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Hemolytic anemia in a newborn after maternal treatment with nitrofurantoin at the end of pregnancy. This global estimate seems questionable, since one of the four subjects in their study with ongoing high iodine concentrations of up to 141 mg/L milk, was not considered in the study summary. For artemisinin, as well as its derivatives artemether, artemotil, artesunate and dihydroartemisinin, there are insufficient data on the breastfeeding period. The American Academy of Pediatrics and the Centers for Disease Control and Prevention state that breastfeeding should not occur if the mother has active (infectious) untreated tuberculosis; however, expressed milk can be used because there is no concern about transmission through the milk. Further selective immunosuppressants Everolimus is a derivative of sirolimus and is used in transplant patients, and in higher doses, as an antineoplastic drug. Observed malformations did not indicate a specific risk in terms of frequency and extent of malformations; defects were seen primarily with combination therapies. The risk for defects in septation of the truncus arteriosus was increased about twofold over nonexposed controls. No data has been published regarding the embryo- or fetotoxic effects of protamine. Case reports about application in the second and third trimester for dangerous disseminated cryptococcosis have not shown evidence of fetal damage. If chronic, significant mercury exposure has occurred before or during pregnancy, maternal blood levels should be monitored. A larger study to prevent perinatal transmission was conducted in France where 445 pregnant women received zidovudine and lamivudine after gestational week 31, and their newborns were also given the combination for 6 weeks (Mandelbrot 2001). Among a similar number of infants born after maternal hydroxycarbamide treatment later in pregnancy, one had pyloric stenosis (Heartin 2004) and two others had congenital anomalies that developed during the first trimester and therefore cannot be attributed to the maternal treatment (Ault 2006, Choudhary 2006). When used for marking twin pregnancies in amniocentesis, small bowel atresia as a fetotoxic effect has been described in the literature. Maternal blood and amniotic fluid levels of moxifloxacin, levofloxacin and cefixime. The best known of the herbal galactogogues is fenugreek (Trigonella foenum-graecum), also known as greek hayseed. In case of a plasma cholinesterase deficiency, there is the risk of prolonged neuromuscular blockade. A 1996 case report and review involved a 24-year-old woman with Gaucher disease who was treated with alglucerase 40 U/kg every 2 weeks (2). The North American Antiepileptic Drug in Pregnancy Registry noted 12 major malformations in 416 first-trimester phenytoin monotherapy exposed pregnancies (2. The amount of free iodine in the contrast medium is normally under 1 of the amount of the contrast medium, but can increase with storage. Pregnancy outcomes in women taking infliximab: the infliximab safety database [abstract]. Although statistically significant results were found in this study, the results must be interpreted cautiously due to the retrospective collection of drug histories and the lack of information pertaining to past and present maternal medical and obstetric histories. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2007 Nov; 50: 1393­8. At 2 weeks of age, the infant experienced mild congestive heart failure with labored breathing. The elimination halflife, calculated for three neonates, ranged between 12 and 15 hours for venlafaxine and between 10 and 37 hours for O-desmethylvenlafaxine. However, fortification of grain, corn and other flour with folic acid can be an excellent adjunct to reduce the incidence of neural tube defects sensitive to folic acid. Male painters in the Netherlands exposed to organic solvents for 3 months before a conception had a significantly increased risk for malformations in their offspring compared to carpenters with little or no solvent exposure (Hooiveld 2006). Congenital malformations have been reported in infants exposed during pregnancy, but they do not appear to be related to the drug. Carbamazepine, phenobarbital, primidone, phenytoin, felbamate, oxcarbazepine and topiramate are inducers of the hepatic cytochrome P450­3A4 enzyme system. A randomised controlled trial of artemetherlumefantrine versus artesunate for uncomplicated plasmodium falciparum treatment in pregnancy. In North Carolina, 865 infants were enrolled in around 1980 to investigate their development until the age of 5 and at puberty (Gladen 2000, 1991, 1988).

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A case report describes a 16-day-old, otherwise healthy, fully-breastfed child, who, after several mild apnea episodes became significantly cyanotic and had to be reanimated. A case of methotrexate embryopathy with holoprosencephaly, expanding the phenotype. The various prostaglandins have been observed both to enhance and impede milk production. Coadministration of flecainide acetate and soltalol during pregnancy: lack of teratogenic effects, passage across the placenta, and excretion into human breast milk. In 2011, the World Congress of Gastroenterology stated "Adalimumab in pregnancy is considered low risk and compatible with use during conception and pregnancy in at least the first two trimesters" (3). In addition, liver and kidney function as well as hematological parameters need to be monitored in the pregnant patient. In cases of accidental electric shock, the most common sign of adverse fetal effects was immediate cessation of fetal movements. Behavioral and biochemical studies in rats following prenatal treatment with -adrenoceptor antagonists. The teratogenic metabolites of vitamin A in women following supplements and liver. Two of the children had cleft lip and palate, but the malformations were different in all of the others. If a pregnant woman is demonstrating signs of renal toxicity ­ increased -microglobulins and cadmium in their urine ­ then very close monitoring of the pregnancy, with determination of the source of cadmium to eliminate any further exposure, is required to reduce risk of pregnancy loss. A case report of risperidone distribution and excretion into human milk: how to give good advice if you have not enough data available. A 10-year retrospective analysis of pregnancy outcome in pregestational Type 2 diabetes: comparison of insulin and oral glucose-lowering agents. Compared to dihydralazine it may have the advantage that it does not increase the intracranial pressure. Moreover, the association was stronger if the initial use of drugs was around conception or if they were used longer than 1 week. Congenital salicylate intoxication was found in two newborns exposed to high aspirin doses before delivery (42,43). Nearly complete reperfusion of the right lung and the lower two-thirds of the left lung was observed at the end of the alteplase infusion. Concern has been expressed about possible effects on fetal development of living in an area close to high-voltage power lines. The animal data, involving only one species, suggest low risk, but the limited human pregnancy experience prevents a more complete assessment of the embryo­fetal risk. Ivermectin ­ available for example in France ­ is used orally for scabies (Chapter 2. After 6 weeks of breastfeeding with this therapy, the baby was functionally normally developed, and weight gain was regular (Aichhorn 2004). No information on the long-term health of the infant has been reported and use in pregnancy needs to be decided on an individual basis. According to a recent review of a large number of studies published since 2000 on European populations, average concentrations of total mercury in blood ranged from 0. Surprisingly, the German Commission E (Blumenthal 1998) and the American Herbal Products Association (McGaffin 1997) contraindicate the use of ginger during pregnancy. Of a group of 838 mothers who had drug therapy while breastfeeding, about 11% reported symptoms in their infants that were possibly caused by the medication. In a population-based case control study, high maternal stress levels were associated with an increased risk of cleft palate, cleft lip, transposition of the great arteries, and tetralogy of Fallot, after adjustment for multiple potential confounding variables (Carmichael 2007). The milder anomalies and dysmorphisms as well as functional deficits include: Midface hypoplasia (short nose, low and wide bridge of the nose or hypertelorism, epicanthus, long upper lip). Available for this purpose are malathion and the natural extract of chrysanthemums, pyrethrum, as well as its synthetic derivates, permethrin and allethrin (bioallethrin), which are characterized particularly by longer half-lives. Similarly, no teratogenicity was observed in animal studies that utilized doses much higher than those used in humans (Watanabe 1980a, 1980b).

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Causes for the other two defects were not proposed, but they were not thought to be the result of germ cell damage. A large number of chemicals are found in arnica, including flavonoids glycosides, isomeric alcohols, terpenoids (including sesquiterpene lactones), amines, coumarins, carbohydrates, volatile oils, fatty acids, and other compounds. There is no risk for the infant from the usual shortterm high-dose treatment, even when breastfed right after the injection. In a study of three pregnant women who delivered viable infants while undergoing treatment for acetaminophen toxicity, the mean acetylcysteine cord blood concentrations was 9. Infection after birth occurs mostly through the close contact between mother and child. If there was an exposure during organogenesis, such exposure does not justify a termination. Because the risk for oral clefts among penicillins appeared to be related only to the aminopenicillins (ampicillin and amoxicillin), the authors speculated that the aminobenzyl group has a role in the development of oral clefts. Methimazole pharmacology in man: studies using a newly developed radioimmunoassay for methimazole. A venous blood specimen obtained simultaneously with the first milk sample had concentrations of amoxapine and 8-hydroxyamoxapine of 97 and 375 ng/mL, respectively. The infant, with repeated normal head ultrasound scans, went home on the 83rd day of life with no evidence of focal neural deficits (11). It alleviates birth pains without significantly affecting the strength of the contractions or the cooperation of the woman giving birth. Systemic antidote treatment consisted of N-acetylcysteine (N = 33), ipecac (N = 52), and methionine (N = 16). Accidental use, however, does not justify a risk-grounded termination of pregnancy (Chapter 1. Levels of the active metabolite at these times were 113 and 168 ng/mL, respectively. Collectively, the published case reports document around 82 exposed pregnancies, resulting in the live births of 65 apparently healthy infants (including three preterm) with no congenital malformations, two spontaneous abortions, two maternal and fetal deaths (possible duplicate reporting of the same case), and five elective terminations. Pregnancy Terbinafine is used for both oral and topical treatment of fungal infections of the nails and other dermatophytoses. A nonrandomized 1983 study compared atenolol (N = 28; enrolled before May 1981) with labetalol (N = 28; enrolled after May 1981) in the treatment of chronic (N = 6) or gestational hypertension (N = 50) (7). When tazarotene is used topically, 6% of the dose applied is absorbed through the skin. Addition of clonidine to a continuous patient-controlled epidural infusion of low-concentration levobupivacaine plus sufentanil in primiparous women during labour. While the results of this study should be viewed with caution because of limitations in case numbers and methodology, the high number of affected children is of concern. After administration of 1,000 mg meropenem every 8 hours, the maximum concentration in milk was 0. There is no documented experience on the use of acemethacin, dexketoprofen, lornoxicam, meloxicam, nabumetone or proglumetacin during breastfeeding. By extrapolation, the minimum daily dose absorbed by the infant was estimated to be 8. First-trimester itraconazole exposure and pregnancy outcome: a prospective cohort study of women contacting teratology information services in Italy. The manufacturer reported on 69 pregnancies with known outcomes after maternal fingolimod treatment. Cannabis Street terminologies for drugs containing marijuana are extensive and generally describe products containing dried leaves or resin of Cannabis sativa, or the related Cannabis indica (Indian Hemp) plant. These factors should be considered as potential confounding variables for the outcome of the pregnancy, including the occurrence of oral clefts. However, analysis of 522,630 births, 86 with 1st trimester exposure to amitriptyline, did not confirm an association with this defect (6­13). For other indications a risk-benefit evaluation should be made including risks of using alternative substances. Differentiating the daily dose above and below 1000 mg of monotherapy, the malformation rates were 16. The available data, although limited, do not indicate that use of acetylcysteine as an antidote in human pregnancy is associated with fetal toxicity. Plasma protein binding to albumin of alvimopan and its metabolite is 80% and 94%, respectively.

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One of the studies found that potassium replacement reduced the risk of congenital defects in rats (6). This is definitely not supported by the popular data, popular experience, or traditional-based evidence. Should single doses of a serotonin antagonist such as ondansetron be indicated, breastfeeding can be continued as long as the infant is observed for symptoms. Ophthalmic medications With eye drops, in particular, quantitative absorption of the medication via the conjunctiva should be assumed. Biphosphonates and the other osteoporosis drugs are not indicated during pregnancy. Newborns, exposed to cannabis in utero, have been reported to show withdrawal signs and neurological symptoms such as restlessness and excitability after birth (de Moraes Barros 2006). Sulpiride Sulpiride is a dopamine antagonist that stimulates the secretion of prolactin and thus, may increase the amount of milk. On several occasions, a lower mean birth weight in comparison to control groups was described. Six (12%) of the infants in the study group had a congenital defect compared with seven (14%) of the controls. In the case of paracetamol (acetaminophen), it was even demonstrated that there was a higher concentration of medication if the breast had been frequently pumped (Notarianni 1987). Even considering the highest measured value in the milk, the relative dose for an exclusively breastfed baby amounts to only 5. At least six of these children or fetuses had malformations, but they differed in each case. Over half of the poisonings were documented as mild, with only two reported as severe. Pregnancy outcomes in women exposed to adalimumab: an update on the autoimmune diseases in pregnancy project. The authors, quite rightly, hesitate to make a connection between the medication and the symptoms (Brent 1998). Eighteen pregnant women had been treated for severe hypertension and four for an intracranial aneurysm. The deficiencies of calcium and magnesium resolved quickly after treatment, as did the acidosis, even though the mother continued her medications while breastfeeding the infant. The use of alendronate in women who may become pregnant or during pregnancy is not recommended. Successful caspofungin treatment of multidrug resistant Candida parapsilosis septicaemia in an extremely low birth weight neonate. These guidelines are generally implemented in many countries as international guidelines. Twelve of the exposed infants had transposition of the great arteries and six had tetralogy of Fallot, but the association between the drug and these defects was weak. Abiraterone is highly bound (>99%) to human plasma proteins, albumin, and 1-acid glycoprotein and the mean terminal half-life is 12 hours (1). Child development following exposure to tricyclic antidepressants or fluoxetine throughout fetal life: a prospective, controlled study. Recombinant tissue type plasminogen activator treatment of thrombosed mitral valve prosthesis during pregnancy. Finasteride inhibits the enzyme, 5-reductase, which converts testosterone into the active dihydrotestosterone. Regarding the extended folic acid prophylaxis when planning a pregnancy, see Section 2. A case report describes a 3-week-old baby, whose weight gain was insufficient from the beginning of the maternal therapy until the age of 4 months and whose slightly elevated transaminases (liver enzymes), increased muscle tonus (hypertonia) in the upper extremities and frequent crying and hyperirritability were striking. The distribution and elimination half-lives are 13 and 85 minutes, respectively (1). The outcomes of the 67 pregnancies exposed before conception were 9 spontaneous abortions, 18 induced abortions (15 fetuses with no information, 3 normal fetuses), 4 newborns with nontypical abnormalities, and 36 normal newborns.

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When immunization is urgent for the mother, the killed virus vaccine can be given to her intramuscularly. Being aware of the characteristic side-effects, they can be used at any time during the entire pregnancy. Severe adverse effects have been observed in adults, such as hypotension, fever, nausea/vomiting, and diarrhea (1). Both dosages increased milk production, but there was no statistically significant difference in milk volume between the two groups (Wan 2008, Knoppert 2013). In a different subset of over 28,000 children examined 2 years later, also at 7 years of age, and with more control for possible confounders, the association between behavioral problems and cell phone use was confirmed. Because the maternal benefit appears to exceed the unknown embryo­fetal risk, the agent should not be withheld because of pregnancy. This is approximately the expected incidence of abnormalities in a nonexposed population. Generally speaking, however, a failed attempt at a medicinal termination of pregnancy, can pose a risk to fetal development. Overall there are more than 250 analyzed pregnancies from a number of case series and registries including a report of about 95 pregnancies 2. Tibial hemimelia and tetralogy of Fallot was reported in an infant born from a mother exposed during early organogenesis to amantadine (6). The Rocky Mountain Poison and Drug Center reported the results of a nationwide study on acetaminophen overdose during pregnancy involving 113 women (13). Fixed combinations of aluminum and magnesium salts as well as combination preparations are preferable, whereby attention should be paid to keeping to a therapeutic dose. Delivery outcome after maternal use of antidepressant drugs in pregnancy: an update using Swedish data. For the other benzimidazole derivatives such as flubendazole and triclabendazole, no relevant reports about their use during lactation have been found. Minor malformations characteristic of the retinoic acid embryopathy and other birth outcomes in children of women exposed to topical tretinoin during early pregnancy. However, in one study of more than 700 children born to mothers who became pregnant in spite of the use of vaginal contraceptives, a slight increase in rate of malformations was observed (Jick 1981). Exposure to selective serotonin reuptake inhibitors and the risk of congenital malformations: a nationwide cohort study. Aluminumcontaining substances should, for theoretical safety considerations, not be used long-term. Collectively, the findings of these three prospective studies indicate that the most sensitive period for exposure to lead occurs from the age of 18 months onwards. There are no data available on the use of bupropion, which is also approved for weaning from smoking (see Chapter 4. Isotretinoin exposure and pregnancy outcome: an observational study of the Berlin Institute for Clinical Teratology and Drug Risk Assessment in Pregnancy. Nevertheless, in a study on two women who received 2,000 mg daily, only about 1% of the maternal dose for the pharmacologically active substance (s-isomer) was estimated as a maximum dosage for the infant (Tran 1998). Structurally, these octapeptide hormones are similar to the hypothalamic hormones. In two infants, the anomalies were attributed to concomitant alcohol exposure in utero. We received reports of three newborns that after having been exposed until birth displayed tremor, shaking, and 196 2. Two other women who were treated with the same combination of drugs beginning at the 23rd week of gestation have been reported. Aerial spraying of 2,4,5-T and human birth malformations: an epidemiological investigation. However, it could not be ruled out that the infection of the child occurred via direct contact with 826 4. In addition, three fetuses of interrupted pregnancies showed retinoid specific malformations (Geiger 1994). Outcome of pregnancy in women with inflammatory bowel disease treated with antitumor necrosis factor therapy. Thyroid hormones should not be given together with thyrostatics, because a higher thyrostatic dosage would be necessary. Similar to other -mimetics, the drug can cause maternal and fetal tachycardia and hyperglycemia.

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The molecular weight of the parent drug (about 425 for the nonhydrated molecule), moderate plasma protein binding (80% parent drug; 94% active metabolite), and long half-lives (10­17 and 10­18 hours, respectively) suggest that both alvimopan and its active metabolite will be excreted into breast milk. Favorable outcome of pregnancy with an elective use of epoprostenol and sildenafil in women with severe pulmonary hypertension. Anticoagulant therapy in pregnant women with mechanical prosthetic heart valves: no easy option. In normal adults given a higher abuse dose of aspartame (200 mg/kg), plasma levels of aspartate plus glutamate were increased from a baseline of 2. The current authors observed a case of lead poisoning due to acid spring water (pH 5. A possible association was found between the use of the drug in the 1st trimester and the following: cardiovascular malformations (7 cases), polydactyly in blacks (2 cases in 29 blacks), genitourinary malformations other than hypospadias (3 cases), inguinal hernia (9 cases), and clubfoot (4 cases). Because of the disclaimer on the container, there is no guarantee that the contents are the real plant; they may not be a true mixture, or may be contaminated. Two women who were bitten at 30 and 38 weeks gestation, respectively, were reported to have delivered healthy term infants (Sherman 2000, Scalzone 1994). The typical pattern of anomalies consists of skull, limb and other skeletal defects, some minor craniofacial abnormalities and growth restriction (Feldkamp 1993). Immunoglobulins are given directly to infants and are not contraindicated during lactation. Reproductive studies in mice, rats, and rabbits have found no teratogenicity, but embryotoxicity was observed in rats and rabbits given oral doses approximating the human dose (1). By contrast, no increased risk of hypospadias was determined in a Danish case-control study (Sшrensen 2005). No serious toxicities were observed and the newborns had no physical anomalies (8). In a surveillance study of Michigan Medicaid recipients conducted between 1985 and 1992 involving 229,101 completed pregnancies, 9146 newborns had been exposed to acetaminophen during the 1st trimester (F. Duration of effect > 36 hours Cushing threshold dose: 20 mg/day Cushing threshold dose: 0­40 mg/daily. Lidocaine and procainamide lowered the heart rate somewhat but were associated with unacceptable maternal toxicity. A once daily fixed dose combination of tenofovir, lamivudine (or etravirene), and efavirenz is the preferred first line regimen for the mother. As well as this chapter, they can be found in "Antiasthmatics and cough medications" (see Chapter 2. A 1992 report described the outcomes of 29 women with pregnancy-induced hypertension in the 3rd trimester (26). Neither does it increase the risk of birth defects or genetic disease in children born of subsequent pregnancies. Long-term behavioral effects of fetal methadone exposure such as increased aggression and delayed cognitive and social development at the age of 7 have also been reported. The mother, who was asymptomatic, had started drinking a tea made from arnica flowers 48 hours before the onset of symptoms. The authors concluded that this small prospective case series showed no evidence of increased risk above baseline for major malformations or other adverse outcomes for levodopa and pramipexole. Potential effects of chlorpyrifos on fetal growth outcomes: implications for risk assessment. Hydroxyzine is an antihistamine with sedative, antiemetic, and anxiolytic properties. Peak serum concentrations are attained 30­60 minutes after ingestion but will be influenced by variation in interindividual metabolism and physical characteristics, and the circumstances under which the alcohol has been consumed. Adverse pregnancy outcomes associated with maternal enalapril antihypertensive treatment. Development into adolescence seems age-appropriate, according to large long-term studies, i. The higher objectives of treating multiple sclerosis are to prevent relapses and delay disability progression; however, treating relapses and improving multiple sclerosis-related symptoms such as depression and bladder disturbances are other indications for a medicinal drug treatment.

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Fetal exposure to antidepressants and normal milestone development at 6 and 19 months of age. Buprenorphine is also used in the treatment of opioid dependence and is administered sublingually, transdermally or intravenously. Similar significant associations were found by Vajda (2013a) except in relation to cleft palate and hypospadias, and by Werler (2011) in relation to neural tube defects, oral clefts, and hypospadias. Interventions for both the mother and child are important in not only reducing usage but also in controlling withdrawal. Single doses, however, do not require limitation of breastfeeding, but the therapy should be changed. Other studies reported similar high usage (Lapi 2012, Nordeng 2011, Cuzzolin 2011, Bercaw 2010, Low Dog 2009, Moussally 2009, Holst 2008, 2009, 2010, Fugh-Berman 2003). However, due to the long half-life and the potentially serious adverse effects which include hematological disturbances and renal and liver toxicity, use during breast feeding is not justifiable. Serum protein binding is very low (4%) and the terminal elimination half-life is about 7. None of the other degradation products have shown toxic effects after extensive study (3). The three children displayed various degrees of intrauterine growth restriction as well as hypoplasia of the midface and the distal phalanges. Maternal and infant use of erythromycin and other macrolide antibiotics as risk factors for infantile hypertrophic pyloric stenosis. Prenatal exposure to organic mercury from maternal consumption of seafood may influence mental development. No mention was made of hepatic or other toxicity in the infant and his course was thought to be satisfactory for his gestational age. Raspberry leaf (Rubus idaeus) is mentioned in several mixtures, but it is astringent and may, over time, decrease milk supply. Lamotrigine in pregnancy: pharmacokinetics during delivery, in the neonate, and during lactation. Sodium perchlorate also blocks the transport to the breast, where iodine accumulates (Janssen 2001). According to neurological recommendations for nonpregnant patients (Wiendl 2008), first line treatments for relapsing remitting multiple sclerosis are the disease-modifying drugs interferon -1a, interferon -1b (Section 2. Primarily, the drugs evaluated were alprazolam, chlordiazepoxide, diazepam, and oxazepam. There is no clear evidence of adverse effects on fertility or pregnancy outcomes from working in the nuclear industry. Furthermore, the epidemiological evidence suggested that the background incidence of anophthalmia or microphthalmia originally used for comparison in the English clusters had limitations because of substantial underascertainment (Busby 1998, Kдllйn 1996). From these measurements, a relative dose for an exclusively breastfed baby of between <1 and 7% was calculated. As in about 10% of cases oligohydramnios developed (Hutter 2010, Saleeb 1999, Vesel 2004), a pediatric cardiology team from Toronto modified the regimen for relatively uncomplicated courses by giving 8 mg per day only for 2 weeks, then 4 mg/d, and after 38 weeks 2 mg/d. Most of the infants were normal, but the woman mentioned in the previous paragraph who was treated with paclitaxel beginning in the second trimester of pregnancy and subsequently gave birth to an infant with pyloric stenosis was also treated with docetaxal late in the pregnancy (Cardonick 2010a, 2012). All the pregnancies resulted in live-born children; one child had a cardiac disorder and another had microcephaly (Brewer 2000). Due to a molecular mass of 426, protein binding of 90%, and poor oral bioavailability, the relative dose for a fully breastfed child is only 0. A syndrome of methylmalonic aciduria, homocystinuria, megaloblastic anemia and neurologic abnormalities in a vitamin B12-deficient breastfed infant of a strict vegetarian. Management of primary herpes in pregnancy complicated by ruptured membranes and extreme prematurity: case report. The American Academy of Pediatrics classifies amphetamines as contraindicated during breastfeeding because of irritability and poor sleeping pattern (36).

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Developmental toxicity was observed in two animal species at systemic exposures that were equal to or less than human plasma exposures. Herbals and herbal products, at least those of unknown dosage and contamination, should be used with caution and obtained from a reliable source. Induction intravaginally of labor or enhancement of contractions with dinoprostone, applied as intravaginal suppositories, as vaginal inserts, or as a gel intracervically or extra-amniotically. Due to central stimulation of the sympathetic nervous system, it leads to indirect cardiovascular effects (increased heart rate, cardiac output and blood pressure). In contrast to these reassuring findings, another study analyzes data of 1,112 infants born between 2002 and 2007. Six cases of amiodarone therapy for refractory fetal tachycardia have been described in the literature (6,10,17­20). In a study of 20 women with postpartum uterine atony, either 200 g misoprostol or 250 g methylergometrine were administered orally. Multicenter Allergy Study Group, Germany: the association between pre- and postnatal tobacco smoke exposure and allergic sensitization during early childhood. There are several dozen cases available from a prescription study (Wilton 2002) and from the Australian Registry for Epilepsy and Pregnancy. Specific congenital malformations after exposure to cyclophosphamide, epirubicin and 5-fluorouracil during the first trimester of pregnancy. There is no experience on use in pregnancy for teriflunomide, laquinimod, and fampridine/dalfampridine. Acetaminophen has been used as an antipyretic just before delivery in women with fever secondary to chorioamnionitis (24). An ototoxic effect has been described, especially in combination with aminoglycosides. There is concern about treatment with mistletoe preparations (viscum album) while breastfeeding. In addition, it is used intravenously to obliterate varicose veins, for lesions of the oral mucosa, in vaginal spermicides and in cosmetics (Reich-Schupke 2012). Because of maternal risks, routine prescription of bromocriptine to stop lactation is not indicated. While the virus may appear in the milk, as reported in several studies (Losonsky 1982, Isacson 1971), symptoms in these infants were rare (Landes 1981). For example, in the study cited above, maternal phenylalanine levels <60 µmol/dL (mild hyperphenylalaninemia without urine phenylketones) were associated with normal intelligence in the infants (16). The findings relating maternal preconceptual monitoring to increased risk of fetal death remain equivocal, and require ongoing investigation (Doyle 2000). The molecular weight (about 345 for the free base), moderate plasma protein binding, and prolonged terminal half-life suggest that the drug will be excreted into breast milk. Several publications on over 100 women exposed in pregnancy revealed an apparently considerable risk of masculinization of female fetuses, when they continued to be treated with 200 mg or more daily after the eighth week of pregnancy (when the androgen receptors begin to function). Maternal occupational exposure to solvents and congenital malformations: a prospective study in the general population. Moreover, use of acetaminophen appeared to decrease the risk of selected malformations when used for febrile illness. A case control study utilizing data from six health care organizations in the Vaccine Safety Datalink found no statistically significant increase in spontaneous abortion in the 4 weeks after 182 2. Intrauterine growth retardation: association with organochlorine pesticide residue levels and oxidative stress markers. External treatment with amorolfine, butenafine, ciclopirox, haloprogin, natamycin, naftifin, tolciclate, and tolnaftate should be avoided during pregnancy. However, neither a significant increase in the frequency of malformations, nor a distinct pattern of malformations has been shown in the live-born children. The transplacental transfer of exenatide was only minimal in a placenta model (Hiles 2003). In addition, the stability of products and possible contamination of the plant or product grown in other parts of the world may still be an issue because of the lack of regulatory standards. The maternal values for escitalopram and its metabolites were 24 or 20 g/L on average. Due to the less favorable properties of enflurane in comparison to isoflurane it is now only rarely used for anesthesia.

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