Pregnancy Advisor Self Help

One of the problems that are very interesting in the world of medicine to current drugs is about what can and can not be consumed during pregnancy, especially when pregnant young. As is known, the pregnant young is the starting formation of the various organs of the body (often called the period of organogenesis). In fact, said that since two weeks after conception implantasi results, the establishment and development of various organs have also been held. Therefore, it makes sense that many myths that mixed scientific facts about the young pregnant this, given the close relation with disability or difference in the fetus.

IN the other hand, the doctor who handles pregnant women should be aware and understand the working mechanisms of a drug and its impact on the fetus. Thus, he medicine can provide a truly believed safe for the mother while janinnya. Giving medicine to pregnant women should be considered with a mature and scientific, given the very medicines may pass through the sawar placenta (placental barrier) and then enter the body of the fetus. Biotransformasi (ie changes in the chemical and drugs that can cause that) can occur in ari-ari/plasenta, where it can be protektif (benefit), but can also produce a substrate that teratogenik or dismorfogenik (both terms are used to the nature of a drug / material that “damage” fetus or embryo).

First, Teratology is a study about the terminology or malaformasi kongenital (disabled fetus / baby in the kasat eyes can be seen being born), which is caused or triggered by a material / medicine into the body of the mother during the formation of body organs fetus (organogenetic period). Later, this expanded, so in this sense includes any deviation (morphology, biokimiawi, behavior, etc.) that occur in the life of the fetus in the womb when born and afterwards. Meanwhile, Dysmorphisme concerning the understanding of the broad, namely, fetal abnormalities in the structural and functional.

Thalidomide tragedy

A drug to reduce / eliminate nausea, vomiting, and the emergency, namely, Thalidomide, in the 1950s to the early 1960s declared safe (even recommended) to be given to pregnant young women. In fact, this drug has been marketed haphazardly, when not have been examined carefully and adequate experiment on animals! When giving drugs to young pregnant women is associated with various aberration / disability (weight only form of a “bulge” classic), heart anomaly, and defects in the eye, a bustling medical world and the reporting of a new era always consider the safety of drugs on the fetus in the womb .

The old concept that states that Hampi and always able to “filter” material that can affect the fetus in the womb, with a total changed the paradigm that each new drug given to pregnant women must be proven safe to convince janinnya also. Evidence that the form of a series of accurate, adequate, and can be scientifically and statistically. Before recommendations can be given to pregnant women, a drug must go through a trial that adekuat in animal experiments that most “similar” to humans, such as waiting for. In 1971, Food and Drug Administration (FDA), which is the Food And Drug Control Directorate General of the United States will also revoke the recommendations of the drug Diethylstilbestrol (Dec), namely, the preparation of similar synthetic hormone estrogen, which since 1940 recommended to overcome abortus imminens (often also called abortus threatening). In the period, approximately 10 million patients have received DES to maintain her pregnancy. From the retrospective research, proved that the display (exhibition) DES in a young pregnant women increase the risk of cancer (small cell carcinoma) in the vagina of women who are baby dikandungnya, while the infant male lead to deviation in the genital channel (epidydimis) and sterility.

The Registry for Research on Hormonal Transplacental Carcinogenesis (RRHTC) report, in 1987 recorded 50 percent of 384 cancer patients are exposed to DES before the age of 12 weeks gestation and 70 percent before 17 weeks. Thus, Dec actual cause of the low-risk cancer (particularly in the fetus / baby girls), namely, with the possibility of a 1,000 babies of women exposed to DES, which, even among many call as incomplete carcinogen, but the result of what happened clearly very good, namely cancer!

Although the DES tragedy is not in a Thalidomide (because of the use of DES is more limited), but the second tragedy that provide new understanding about the drugs or materials that can be awarded or recommended for pregnant women. Lessons learned is that each time must be done and research on drugs that can be given to pregnant women, meaning that, at the time can now be recommended, but if a drug proven to contain the risk of harm, the recommendations can be revised or revoked.

Mechanism for fetal defects

A material or drugs can cause structural or functional disability (on the fetus in the womb) through several mechanisms, namely:

1. The effects of drugs directly to the fetus, where access to drugs fetus is determined by several factors, such as the amount / rate sawar drugs that pass through the placenta, the structure biokimiawi (enzimatik system) from Hampi, and the chemical structure of the drug itself (molecular weight, or terionisasi not soluble in fat or not).

2. Effects of drugs on the function of Hampi, in which the functions of Hampi, which is very complicated for the life and development of the fetus, or in other words, Hampi actually functions as the lung, kidney, intestine, liver, and the system endokrin fetus before the formation of organs is Perfect. Thus, a drug / material that can disrupt the function of Hampi is also causing disruption in the fetus.

3. Effects of drugs on the metabolic functions of the body or the mother, for example, the occurrence of high blood pressure during pregnancy.

4. Phase fetus in the womb of development, meaning that the effects of drugs on different stages of fetal development. For example, in the very early pregnancy (before the stage of differentiation), cell-cell embrionik be omnipotent (developed into various forms of organs) and any disruption at this stage, had tended to all or none, meaning that any damage cells in total or had no effect as because the nature of multipotent cells from it.

5. Genetic vulnerability or susceptibility gene, in which each race or tribe known to have a tendency of the different effects of a drug. In the animal is clearly visible that the vulnerability is different for each species and strain, so people also have assumed the same trend.

6. Substrate metabolism / drug that has been understood through the mechanism that is quite complicated. For example, a substrate enzyme known as the Cytochrome P450 are known to play an important role in the establishment and development of cells and organs of the body of the fetus.

Classification

Since the occurrence of DES and Thalidomide tragedy was the world’s medical concern that is very serious towards drugs and other materials during the pregnancy.

FDA Drug Bulletin in 1980, displayed the intricate details of drugs and materials that can and can not be given when pregnant, where the description is still used as a “reference” or the “fad / reference” in the world, including Indonesia ( Williams Obstetrics edition, 21 years old, 2001, page 1009). At the FDA to make the classification of drugs / materials, according to the level of danger to the fetus, namely:

1. Category A, where the study of control (controlled studies) in humans do not show any risk to the fetus. Some types of multi-vitamins and given during pregnancy included in this category, but “megavitamins” not including this category.

2. Category B, which also does not indicate the risk in the fetus, but yet there is no adequate research on humans. Or, the effect can not be expected diperlihatkn in animal experiments, but can not be proven in humans. Some antibiotics such as penicillin, including this category.

3. Category C, where there has been no research that adekuat on human and animal experiments. Or, have been found harmful effects in animals, but not obtained enough data to convince / valid in humans. Most drugs or other materials that are often drunk during pregnancy is now included in this category.

4. Category D, where it was found evidence of risk in the fetus, but the profit is seen develop greater than the risk. For example, Phenytoin and Carbamazepine (similar drugs for epilepsy) and several antikanker drugs or chemotherapy.

5. Category X, in which the fetus at risk far greater than the benefits. In other words, the drug in this category can not be given in pregnancy (the term: kontraindikasi absolute). Examples are similar to acne drug, known as isotretinoin, which can cause multiple aberration in the nervous system, face, and cardiovascular. More medicines that include this category and its information can be found on the table.

Unless that is really needed and safe in pregnancy, then all types of drugs should be avoided, especially during the formation of the organs of the fetus (fetus / organogenesis). The use of the drug without mature consideration during pregnancy can be ended with the disaster that is not possible before, namely the risk of disability or suffering from cancer in the fetus / baby.

So, in consultation with the doctor who treated during pregnancy is one of the wise steps to maintain and optimize the results of the pregnancy. On the other hand, the doctor should also have knowledge of adequate and up to date about drugs that can and can not be given to pregnant women.

For the rare doctors do not provide or recommend a certain drug in pregnant patients is not based on scientific considerations, but because sugesti purely due to “eaten accidentally” ad / campaign. Is not this now very frequently advertised various types of drugs or supplements that perhaps can make the fetus / baby if consumed when pregnant women? Is this true?