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Official websites use. Share sensitive information only on official, secure websites. Cannabis, which some people call marijuana, refers to the dried leaves, flowers, stems, and seeds of the Cannabis sativa L plant. The plant contains at least different cannabinoids, 1 including delta-9 tetrahydrocannabinol THC. The Cannabis sativa L plant also contains non-intoxicating cannabinoid compounds like cannabidiol CBD. CBD products are marketed for a variety of uses. Cannabis sativa L plants containing very small, non-intoxicating amounts of delta-9 THC, which are also called hemp, are mainly used for textile fiber and for their edible seed oils. Unless mentioned otherwise, the information on this webpage is only about cannabis products containing intoxicating amounts of delta-9 THC. Dried cannabis can also be vaped using electronic vaporizing devices such as dry herb vaporizers and vape pens. However, along with the cannabis plant flower, there are many products made from the cannabis plant and new ones are constantly being developed and sold. These include:. Between and the delta-9 THC potency strength in illegal cannabis products seized by law enforcement quadrupled from 3. Delta-8 THC is another intoxicating cannabinoid found in the cannabis plant. Eating large amounts of products containing deltaTHC has led to medical emergencies, including breathing problems 5,6. Cannabidiol CBD is a compound found in the cannabis plant. CBD is marketed as an ingredient in many consumer products, including supplements, foods, oils, and lotions. Synthetic cannabinoids, which are lab-made substances that are chemically similar to compounds found in the cannabis plant, can produce serious negative health effects. Use of synthetic cannabinoids is associated with severe, potentially life-threatening health effects. Cannabis can cause altered time perception, and impaired thinking, memory, and body movement. It can also it can also make people feel more irritable or restless. These effects are more common when a person takes a large amount, the cannabis product is strong has a high level of THC , or the person has little experience with using cannabis. Commonly reported symptoms of cannabis use include increased appetite. Children eating cannabis edibles, such as gummies, is a growing health concern. This usually happens by accident and can result in hospitalization and serious illness. The smoke from cannabis products contains many of the same toxins, irritants, and carcinogens as tobacco smoke, and smoking cannabis can also harm lung tissue. Cannabis use has been linked to certain mental health conditions. Read more about cannabis use and mental health. Cannabis can increase heart rate and blood pressure right after use. Some research shows an association between long-term cannabis use and an increased risk of stroke, heart attack, and arrythmias. These include cannabinoid hyperemesis syndrome CHS , which is when a person has nausea, vomiting, and abdominal pain after long-term, heavy cannabis use. Research has linked the use of cannabis products with an increased likelihood of developing head, neck, or throat cancer, 40 particularly in people who smoke cannabis. Frequent or heavy cannabis use has been linked to problems in cognitive functions like learning and memory, attention, processing speed, perceptual motor function, and language. Some evidence has linked cannabis use to earlier onset of psychosis in people with genetic risk factors for psychotic disorders, including schizophrenia, as well as worse symptoms in people who already have these conditions. The association between heavy cannabis use and schizophrenia has been found to be especially strong in young males compared to females. Cannabis intoxication can also induce a temporary psychotic episode in some people, especially at high doses. Experiencing such an episode may be linked with developing a psychotic disorder later in life. Some research has also shown an increased risk of depression in people who use cannabis during adolescence. While people with mental health disorders and related symptoms are more likely to use cannabis, 51 many factors that influence mental health—such as genes, trauma, and stress—also influence how likely someone is to use drugs, including cannabis. Cannabinoid hyperemesis syndrome CHS is when a person has nausea, vomiting, and abdominal pain after long-term, heavy cannabis use. People sometimes try to temporarily relieve their symptoms by taking hot showers or baths. However, CHS only resolves when a person stops using cannabis completely. Secondhand smoke from cannabis products has many of the same toxins, irritants, and carcinogens as secondhand tobacco smoke. Secondhand exposure can also produce positive urine tests. Positive urine tests have been reported in children exposed to secondhand cannabis in their homes or in attached homes, 59 which can lead to respiratory infections. Research has linked it with lower birth weight, preterm birth, hospitalization, death within one year of birth, and other negative outcomes. This study aims to better understand healthy development and shed light on how early exposure to cannabis and other substances, stressors, and trauma affect brain development and mental health, and how to reduce adverse outcomes. Chronic, heavy—every day or almost—use of cannabis products with THC is associated with developing cannabis use disorder, a type of substance use disorder. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition DSM-5 —a reference text published by the American Psychiatric Association that health professionals use to diagnose substance use disorders and other psychiatric disorders—defines cannabis use disorder as a pattern of use that leads to clinically significant impairment or distress. This means a person has had two or more of the following symptoms in a month period:. Cannabis use disorder can be diagnosed as mild when a person has two or three of these symptoms , moderate four or five of these symptoms , or severe six or more of these symptoms. One study estimated that Research shows that behavioral interventions such as cognitive behavioral therapy, motivational enhancement therapy, and contingency management can be effective in treating cannabis use disorder. There are currently no FDA-approved medications for the treatment of cannabis use disorder or for medically assisted withdrawal, 69 but research is ongoing. Cannabis products are among the first substances along with alcohol and tobacco that a person will likely encounter in their life MTF, , and people who use substances commonly use these before trying others. Still, most people who use or have used cannabis do not go on to use other substances later in life. However, risk factors for cannabis use are similar to risk factors for use of other drugs with addiction potential, 72 and studies have associated use of cannabis with developing cannabis use disorder. Using these products at a younger age in particular increases the likelihood of developing a cannabis use disorder later in life. Adolescence is an important period of brain development, and cannabis use may influence the brain in ways that could lead to long-term harmful effects. Cannabis use at a young age has also been linked to other mental health conditions, including the likelihood of developing psychosis 87 and to developing cannabis use disorder later in life. The NIDA-funded Monitoring the Future survey measures drug and alcohol use and related attitudes among adolescent students nationwide. Find recent survey data related to cannabis use here. This study will provide critical insights into risk and resilience factors for cannabis and other substance use to inform future prevention interventions. In recent years, adults aged 50 years or older have had the largest increase in cannabis use compared to any other age group, with the greatest increase among those 65 years or older. Some research suggests that cannabis use may have different effects on the brain in older adults compared to adolescents or young adults who use cannabis. The U. Food and Drug Administration FDA has not approved the use of any product containing whole cannabis plant material for any purpose, even though cannabis and cannabinoid products are marketed for various therapeutic uses and are available in many states from medical cannabis dispensaries. However, the FDA has approved synthetic THC-based medications dronabinol and nabilone to treat nausea and vomiting associated with cancer chemotherapy. The FDA has also approved a plant derived cannabidiol-based medication to treat seizures associated with rare forms of epilepsy. There is evidence that cannabis can be effective in treating some forms of pain, and there is emerging evidence that it may have additional therapeutic uses. Research will continue to explore potential therapeutic effects of cannabis to help inform individual and public health decisions, including strategies to minimize potential harms associated with cannabis use. It is important to consult with a doctor before consuming cannabis and cannabinoid products to treat medical conditions. Although research shows that people in the United States increasingly view cannabis use as low risk, it may cause negative health effects and can interact with other drugs a person is taking. Research Topics. More Research Topics. Quick Links. About NIDA. Highlights Image. Expand All What is cannabis? How do people use cannabis? These include: Oils and concentrates. Compounds in cannabis can also be extracted to make oils and concentrates that can be vaped or inhaled with devices that are like e-cigarettes. Smoking or vaporizing highly concentrated oils or extracts, also called wax or shatter, from the cannabis plant is known as dabbing. Dabbing can rapidly deliver large amounts of THC to the body, which increases the risk of negative side effects. Cannabis can also be mixed or added to foods like baked goods, candies, gummies, and drinks. Edibles typically take longer to show effects. People may use more of a product as a result, increasing the likelihood of serious negative health effects. Tinctures are cannabis-infused alcohol or oils consumed in small amounts under the tongue or by adding to foods or drinks. This form of cannabis can also deliver large amounts of THC to the body. Lotions and balms. These are products applied directly to the skin. Are cannabis products getting stronger? What is Delta-8 THC? What is CBD? What are synthetic cannabinoids? Cannabis has a wide variety of effects Cannabis may affect people differently depending on: 13,14,15,16 The amount taken. Potency concentration of THC. The way it is ingested. Other drugs a person may have taken. Age, sex, and genetic differences. What are the short-term health effects of cannabis use? What are the long-term health risks of cannabis use? Harms to Lung Health The smoke from cannabis products contains many of the same toxins, irritants, and carcinogens as tobacco smoke, and smoking cannabis can also harm lung tissue. Cardiovascular Effects Cannabis can increase heart rate and blood pressure right after use. What is the relationship between cannabis use and mental health? What is cannabinoid hyperemesis syndrome? What are the effects of secondhand exposure from cannabis smoke or vapor? Does cannabis use during pregnancy affect a developing baby? Is cannabis addictive? This means a person has had two or more of the following symptoms in a month period: Using cannabis in larger amounts or over a longer period than was intended. Persistent desire or unsuccessful efforts to cut down or control cannabis use. Spending a lot of time getting, using, or recovering from the effects of cannabis. Craving, or a strong desire or urge to use cannabis. Using cannabis even though it causes problems at work, school, or home. Continuing to use cannabis despite social or relationship problems. Giving up important hobbies, or activities with friends and family, or in the workplace to use cannabis. Using cannabis in situations with risk of injury. Continued use despite knowing that ongoing physical or psychological problems have been caused or worsened by cannabis use. Cannabis tolerance, which is a need for increased amounts of cannabis to achieve the desired effect. Withdrawal symptoms after stopping cannabis use. Can people have cannabis withdrawal symptoms? Are there treatments for cannabis use disorder? Does cannabis use affect driving? How does cannabis use impact adolescents? How does cannabis use impact older adults? Are some cannabis products safe and effective medicines? How is NIDA researching cannabis? NIDA funds research on the endocannabinoid system, cannabinoid compounds, and health effects of cannabis to support individual and public health. It also includes research on the factors underlying substance use and substance use disorders, and on developing new ways to prevent substance use disorders. NIDA supports epidemiology, policy research and public health outcomes research related to cannabis use, including the Monitoring the Future survey and a medicinal cannabis use registry. The study will collect information about participants during pregnancy, at birth, and through early childhood. A subset of participants will include babies that were exposed during pregnancy or infancy to cannabis. NIDA also funds research on potential therapeutic uses of cannabis and cannabinoids to reduce use of other substances, including opioids. Nora's Blog. September 26, Commercial interests are among the social determinants that contribute to substance use and addictive behaviors. News Release. March 12, Psychoactive cannabis product use higher in states without delta-8 regulations or cannabis legalization. December 13, New data show relatively low use of illicit substances, and yet overdose death rates among teens have risen. Learn more about the regulation of products containing cannabis or cannabis-derived compounds from the FDA. Find information and statistics on drug-impaired driving from the National Highway Traffic Safety Administration. Cannabinoids, Phenolics, Terpenes and Alkaloids of Cannabis. Published May 8. Pharmaceuticals Basel. Published Feb 9. Mapping cannabis potency in medical and recreational programs in the United States. PLoS One. Published Mar Higher average potency across the United States is associated with progression to first cannabis use disorder symptom. Drug Alcohol Depend. Cannabis Cannabinoid Res. Delta-8 tetrahydrocannabinol: a scoping review and commentary. Epub Feb PMID: Cannabidiol and brain function: current knowledge and future perspectives. Front Pharmacol. Published Jan Food and Drug Administration. Published March 5, Accessed September 13, Epilepsy Behav. Brain Sci. Published Jun Front Public Health. Published Jun 7. Synthetic cannabinoids: epidemiology, pharmacodynamics, and clinical implications. The pharmacokinetics and the pharmacodynamics of cannabinoids. Br J Clin Pharmacol. Br J Pharmacol. Sex differences in the acute effects of oral and vaporized cannabis among healthy adults. Addict Biol. High genes: Genetic underpinnings of cannabis use phenotypes. Prog Neuropsychopharmacol Biol Psychiatry. The why behind the high: determinants of neurocognition during acute cannabis exposure. Nat Rev Neurosci. Chemistry, metabolism, and toxicology of cannabis: clinical implication s. Iran J Psychiatry. Cannabis induced psychosis: A systematic review on the role of genetic polymorphisms. Pharmacol Res. Why do patients come to the emergency department after using cannabis?. Clin Toxicol Phila. Published Apr Cannabinoids and appetite: food craving and food pleasure. Int Rev Psychiatry. J Clin Oncol. Published online August 16, J Clin Med. Published Jul Cannabis contaminants: sources, distribution, human toxicity and pharmacologic effects. Damaging Effects of Cannabis Use on the Lungs. Adv Exp Med Biol. Marijuana: respiratory tract effects. Clin Rev Allergy Immunol. Pulmonary effects of inhaled cannabis smoke. Am J Drug Alcohol Abuse. Pulm Ther. Assessing the overlap between tobacco and marijuana: Trends in patterns of co-use of tobacco and marijuana in adults from Addict Behav. J Am Heart Assoc. Cardiovascular effects of marijuana and synthetic cannabinoids: the good, the bad, and the ugly. Nat Rev Cardiol. Cannabis and Cardiovascular Disease. Curr Atheroscler Rep. Cannabis hyperemesis syndrome: an update on the pathophysiology and managemen t. Ann Gastroenterol. Cannabis Use and Head and Neck Cancer. Published online August 8, Cannabis smoke can be a major risk factor for early-age laryngeal cancer--a molecular signaling-based approach. Tumour Biol. JAMA Psychiatry. Cannabis effects on brain structure, function, and cognition: considerations for medical uses of cannabis and its derivatives. Acute effects of partial CB1 receptor agonists on cognition - A meta-analysis of human studies. Evidence on the acute and residual neurocognitive effects of cannabis use in adolescents and adults: a systematic meta-review of meta-analyses. Schizophr Bull. Published Jun 1. Suicide Life Threat Behav. Influence of cannabis use on incidence of psychosis in people at clinical high risk. Psychiatry Clin Neurosci. Cannabis and mental health: Prevalence of use and modes of cannabis administration by mental health status. Cannabinoid Hyperemesis Syndrome. In: StatPearls. J Med Toxicol. Health effects of exposure to second- and third-hand marijuana smoke: a systematic review. CMAJ Open. Concentrations of delta9-tetrahydrocannabinol and norcarboxytetrahydrocannabinol in blood and urine after passive exposure to Cannabis smoke in a coffee shop. J Anal Toxicol. Non-smoker exposure to secondhand cannabis smoke. Urine screening and confirmation results. Secondhand marijuana exposure in a convenience sample of young children in New York City. Pediatr Res. Association between secondhand marijuana smoke and respiratory infections in children. The associations between prenatal cannabis use disorder and neonatal outcomes. The deleterious effects of cannabis during pregnancy on neonatal outcomes. Med J Aust. What is the prevalence and risk of cannabis use disorders among people who use cannabis? J Addict Nurs. DSM-5 cannabis withdrawal syndrome: Demographic and clinical correlates in U. Cannabis Use Disorder. Interventions for cannabis use disorder. Curr Opin Psychol. Jorgensen C, Wells J. Is marijuana really a gateway drug? A nationally representative test of the marijuana gateway hypothesis using a propensity score matching design. J Exp Criminol. Conditional probabilities of substance use disorders and associated risk factors: Progression from first use to use disorder on alcohol, cannabis, stimulants, sedatives and opioids. Likelihood of developing an alcohol and cannabis use disorder during youth: association with recent use and age. JAMA Pediatr. Front Psychiatry. Cannabis and Driving. Published Sep Trends in alcohol and other drugs detected in fatally injured drivers in the United States, Am J Epidemiol. Marijuana use and motor vehicle crashes. Epidemiol Rev. Acute cannabis consumption and motor vehicle collision risk: systematic review of observational studies and meta-analysis. Report No. Systematic review of structural and functional neuroimaging studies of cannabis use in adolescence and emerging adulthood: evidence from 90 studies and participants. Cannabis exposure during adolescence: A uniquely sensitive period for neurobiological effects. Int Rev Neurobiol. Cognitive Development and Cannabis Use in Adolescents. Behav Sci Basel. Familial factors may not explain the effect of moderate-to-heavy cannabis use on cognitive functioning in adolescents: a sibling-comparison study. Associations of adolescent cannabis use with academic performance and mental health: A longitudinal study of upper middle class youth. Associations between adolescent cannabis use and young-adult functioning in three longitudinal twin studies. Clin Ther. Gerontol Geriatr Med. Cannabis use patterns and motives: A comparison of younger, middle-aged, and older medical cannabis dispensary patients. J Am Geriatr Soc. Published May 1. J Stud Alcohol Drugs. Medical Marijuana Use in Older Adults. Published Feb Drug interactions with cannabinoids. September

How can I buy cocaine online in Ede

Medications may be required for various indications during pregnancy. The most commonly used medications include antiemetics, antacids, antihistamines, analgesics, antimicrobials, diuretics, antidepressants, and tranquilizers. Substance use and misuse is also common. Despite this trend, firm evidence-based guidelines for safe use of medications during pregnancy are still lacking. Until the s, the U. However, few well-controlled studies of therapeutic drugs have been done in pregnant women. Most information about drug safety during pregnancy is derived from animal studies, uncontrolled studies, and postmarketing surveillance. Consequently, the FDA classification system led to confusion and difficulty applying available information to clinical decisions. The information required by the FDA has 3 subsections:. Pregnancy: Information relevant to the use of the drug in pregnant women eg, dosing, fetal risks and information about whether there is a registry that collects and maintains data on how pregnant women are affected by the drug. Lactation: Information about using the drug while breastfeeding eg, the amount of drug in breast milk, potential effects on the breastfed child. Females and males of reproductive potential: Information about pregnancy testing, contraception, and infertility as it relates to the drug. The pregnancy and lactation subsections each include 3 subheadings risk summary, clinical considerations, and data that provide more detail. The final rule does not apply to nonprescription over-the-counter drugs. During pregnancy, medications are often required to treat certain disorders. In general, when potential benefit outweighs known risks, medications may be considered for treatment of disorders during pregnancy. Not all medications or other substances in the maternal circulation cross the placenta transfer to the fetus. Some drugs that cross the placenta may have a direct toxic effect or a teratogenic effect. Drugs that do not cross the placenta may still harm the fetus by. Constricting placental vessels and thus impairing gas and nutrient exchange. Producing severe uterine hypertonia that results in anoxic injury. Altering maternal physiology eg, causing hypotension. For a list of some medications with adverse effects during pregnancy, see table Safety of Selected Drugs in Pregnancy. Drugs diffuse across the placenta similarly to the way they cross other epithelial barriers see Absorption. Substances with a high molecular weight eg, protein-bound drugs usually do not cross the placenta. One exception is immune globulin G, which may be used to treat disorders such as fetal alloimmune thrombocytopenia or fetal hemachromatosis. Generally, equilibration between maternal blood and fetal tissues takes at least 30 to 60 minutes; however, some drugs do not reach similar concentrations in the maternal and fetal circulation. Fetal age affects the type of drug effect:. Before the 20th day after fertilization: Drugs given at this time typically have an all-or-nothing effect, killing the embryo or not affecting it at all. Teratogenesis is unlikely during this stage. During organogenesis between 20 and 56 days after fertilization : Teratogenesis is most likely at this stage. Drugs reaching the embryo during this stage may result in spontaneous abortion , a sublethal gross anatomic defect true teratogenic effect , covert embryopathy a permanent subtle metabolic or functional defect that may manifest later in life , or an increased risk of childhood cancer eg, when the mother is given radioactive iodine to treat thyroid cancer ; or the drugs may have no measurable effect. After organogenesis in the second and third trimesters : Teratogenesis is unlikely, but drugs may alter growth and function of normally formed fetal organs and tissues. As placental metabolism increases, doses must be higher for adverse fetal effects to occur. Maternal factors include those that affect drug absorption , distribution , metabolism , and excretion. For example, nausea and vomiting may decrease absorption of an oral drug. It is difficult to determine the overall rate of congenital malformations caused by therapeutic drugs. Safety of Selected Drugs in Pregnancy. Adverse Effects. Ototoxicity eg, damage to fetal labyrinth , resulting in deafness. Gray baby syndrome. In women or fetuses with G6PD deficiency , hemolysis. Possibly arthralgia; theoretically, musculoskeletal defects eg, impaired bone growth , but no proof of this effect. In women or fetuses with G6PD deficiency, hemolysis. Contraindicated during the first trimester, at term 38 to 42 weeks , during labor and delivery, and just before onset of labor. When given after about 34 weeks gestation, neonatal jaundice and, without treatment, kernicterus. Slowed bone growth, enamel hypoplasia, permanent yellowing of the teeth, and increased susceptibility to cavities in offspring. Occasionally, liver failure in pregnant women. Increased risk of neural tube defects due to folate antagonism. Should be avoided during the first trimester. Thrombocytopenia and maternal bleeding. Compatible with pregnancy; does not cross placenta. Inadequate human data; possible harm to the fetus because these drugs appear to cross the placenta. No antidote for reversal; to be avoided during pregnancy. When given during the first trimester, fetal warfarin syndrome eg, nasal hypoplasia, bone stippling, bilateral optic atrophy, various degrees of intellectual disability. When given during the second or third trimester, optic atrophy, cataracts, intellectual disability, microcephaly, microphthalmia, and fetal and maternal hemorrhage. Absolutely contraindicated during first trimester of pregnancy. Hemorrhagic disease of the newborn. Risk of congenital malformations including neural tube defects. Compatible with pregnancy. No adequate data available on fetal risks associated with use in pregnant women \[1\]. Caution is advised, with consideration of whether the benefits outweigh the potential risks and of alternative treatment options. Minor skeletal malformations in animal studies, but no appreciable increased risk in humans. Risk of congenital malformations. Congenital malformations eg, cleft lip, genitourinary defects such as hypospadias, cardiovascular defects. High risk of congenital malformations eg, cleft palate; cardiac, craniofacial, hand, and abdominal defects and risk of spontaneous abortion. Almost always contraindicated during pregnancy. Major congenital malformations eg, neural tube defects such as meningomyelocele ; cardiac, craniofacial, and limb defects. Conflicting data on risk of congenital malformations from first trimester exposure. Dosing affected by hepatic or renal impairment. When given during the first trimester, increased risk of congenital malformations particularly cardiac. When given during the third trimester, discontinuation syndrome and persistent pulmonary hypertension of the newborn. Consideration of dose tapering during the third trimester in consultation with a mental health professional. Long half-life; drug-drug interactions possibly occurring for weeks after the drug is stopped. When given during the third trimester, discontinuation syndrome. Dosing greatly affected by hepatic or renal impairment. No evidence of increased risk of congenital malformations. No significant teratogenic risk in animal studies. When given during the first trimester, possible risk of congenital heart disease evidence is weak. Used during pregnancy only for hyperemesis gravidarum when other treatments are ineffective. Generally no increased risk of congenital malformations. Possibly decreased platelet aggregation in neonates. Monitoring recommended for systemic toxicities electrolyte imbalance, renal dysfunction in the mother. Teratogenic at high doses in animal studies. With oral use, adverse effects in animal studies. When applied to the skin, no significant risk of congenital malformations. Intravaginal use during the first trimester not shown to increase risk of congenital malformations. Adverse effects in animal studies. No significant risk of congenital malformations. Possible hypospadias weak association. Teratogenic in rodents, but no proof of this effect in humans. Antihyperglycemics oral. Neonatal hypoglycemia. Unknown long-term effects on fetus. Crosses the placenta. Crosses the placenta; generally considered safe in pregnancy. ACE inhibitors. When given during the second or third trimester, fetal hypocalvaria and hypoperfusion which can cause renal defects , renal failure, and the oligohydramnios sequence oligohydramnios, craniofacial deformities, limb contractures, and hypoplastic lung development. Aldosterone antagonists. Beta-blockers \[3\]. Calcium channel blockers. Considered safe in pregnancy. Thiazide diuretics. Prevention of normal maternal volume expansion, reducing placental perfusion and contributing to fetal growth restriction. Neonatal hyponatremia, hypokalemia, and thrombocytopenia. Teratogenic in animals, but no proof of this effect in humans. Congenital malformations eg, fetal growth restriction, mandibular hypoplasia, cleft palate, cranial dysostosis, spinal defects, ear defects, clubfoot. No increased risk of major birth defects or pregnancy loss has been found with maternal use throughout pregnancy including first trimester for familial Mediterranean fever or other rheumatic diseases \[6\]. Teratogenic in animals and humans. Potential for dose-dependent cardiac dysfunction. Use during pregnancy not recommended. Effective contraception recommended during pregnancy and for 6 months after treatment of male or female partner. Contraindicated during pregnancy except for ectopic pregnancy, which requires an initial and a follow-up visit to confirm a diagnosis of ectopic pregnancy to avoid harming the fetus if the pregnancy is intrauterine. Effective contraception recommended for 8 weeks after the last dose. Antipsychotics and mood stabilizers. Symptoms in the newborn may include agitation, feeding problems, hypertonia, hypotonia, respiratory distress, somnolence, and tremor; these effects may be self-limiting or require hospitalization. When given during the first trimester, possibly limb malformations. When given during the third trimester, increased risk of extrapyramidal symptoms or withdrawal symptoms in the neonate. No evidence of adverse effects in animal studies. When given during the first trimester, teratogenic cardiac malformations. When given later in pregnancy, lethargy, hypotonia, poor feeding, hypothyroidism, goiter, and nephrogenic diabetes insipidus in the neonate. Based on limited data, no increased teratogenic risk. When given late in pregnancy, respiratory depression or a neonatal withdrawal syndrome that can cause irritability, tremors, and hyperreflexia. Fetal kernicterus. Use permitted for short durations during the second trimester if the fetus is carefully monitored. Does not appear to cause major malformations. Use in second trimester may increase risk of oligohydramnios. Opioids and partial agonists. Adverse effects but no teratogenicity in animal studies. Risk of a neonatal opioid withdrawal syndrome neonatal abstinence syndrome. Improved fetal outcomes compared with those when pregnant women use illicit substances. In neonates of women addicted to opioids, withdrawal symptoms possibly occurring 6 hours to 8 days after birth. With high doses given in the hour before delivery, possibly neonatal CNS depression and bradycardia. Risk of a neonatal opioid withdrawal syndrome. Possible need for acute short-acting analgesics to supplement maintenance dosing during labor and delivery. High teratogenic risk eg, multiple congenital malformations , spontaneous abortion, and intellectual disability. Contraindicated during pregnancy and in patients who may become pregnant. Sex hormones. Contraindicated during pregnancy. Hormonal contraceptives. Exposure to estrogen-progestin contraceptives prior to conception or during pregnancy does not appear to be associated with an increased risk of major birth defects \[8, 9\]. No indication for use during pregnancy; should be discontinued. When taken in second or third trimester, associated with an increased risk of gestational diabetes weak association \[12\]. Contraindicated during first trimester of pregnancy. Exposure during pregnancy not associated with increased risk of major birth defects \[13\]. Thyroid medications. Preferred treatment of maternal hypothyroidism with established safety profile. Fetal goiter, facial dysmorphism,neonatal scalp defects aplasia cutis , and other potential abnormalities. Fetal goiter and maternal hepatotoxicity and agranulocytosis. Typically used in the first trimester of pregnancy. Radioactive iodine I. Destruction of the fetal thyroid gland or, when the drug is given near the end of the first trimester, severe fetal hyperthyroidism. Increased risk of childhood cancer. Absolutely contraindicated during pregnancy. Large fetal goiter, which may obstruct breathing in neonates. Fetal goiter. Ultrasonography to monitor the fetus for potential goiter. Vaccines \[14\]. COVID vaccines. No safety concerns for pregnant people, or for fetuses or neonates, found in early data from safety monitoring systems \[15\]. Inactivated influenza vaccine. No safety concerns for pregnant people or for fetuses or neonates \[16\]. Tetanus, reduced diphtheria toxoid, acellular pertussis Tdap vaccine. No safety concerns for pregnant people or for fetuses or neonates \[17\]. Live-virus vaccines such as the measles, mumps, and rubella vaccine ; polio vaccine ; varicella vaccine ; and. With rubella and varicella vaccines, potential infection of the placenta and developing fetus. With other live vaccines, potential but unknown risks. Contraindicated in patients who are or may be pregnant. When used during the first trimester, possibly orofacial clefts. No increased risk at usual doses. May be started in the first trimester for risk reduction. Possible transient increases in maternal aminotransferase levels, peripheral neuropathy. Not to be used with other hepatotoxic drugs. Placental vasoconstriction and possible risk of gastroschisis. Use considered for pregnant patients with early mild to moderate COVID, particularly for patients with at least one additional risk factor for severe disease. Congenital malformations. Vitamin K. Ann Oncol 24 Suppl 6:vivi, Increasing use of newer antiseizure medication during pregnancy: an observational study with special focus on lacosamide. Seizure , Sun L, Xi Y, Wen X, Zou W : Use of metoclopramide in the first trimester and risk of major congenital malformations: a systematic review and meta-analysis. PLoS One 16 9 :e, Published Sep Easterling T, Mundle S, Bracken H, et al : Oral antihypertensive regimens nifedipine retard , labetalol , and methyldopa for management of severe hypertension in pregnancy: an open-label, randomised controlled trial. Lancet , Bellos I, Pergialiotis V, Papapanagiotou A, et al : Comparative efficacy and safety of oral antihypertensive agents in pregnant women with chronic hypertension: a network metaanalysis. Am J Obstet Gynecol 4 , Sridharan K, Sequeira RP : Drugs for treating severe hypertension in pregnancy: a network meta-analysis and trial sequential analysis of randomized clinical trials. Br J Clin Pharmacol 84 9 , Acta Psychiatr Scand Suppl , BMJ h, Published Jan 6. Epidemiology 21 2 , Teratology 38 2 , Arch Pediatr Adolesc Med 10 , Pergialiotis V, Bellos I, Hatziagelaki E, et al : Progestogens for the prevention of preterm birth and risk of developing gestational diabetes mellitus: a meta-analysis. Am J Obstet Gynecol 5 Accessed August 29, December Obstet Gynecol 4 :ee, Obstet Gynecol 3 :ee, Immunization is as effective in women who are pregnant as in those who are not. Influenza vaccine is recommended for all pregnant women during influenza season. The tetanus-diphtheria-pertussis Tdap vaccine is recommended for all pregnant women during the third trimester. The CDC recommends COVID vaccination for all people 5 years and older, including people who are pregnant, breastfeeding, trying to get pregnant, or might become pregnant in the future. Evidence about the safety and effectiveness of COVID vaccination during pregnancy has been growing. These data suggest that the benefits of receiving a COVID vaccine outweigh any known or potential risks of vaccination during pregnancy. In August , the US Food and Drug Administration approved use of a respiratory syncytial virus RSV vaccine in pregnant individuals between 32 to 36 weeks of gestation, with a warning to avoid use prior to 32 weeks. Clinical trials have found increased rates of preterm birth, preeclampsia in pregnant patients, and low birth weight and jaundice in infants following prenatal administration of RSV vaccine versus placebo; further study is needed to evaluate these potential risks 3. Other vaccines should be reserved for situations in which the woman or fetus is at significant risk of exposure to a hazardous infection and risk of adverse effects from the vaccine is low. Vaccinations for cholera , hepatitis A , hepatitis B , measles, mumps , plague, poliomyelitis , rabies , typhoid , and yellow fever may be given during pregnancy if risk of infection is substantial. Live-virus vaccines should not be given to women who are or may be pregnant. Rubella vaccine , an attenuated live-virus vaccine, may cause subclinical placental and fetal infection. However, no defects in neonates have been attributed to rubella vaccine, and women vaccinated inadvertently during early pregnancy need not be advised to terminate pregnancy based solely on theoretical risk from the vaccine. Varicella vaccine is another attenuated live-virus vaccine that can potentially infect the fetus; risk is highest between 13 weeks and 22 weeks gestation. This vaccine is contraindicated during pregnancy. The American College of Obstetricians and Gynecologists. Antivirals for influenza. Physiologic and psychosocial changes during pregnancy can affect depression possibly worsening it and possibly reduce the response to antidepressants. Ideally, a multidisciplinary team that includes an obstetrician and a psychiatric specialist should manage depression during pregnancy. Pregnant women who are taking antidepressants should be asked about depressive symptoms at each prenatal visit, and appropriate fetal testing should be done. It may include the following:. A detailed evaluation of fetal anatomy during the second trimester. To reduce the risk of withdrawal symptoms in the neonate, clinicians should consider tapering the dose of all antidepressants to the lowest effective dose during the third trimester. However, the benefits of tapering must be carefully balanced against the risk of symptom recurrence and postpartum depression. Postpartum depression is common, often unrecognized, and should be treated promptly. BMJ j, Published May Published Nov 1. Liggins GC, Howie RN : A controlled trial of antepartum glucocorticoid treatment for prevention of the respiratory distress syndrome in premature infants. Pediatrics 50 4 , Bennett HA, Einarson A, Taddio A, et al : Prevalence of depression during pregnancy: systematic review \[published correction appears in Obstet Gynecol 6 , \]. Obstet Gynecol 4 , The new labeling requires a summary of the risks of drug use during pregnancy and lactation, data to support that summary, and relevant information to help health care professionals make prescribing decisions and advise women about drug use during pregnancy and lactation. Teratogen Information System : This web site provides resources to help clinicians determine the risks of drugs and of environmental exposures \[eg, vaccines, infections\] during pregnancy. Clinical and experimental literature is summarized, and based on that information, teratogenic risk is assigned. A subscription is required. All rights reserved. Avinash S. The information required by the FDA has 3 subsections: Pregnancy: Information relevant to the use of the drug in pregnant women eg, dosing, fetal risks and information about whether there is a registry that collects and maintains data on how pregnant women are affected by the drug Lactation: Information about using the drug while breastfeeding eg, the amount of drug in breast milk, potential effects on the breastfed child Females and males of reproductive potential: Information about pregnancy testing, contraception, and infertility as it relates to the drug The pregnancy and lactation subsections each include 3 subheadings risk summary, clinical considerations, and data that provide more detail. Drugs that do not cross the placenta may still harm the fetus by Constricting placental vessels and thus impairing gas and nutrient exchange Producing severe uterine hypertonia that results in anoxic injury Altering maternal physiology eg, causing hypotension For a list of some medications with adverse effects during pregnancy, see table Safety of Selected Drugs in Pregnancy. Fetal age affects the type of drug effect: Before the 20th day after fertilization: Drugs given at this time typically have an all-or-nothing effect, killing the embryo or not affecting it at all. It may include the following: A detailed evaluation of fetal anatomy during the second trimester To reduce the risk of withdrawal symptoms in the neonate, clinicians should consider tapering the dose of all antidepressants to the lowest effective dose during the third trimester. Test your Knowledge Take a Quiz! About us Disclaimer Cookie Preferences. Gray baby syndrome In women or fetuses with G6PD deficiency , hemolysis. When given after about 34 weeks gestation, neonatal jaundice and, without treatment, kernicterus In women or fetuses with G6PD deficiency, hemolysis. Slowed bone growth, enamel hypoplasia, permanent yellowing of the teeth, and increased susceptibility to cavities in offspring Occasionally, liver failure in pregnant women. When given during the first trimester, fetal warfarin syndrome eg, nasal hypoplasia, bone stippling, bilateral optic atrophy, various degrees of intellectual disability When given during the second or third trimester, optic atrophy, cataracts, intellectual disability, microcephaly, microphthalmia, and fetal and maternal hemorrhage. Hemorrhagic disease of the newborn Risk of congenital malformations including neural tube defects. Hemorrhagic disease of the newborn Risk of congenital malformations. Congenital malformations eg, cleft lip, genitourinary defects such as hypospadias, cardiovascular defects Hemorrhagic disease of the newborn. When given during the first trimester, increased risk of congenital malformations particularly cardiac When given during the third trimester, discontinuation syndrome and persistent pulmonary hypertension of the newborn. Long half-life; drug-drug interactions possibly occurring for weeks after the drug is stopped Consideration of dose tapering during the third trimester in consultation with a mental health professional. Dosing greatly affected by hepatic or renal impairment Consideration of dose tapering during the third trimester in consultation with a mental health professional. No significant teratogenic risk in animal studies When given during the first trimester, possible risk of congenital heart disease evidence is weak. No significant teratogenic risk in animal studies Generally no increased risk of congenital malformations Possibly decreased platelet aggregation in neonates. With oral use, adverse effects in animal studies When applied to the skin, no significant risk of congenital malformations. Adverse effects in animal studies No significant risk of congenital malformations. Neonatal hypoglycemia Unknown long-term effects on fetus. Prevention of normal maternal volume expansion, reducing placental perfusion and contributing to fetal growth restriction Neonatal hyponatremia, hypokalemia, and thrombocytopenia. Teratogenic in animals and humans Potential for dose-dependent cardiac dysfunction. Use during pregnancy not recommended Effective contraception recommended during pregnancy and for 6 months after treatment of male or female partner. Contraindicated during pregnancy except for ectopic pregnancy, which requires an initial and a follow-up visit to confirm a diagnosis of ectopic pregnancy to avoid harming the fetus if the pregnancy is intrauterine Effective contraception recommended for 8 weeks after the last dose. Adverse effects in animal studies When given during the first trimester, possibly limb malformations When given during the third trimester, increased risk of extrapyramidal symptoms or withdrawal symptoms in the neonate. No evidence of adverse effects in animal studies When given during the third trimester, increased risk of extrapyramidal symptoms or withdrawal symptoms in the neonate. Adverse effects in animal studies When given during the first trimester, teratogenic cardiac malformations When given later in pregnancy, lethargy, hypotonia, poor feeding, hypothyroidism, goiter, and nephrogenic diabetes insipidus in the neonate. Adverse effects in animal studies When given during the third trimester, increased risk of extrapyramidal symptoms or withdrawal symptoms in the neonate. Adverse effects in animal studies Based on limited data, no increased teratogenic risk When given during the third trimester, increased risk of extrapyramidal symptoms or withdrawal symptoms in the neonate. Does not appear to cause major malformations Use in second trimester may increase risk of oligohydramnios. Adverse effects but no teratogenicity in animal studies Risk of a neonatal opioid withdrawal syndrome neonatal abstinence syndrome. In neonates of women addicted to opioids, withdrawal symptoms possibly occurring 6 hours to 8 days after birth With high doses given in the hour before delivery, possibly neonatal CNS depression and bradycardia. Adverse effects in animal studies Risk of a neonatal opioid withdrawal syndrome. Improved fetal outcomes compared with those when pregnant women use illicit substances Possible need for acute short-acting analgesics to supplement maintenance dosing during labor and delivery. Destruction of the fetal thyroid gland or, when the drug is given near the end of the first trimester, severe fetal hyperthyroidism Increased risk of childhood cancer. With rubella and varicella vaccines, potential infection of the placenta and developing fetus With other live vaccines, potential but unknown risks.

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