An important mineral throughout pregnancy is calcium, which is used in the formation of the fetal skeleton and tooth buds. Calcium is also used to conduct nerve impulses and to form muscle (including cardiac muscle). Maternal calcium absorption increases during pregnancy; thus, the calcium needs of pregnant women are similar to those of nonpregnant women. According to the Dietary Reference Intake (DRI) values set by the Food and Nutrition Board, the recommended calcium intake for pregnant women is the same as before pregnancy; that is, 1,000 mg per day for women aged 19 to 50 years, which is equivalent to about three to four glasses of milk per day (National Institutes of Health, 2017). The recommendation for pregnant women aged 18 years and younger is 1,300 mg per day. Calcium can be found in milk, cheese, yogurt, ice cream, deep green leafy vegetables, and legumes. Phosphorus is also found in foods that are rich in calcium and protein (MedlinePlus, 2018). Drugs and pregnancy Despite the fact that most clinicians are cautious in prescribing medications to pregnant patients, some patients can potentially receive prescriptions for medications that are contraindicated for use in pregnancy before they realize that they are pregnant or during their pregnancy if the benefit of the use of a contraindicated medication outweighs the risk of fetal development. The FDA has long categorized medications based on their potential for fetal risk (Office on Women’s Health, 2018). For many years, the drug categories were represented by a letter system. This system, however, has recently been superseded by a “narrative risk summary” that applies to pregnancy and lactation. The Pregnancy and Lactation Labeling Rule (PLLR) was published by the (FDA) in 2014 and replaced the prior letter-based system guidelines established in 1979. The (PLLR) guidelines features a narrative section and subsections which highlight the effect of a given medication on pregnancy, lactation and includes the effect of a given medication upon male and females with reproductive potential (Meek, 2019; Drugs.com, 2021). Table 1 presents the letter risk categories for some commonly prescribed agents that may still bear a letter category. Generally, drugs that fall into either category A or B are considered safe and are routinely used. Drugs in category C have been shown to harm fetuses in animal studies, but they have not been adequately studied in humans. Medications with recognized harmful effects to a developing fetus are in categories D and X. Category D medications may provide benefit to the mother in certain medical conditions; however, the benefit must outweigh the risk to the fetus for such drugs to be used. Category X medications are absolutely contraindicated in pregnancy because they are associated with more harm to the fetus than any possible benefit. Examples of category X medications include HMG-CoA reductase inhibitors (statins), warfarin, and vitamin A derivatives. Examples of category D drugs include ACE inhibitors, lithium, and certain anticonvulsants such as phenytoin and carbamazepine. In addition, all of the benzodiazepines, including diazepam, have been rated as either category D or category X (for the hypnotics temazepam, triazolam, and flurazepam). The selective serotonin reuptake inhibitor (SSRI) paroxetine has been moved to category D because of the increased risk of fetal heart defects if taken during the first trimester. An ACOG Committee on Obstetric Practice opinion indicated that pregnant women, or those planning to become pregnant, should avoid taking paroxetine (Berard, et. al., 2016; Shrestha and Fariba, 2021). Untreated depression during pregnancy can increase the risk of premature birth, low birth weight and a decrease in fetal Drugs excreted in breast milk Many mothers who breastfeed their infants also take medications to treat a variety of conditions. Almost all drugs transfer into breast milk, and this may pose a risk to a breastfed infant. The nursing mother’s use of medication, coupled with advice by her
Fluoride hardens enamel by converting hydroxyapatite crystals to fluorapatite, thus making enamel less vulnerable to damage from bacterial acids. However, the use of fluoride supplements during pregnancy is controversial. A Cochrane review concluded that fluoride supplements taken during pregnancy did not protect children’s teeth from caries (Takahashi et al., 2017). The American Dental Association (ADA) has not made any recommendations for prenatal fluoride supplements for pregnant women. In addition, CDC recommendations for using fluoride to prevent and control dental caries note that the use of fluoride supplements by pregnant women does not benefit their offspring as only a trace amount of fluoride reached the developing fetus (Vogell, 2017). Concern has been expressed over fetal neurotoxicity resulting from too much environmental fluoride (Barrett, 2017). growth. It can also decrease the risk of postpartum depression. A pregnant woman’s use of other SSRIs (e.g., sertraline, fluoxetine, and escitalopram) or medications from other classes of antidepressants should be determined on an individual basis. (Mayo Clinic, 2020). Lidocaine with epinephrine is the local anesthetic of choice for pregnant women when clinically indicated; however, aspirin, products containing aspirin, erythromycin estolate, and tetracycline should be avoided (Patton and Glick, 2016; Kolen, 2020). In the case of tetracycline, the drug can cause discoloration of the child’s teeth (Tobah, 2017). Table 1: Acceptable and Unacceptable Drugs for Pregnant Women These Drugs May be Used During Pregnancy FDA Category These Drugs Should Not be Used During Pregnancy FDA Category Antibiotics Penicillin B Tetracyclines D Amoxicillin B Erythromycin in the estolate form B Cephalosporins B Quinolones C Erythromycin (except for estolate form) B Clarithromycin C Analgesics Acetaminophen B Aspirin C Acetaminophen with codeine C Codeine C Hydrocodone C Meperidine C Morphine B After 1st trimester for 24 to 72 hrs. only: Ibuprofen B Naproxen B Note . Adapted from Yenen and Atacag, 2019; Patton and Glick, 2016 physician to stop nursing, is a common reason for the cessation of breastfeeding. Most medications and immunizations are safe during lactation. A consultation with the infant’s pediatrician may be required especially for recently developed medications
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