Pregnancy and lactation

COMMUNITY PHARMACY -II PHARM-D

1. Pregnancy and Lactation

2. Introduction Lactation : It describes the secretion of milk from the mammary glands and the period of time that a mother lactates to feed her young Pregnancy : It described as a state in which a woman cares a fertilized egg inside her body

3. Objectives To produce, healthy, normal weight infants while minimizing health risks to the mother To determine appropriate weight gain during pregnancy for normal, under and overweight women To recognize the additional energy, vitamins and minerals requirement for women during pregnancy To understand changing nutritional needs during pregnancy

4. Recommended Weight Gain BMI weight(kg) height (mtr sqr) Weight gain (kg) Weight gain (lbs) Underweight BMI < 18.5 12.7-18.2 28-40 Normal weight BMI 19-24.9 11.4-15.9 25-35 Overweight BMI 25-29.9 obese 6.8-11.4 15-25 BMI>30.0 6.8 <15

5. Pregnancy and measures to be taken Stages of pregnancy Pre embryonic phase- lasts for 17 days Embryonic phase- lasts for 18-56 days Fetal phase- lasts for 8-36 weeks Measures to be taken Nutritional and drug management

6. Essential Nutrients Foliate (B-vitamin) Help prevent birth abnormalities like spina- bifida Take a daily supplement of at least 400micrograms Green leafy vegetables such as broccoli, salad, orange juice, dried beans and peas 2. Calcium Keep bones healthy and strong Diary products

7. 3. Omega 3 Development of central nervous system, brain growth and eye development in babies before and after they are born Oily fishes, chicken and eggs 4. Iodine Required for healthy thyroid function in both the mother and unborn babies Insufficient iodine can lead to neurological problems in babies 5. Z inc Rapid cell growth that occurs during pregnancy Found in milk, cereals, seafoods and nuts

8. Foods to be Avoided 1.Fish and sea foods I t may cause delayed development in children Avoid all types of shell fish, prawns and smoked fish 2. Red meat and chicken A ll meat and chicken needed to be thoroughly cooked Chicken specially should not be eaten cold the next day 3. Deli foods They are high risks for listeria: has the ability to cross the placenta and may infect the baby leading to infection which may be life threatening Include all processed and sliced meats (smoked meats) and any foods served from open containers (cheese, salads)

9. 4.Fruits and vegetables Wash thoroughly before eating Do not use that have gone moldy 5.Peanuts Avoid this to reduce your child’s chance of allergy to peanut A type of mould called alpha toxin which is dangerous which will also grow on peanuts 6.Other foods Food additives Alcohol Eating out smoking

10. Effects of drugs Drugs which may affect the embryo Drugs which may affect the fetus Drugs causing jaundice and kernicterus Drugs causing fetal or neonatal haemorrhage

11. Drugs which may affect the embryo Cytotoxic drugs, methotrexate, cortisone, nicotine, salicylate, metronidazole Drugs which may affect the fetus Anti-thyroid, beta blockers, reserpine, methyldopa, Drugs causing jaundice and kernicterus Sulphonamides, salicylates, phenylbutasone Drugs causing fetal or neonatal haemorrhage Warfarin, phenindione, heparin

12. Advices during pregnancy Prescribe the drugs which appear safe during pregnancy Attempt non-drug treatment first, avoid all drugs in the first trimester Use lowest effective dose for the shortest possible times New drugs are best avoided Patient should be fully aware of danger caused by drugs Counsel pregnant women to avoid exposure to all other unnecessary drugs Do exercise during pregnancy

13. Exercise during pregnancy Benefits of exercise during pregnancy Help reduce back aches, constipation, blotting and swelling Increased energy, improve move and sleep Improve your posture, promote muscle tone, strenght Exercise to avoid Scuba diving, downhill skiing, trampoline Hot tubs, contact sports like hockey, basketball Warning signs to stop exercise Vaginal bleeding, uterine contraction, decreased fetal movement, fluid leakage from vagina Dizziness, increased shortness of breath, chest pain, headache, muscle weakness

14. Lactation and measures to be taken The WHO to advocate exclusive breast feeding for the first 6 months of life Human milk provides the optimal form of the infant nutrition Other important benefits includes reduced maternal postpartum blood loss and protection for the infants against infectious diseases Drug therapy is frequently cause for concern and may result in unnecessary avoidance, interruptions or cessations of breast feeding

15. Drugs regarding safe during lactation ACE inhibitors Antihistamines Beta lactam antibiotics Benzodiazepines Calcium channel blockers NSAID’s

16. Drugs regarding unsafe during lactation Theophylline Metronidazole Lithium Isoniazid Phenobarbital

17. Advices to be taken during lactation Maternal drug therapy should only rarely constitute a reason to avoid breast feeding In an unsafe drug is to be used, allow an appropriate length of time after stopping the drug before recommencing breast feeding eg: 4 times the elimination half life Monitor the infant for evidence of adverse effect eg: sedation, altered bowel habit

18. Thank you!!!