04. 妊娠中の薬の使用 Drug Use and Pregnancy







1. 医療薬学基礎知識

  1. Which body system is mostly affected when the fetus is exposed to the drugs mentioned in the article?

  2. What is the main mechanism by which smoking affect the development of the fetus? Why the heart septal defects are the most common?

  3. What is cleft palate?
    “cleft palate”とは何ですか?

  4. How can we substitute the nutritional supplements?

  5. Why high doses of vitamins are not recommended?

  6. What other supplements are allowed to be taken during pregnancy and are important for proper growth and development?

  7. The article is focusing on the drugs used in pregnancy mainly the drugs of abuse. Apart from that, some mothers have other diseases that need continuous treatment. Give an example of one of these diseases and discuss how treatment should change to protect the fetus from the drug-effects?

  8. What is the meaning of “stillborn babies”?
    “stillborn babies”とはどういう意味ですか?

  9. What is meant by “attention span disorders”?
    “attention span disordersとはどういう意味ですか?

  10. What is meant by “trimester”?

1. 医療薬学基礎知識(解答)


  1. The central nervous system (CNS). Most drugs of abuse are targeting the central nervous system. That is why most of the side effects appear as behavioral and nervous disorders. All these drugs should be strictly avoided.

  2. Smoking affects the concentrations of oxygen and carbon dioxide and tensions in the blood. Oxygen is fundamental for the healthy growth of the baby. “hypoxia” which is the term used to describe a low oxygen tension and concentration in the blood is the main effect of smoking affecting all systems in the developing fetus.
    In the fetus, the blood circulation is different from that of a born baby. Blood does not pass through the lung and passes from one side of the heart to the other side through holes in the atrium and ventricles located in the septum. After the baby takes his first breath, the sudden increase in oxygen concentration and the expansion of the lung causes these holes to close completely. Hypoxia, due to improper oxygenation by smoking prevents this complete closure of the holes in the septum, leading to abnormal circulation of blood in the heart which can be fatal if left untreated.

  3. “Cleft palate” is a term used to describe a case of “congenital abnormality” i.e birth defect, where the baby is born with unfused palate (the roof or the oral cavity) and upper lips. Usually it is accompanied by other anomalies in the respiratory system of the baby and should be repaired by operations as soon as possible. Structure of the skull bones should be checked to roll out other possible abnormalities.

  4. For a pregnant mother, it is better to advise her to take the natural sources of vitamins and minerals as fruits and vegetables. Going natural is better unless a strong indication requires medical treatment.

  5. During pregnancy, all the nutritional needs of the mother increases, including the vitamins and minerals. It is very popular that mothers start to take vitamins and minerals to meet the increased demands for the growing fetus. Supplements for Vitamin A, and E are better be avoided. They are usually included in the OTC vitamin supplements. Unnecessary high vitamin doses can lead to birth defects.

  6. Iron, vitamin B12 and folate are the most common combinations of vitamin supplementations for the pregnant mother. However, it should be prescribed under the doctor’s permission and based upon laboratory tests showing their deficiency as anemia.

  7. Type 2 Diabetes Mellitus (DM) is a very common metabolic disorder especially in western countries. “Gestational diabetes” is a form of diabetes that appears for the first time during pregnancy and may continue after birth. It is very important to know that all oral drugs used in treatment of DM are “teratogenic”, meaning they cause serious abnormalities in the growing fetus. Any mother with DM should stop taking these drugs immediately when she got pregnant and shift treatment to “Insulin” injections ONLY. Gestational DM is treated with Insulin injections ONLY. The doses need to be calculated according to the mothers’ calories intake and her activity and other diseases if present. Usually given as a morning injection and before dinner injection, i.e twice daily schedule.
    2型糖尿病(DM)は、特に西洋諸国で非常に一般的にみられる代謝障害です。 「妊娠糖尿病」は、妊娠中に初めて現れる糖尿病の一種で出産後も続く可能性があります。糖尿病(DM)の治療に使用されるすべての経口薬は「催奇形性」であり、成長中の胎児に重大な異常を引き起こすことを知っておくことは非常に重要です。糖尿病(DM)の母親が妊娠した場合、これらの薬の服用を直ちに中止し、治療を「インスリン」注射のみに変更する必要があります。妊娠糖尿病はインスリン注射のみで治療されます。母親のカロリー摂取量や活動量、既往症がある場合はそれに応じてインスリンの量を計算する必要があります。通常は1日に2回、朝と夕食の前に注射をします。

  8. “Stillbirth babies” means babies born dead.
    “Stillbirth babies”(死産児)とは、出生時に亡くなった胎児を意味します。

  9. “Attention” means concentration and focusing, “span” means the duration or range. “attention span deficits” is the medical term used to describe children with problems in concentration and focusing in any activity they are doing being so short and frequently interrupted. Usually accompanied by memory defects and they are all enclosed under the term of “cognitive disorders”.
    “Attention”(注意力)は注力や集中力を意味し、 “span” (スパン)はその持続時間または範囲を意味します。“attention span deficits”(注意力持続時間の不足)とは、物事を持続して行える時間が極端に短く、何をしていても頻繁に中断してしまうことで、集中力の持続に問題がある子供を表す医学用語です。通常記憶障害を伴い、それは “cognitive disorders”(認知障害)という枠組みの中に含まれています。

  10. In gynecology (the science concerning the health of the fetus and mother), “trimester” is the term used to describe the duration of pregnancy as a unit of “3 months”. Tri- means 3. During pregnancy, there are 3 trimesters, the first trimester (first 3 months of pregnancy), the second trimester (middle 3 months of pregnancy) and the third trimester (last 3 months or pregnancy). Each trimester has its concerns especially in relation to drugs. For example, some drugs must be totally avoided during the first trimester because they will affect the early formation and development of all body organs especially the CNS, but they can be given in the last trimester before giving birth.

2. 応用問題

  1. Why aspirin should be avoided during the last 3 months of pregnancy?

2. 応用問題(解答)


  1. Aspirin should be generally avoided during pregnancy. In some cases, only low dose of aspirin can be given. However, in first trimester there is a risk of developmental abnormalities and miscarriage (loss of pregnancy). During the last trimester (last 3 months of pregnancy), aspirin intake increases the chance of intracranial hemorrhage (bleeding inside the brain) in the infants and excessive blood loss during delivery from the uterus (also called womb). It is better to be avoided and if it is indicated, strict follow up should be done to the mother and fetus.