd merely to marijuana 46.nine%.^[11] Stimulants are legally prescribed for medical reasons, and for the nonmedical users. The prevalence of utilize, whether legal or illicit, is a substantial global trouble.^[12]

Contraindications

According to the International Programme on Chemical Safety (IPCS) and the United States Food and Drug Administration (USFDA), human studies signal that therapeutic use of stimulant does non crusade developmental abnormalities in the fetus or newborns, only abuse does pose risks to the fetus.^[13] Stimulants have also been shown to laissez passer into chest milk, and then the IPCS and the USFDA advise mothers to avoid breastfeeding when using it.^[14]

Counseling on the usage of stimulants

It is important to take the drug, as per md and chemist'south instructions, that will assistance to maximize the effectiveness and minimize the side effects and risks upon usage of the medication during pregnancy.

The following are some instructions for safe utilise:

Learn about the prescribed medication such as how oftentimes to accept information technology, potential side furnishings, special warnings, and other substances that should be avoided. Outset with a low dose and work up from at that place. Exist patient while finding the right medication and dose considering information technology will take some experimenting, every bit well as open, honest communication with your md. Monitor and observe the drug's effects as how well the medication is working to reduce symptoms. Consult the doctor for guidance on gradually decreasing the dose, if wants to stop taking medication. Sudden stoppage of medication can lead to unpleasant withdrawal symptoms such equally irritability, fatigue, depression, and headaches.

Non all stimulants are equal, and patient response too varies considerably. Abuse and addiction to stimulants is a major wellness concern in pregnancy. During pregnancy, balancing of the risk and benefits has an important challenge for the clinicians.

Retraining Cognition on the Use of Over-the-Counter Medication

Over-the-counter drugs

Medications which tin can be direct available to the consumer for the treatment of common ailments, without a prescription from health-intendance professionals, are known equally over-the-counter (OTC) or nonprescription medications.^[15]

Use of over-the-counter medications

Pregnant women commonly utilize OTC medications^[16] every bit a self-medication for many years, in the treatment of pregnancy-related health problems. However "non all OTC medications are prophylactic to be taken during pregnancy."^[17] Even though most of the drugs have an fantabulous safety profile, some of the OTC drugs are known to cause serious adverse effects to the fetus with unproven condom profiles.^[16],[17] All the drugs are associated with medical complications, merely some may lead to severe harm to both fetus and mother. The utilize of OTC drugs increases the risk of serious impairment to their health and pregnancy. With these drugs, agin drug interactions may not occur in non-pregnant women, simply may occur in pregnant women, which causes serious harm to their wellness and pregnancy.^[18]

Epidemiology

More than than eighty% of the pregnant women utilise medications which are sold as OTC.^[19] Women who were meaning are well-nigh twice and thrice hazard of practicing self-medication with OTC drugs compared to employed pregnant women. On the other hand, the presence of comorbid conditions was found to accept a lx% protective effect against self-medications with OTC drugs. This may exist due to frequent counseling against OTC medication use by health intendance givers when the women come for regular follow-up of comorbid condition checkups.^[eighteen]

Over-the-counter medications during pregnancy

Ordinarily used OTC medications are analgesics, antibiotics,^[twenty] antipyretics, coughing syrups, antiemetics, herbal products, and nutritional supplements.^[17],[20]

Examples: Acetaminophen, ketoprofen, ibuprofen, naproxene, aspirin, streptomycin, tetracycline, sulfonamides,^[21] chlorpheniramine, pseudoephedrine hydrochloride, guaifenesin, dextromethorphan hydrobromide, diphenhydramine, clemastine fumarate, calcium, folic acid, iron, and vitamin supplements.^[17],[21]

Role of calcium

Calcium plays an of import role during pregnancy. In order to prevent the risks associated with hypertensive disorders (eclampsia and pre-eclampsia) and the serious consequences of preterm calcium intake is necessary. Information technology increases the bone mineral density in the infants of supplemented mothers.^[45] According to the WHO, 1.5–2.0 g of oral elemental calcium with the total dose divided into three doses per twenty-four hour period was recommended to start at 20 weeks of gestation and then as to go benefits from the supplements during the mid-pregnancy.^[46] There is no limit on the duration of calcium supplementation, but in extremely low number of cases, at that place were institute to exist elevated risks of a rare syndrome (hemolysis, elevated liver enzymes, and low platelet count).^[47]

Role of folic acid

Before conception and during early pregnancy, folic acid plays a vital role in preventing the infants from neural tube defects, preterm birth, low nascence weight, miscarriage, and poor growth in the womb, which can occur within the start 3–4 weeks of gestation, and as well reduces the risk of pregnancy complications, heart disease, stroke, and Alzheimer'south disease.^[48] According to the WHO, daily 400 μg of folic acid supplementation is recommended for pregnant women.^[49] Excess of folic acid intake may impaired fetal growth and also tedious down the brain development of the baby.^[50]

Part of ferrous sulfate

During pregnancy, ferrous sulfate is required to see the deficiencies associated with anemia, showing negative impact on the health of women, which makes them tired and faint with increased take chances of infections and low birth weight. According to the WHO, 300 mg of ferrous sulfate is recommended daily for pregnant women.^[45]

Consequences during pregnancy

Drugs taken past the female parent may cross the placenta and reach the developing fetus and results in various consequences.^[22] Hence, there is a need to exist cautious in using OTC medication because of concern about the adverse effects on the developing fetus.

Salicylates are commonly associated with increased perinatal mortality, neonatal hemorrhage, decreased birth weight, prolonged gestation and labor, and possible teratogenicity.^[16],[23] Hurting medications are ordinarily associated with oligohydramnios, premature closure of the fetal ductus arteriosus^[16],[24] with subsequent persistent pulmonary hypertension of the newborn, fetal nephrotoxicity, and periventricular hemorrhage.^[16] Even common cold medications such every bit expectorants, decongestants and anti-histamines, which may outcome in various consequences such as vascular disruption (gastroschisis), disruption in the menstruum of claret to the fetus and neural tube defects.^[xvi],[23]

Use of magnesium trisilicate may lead to fetal nephrolithiasis, hypotonia, and respiratory distress.^[16] Usage of sodium bicarbonate may cause metabolic acidosis and fluid overload.^[16],[21] Use of antidiarrheal medication may increment the chances of developing iron deficiency anemia and possible fetal cardiac malformations.^[16] Prolonged usage of antacids may sometimes result in fetal development and injury, fetal death, and spontaneous abortion.^[16] Nonsteroidal anti-inflammatory drugs (NSAIDs) and bismuth subsalicylate may cause premature closure of the fetal ductus arteriosus and may lead to subsequent persistent pulmonary hypertension of the newborn.^[25] Usage of antibiotics (streptomycin, tetracycline, and sulfonamides) may effect in hearing loss in the baby, jaundice in the newborn, and discoloration of teeth.^[21]

Counseling to compete against the usage of over-the-counter medications

• Avoid the usage of OTC medications unless it is necessary. Encourage the pregnant adult female to get for nonpharmacological treatment through hydration, rest, vaporizers or humidifiers, nasal irrigation, and saline nasal sprays in case of cough and cold.^[23] Proper attending needs to exist taken while using OTC medications during the showtime trimester, as information technology is the menstruum of organogenesis and the drug may interfere with the fetal development.^[25] Always communicate with the nearby physician or pharmacists while using OTC medications to avoid accidental harm to the fetus and the mother
• Avoid usage of salicylates at high doses mainly aspirin during the 3rd trimester as information technology may cause bleeding problems in mother and infant at delivery.^[16] Avoid the usage of NSAIDs during the third trimester as it may slow down the claret flow to the babe and the mother.^[23] Avoid using medications in combination that treat many symptoms at in one case because a number of drugs may cause harm to the baby.^[25] Avert taking anabolic steroids.^[21]

Retraining Knowledge on the Use of Prescription Drugs

Prescription drugs

Condom and effective medications, which are prescribed nether the doctor'due south care for the treatment of a patient'due south affliction/ailment, which were bought at the chemist's.^[26]

Usage of prescription drugs in pregnancy

Most of the pregnant women used to accept at least one prescription drug during pregnancy to treat their wellness condition such equally diabetes, hypertension, and depression. However, not all the prescription drugs are safe to apply during pregnancy.^[27] These medications are less risky because they perceived more than physician oversight, had undergone many clinical trials, and included more than specific directions,^[28] fifty-fifty though these drugs may lead to increment the potential hazard to the fetus and the mother.

Examples include opioids, tranqulizers, stimulants, antibiotics, anti-asthmatic drugs, analgesics [Tabular array 1].

Epidemiology

Prescription use during pregnancy is prevalent, with estimates of approximately 44%–99%.^[26] Nearly nine in ten women take at least one medicine during pregnancy and 7 in ten accept at least one prescription medicine.^[30] Women from lower level of education tend to utilise more prescription drugs than that of women from a higher level of didactics. Women with chronic wellness status such equally gestational diabetes, a prenatal hospitalization, a history of infertility, or symptoms of acid reflux were more likely to use prescription drugs than that of women without these conditions.^[31]

Consequences on using prescription drugs^[32]

Contraction of the uterus may affect the fetal blood supply or crusade preterm labor and birth. Interference with normal prenatal evolution can lead to birth defects or fetal demise. prescription drugs also interfere with the function of the placenta, which supplies oxygen and nutrients to the baby, causing babies to be underdeveloped and underweight.

Potential harm to the fetus and the mother^[33]

Upon intake of opiates, it may pb to preterm birth, low birth weight, or fetal death in the fetus and symptoms of tiresome breathing, nausea, constipation, and drowsiness in the mother. Birth defects caused by opiates include spina bifida, middle defects, and glaucoma. Tranquilizers may increase the risk of fetal death, nativity defects in the fetus, and slowed breathing, heartbeat, drowsiness, and dizziness in the mother. Stimulants may issue in rise in body temperature, seizures, irregular heartbeat, loftier or irregular blood pressure, sleep bug, tremors, weight loss, and panic attacks in mother. In addition, they cause fetal defect or preterm birth and can increase the claret pressure, run a risk of encephalon and middle defects, and chance of cleft lip/palate in the fetus. Antibiotics such as chloramphenicol may lead to gray babe syndrome in the fetus.

Counseling to compete against these consequences^[32]

• Avoid consuming larger doses than prescribed and avert using prescription drugs more than ofttimes than prescribed
• Avoid taking medication for reasons other than originally prescribed and avoid taking medications which are prescribed for someone else. Attention should be needed for using medications with other addictive substances .

Some drugs in category Ten that are contraindicated in pregnancy and their furnishings on the fetus are listed in [Tabular array 2].

During the last trimester of pregnancy, drugs may interfere with the vital functions of the fetus^[42] [Table 3].

Discussion

Stimulant use in pregnancy is an underrecognized public wellness epidemic and has important short-term and long-term implications for maternal and neonatal health as stated by Marcela et al.^[11] They depict that illicit stimulant apply is likely associated with adverse perinatal outcomes including shorter gestational historic period and low birth weight, however less is^[44] known near the prescribed stimulant use and perinatal outcomes. In general, using OTC medication during pregnancy may sometimes issue in serious effects as stated by Abduelkarem and Mustafa^[17] that all the OTC medications are not safe during pregnancy as these may be beneficial only for the treatment of modest ailments if, there is a sufficient noesis regarding the utilise of OTC. Using OTC drugs may potentially cause effects on the fetus and the female parent, and this statement correlates with a study conducted by Blackness et al.,^[16] as they describe that near all the OTC medications may adversely increase the take a chance to the fetus too as mothers.

Imparting specific cognition of the potential risks of using nonprescribed medication during pregnancy may assistance meaning women more than safely manage their OTC use as stated by Atmadani et al.^[34] They draw that the pregnant effects of a college level of knowledge of cocky-medication amongst women with lower income and education levels may indicate a level of their competence that is a strength upon which a provider could build. Expanding the role of health-care providers together with the provision of testify-based information in prenatal wellness didactics is crucial to promote significant women's safe management of OTC. In full general, using prescription drugs is more than common among the significant women, i.east., at least 7 in 10%, and this correlates with the information provided by Chan et al.,^[29] as they summarized that the usage of prescription drugs is more prevalent during pregnancy, even though in that location was no proper information related to teratogenic and fetotoxic effects of these drugs. Many women with lower levels of education tend to use more than prescription drugs as they do non understand the proper use of medications, hence there is a need of providing guidance regarding the safety of using drugs during pregnancy. In relation to the to a higher place, these data coincide with the study conducted by Riley et al.,^[31] as they concluded that in that location is a need to suggest pharmacists to safeguard prescribing practices for women of reproductive age, which supports the importance of expanding the show about the risks and benefits of using prescription drugs.

Pregnancy can be a confusing fourth dimension for women facing many choices about legal drugs, such as stimulants, tobacco and alcohol, too as prescription and OTC drugs. During that menstruum, the pharmacist spends more fourth dimension with pregnant women for personal counseling that offers better effect to the mother and fetus because the pharmacists are capable of monitoring abuse issues, evaluate their severity, and offering proper counseling for individuals in their recovery as stated by Kenna et al.^[35] Most of the OTC drugs have been linked with agin effects during pregnancy, and then pharmacist plays an important office in selecting and providing information or medication counseling regarding the condom of OTC drugs, dietary supplements, and herbal products to use in pregnancy as stated past Verstappen et al.^[24] Presence of comorbid conditions was found to have a 60% protective effect confronting self-medications with OTC drugs. This protective outcome due to frequent counseling by health care givers against OTC medications, women who has come up for regular checkups of comorbid condition as stated by Mohammed et al.^[18]

Determination

This review concluded that, same as the illegal drugs, upon prolonged utilize some of the prescription medications and stimulants likewise dangerous to pregnant women and harmful or potentially fatal to fetuses. The articles included revealed that pregnancy is a confusing time, so many women with lower levels of didactics tend to use more prescription drugs as they do not empathize the proper apply of medications, hence in such circumstances, a well-qualified counselor provides information regarding the medications generally used in pregnancy, in an effort to highlight the noesis and proper counseling or guidance during pregnancy. We believe that pharmacist provides space for meaning women's concerns or frustrations in a safety, nonjudgmental environment and pregnant women should be counseled and educated regarding the safe and effectiveness of medication during pregnancy; this could besides be a milestone to prevent medication misadventures during pregnancy.

Financial back up and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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50.	4 Potential Side Effects of Too Much Folic Acid. Updated on: mar-23, 2020. Bachelor from: https:// www.healthline.com/diet/folic-acid-side-effects.. [Last assessed on 2020 Jun 28].

  [Table 1], [Table 2], [Table 3]

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Source: https://www.amhsjournal.org/article.asp?issn=2321-4848;year=2020;volume=8;issue=2;spage=247;epage=254;aulast=Tabassum

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