LETTERS
TO
THE
EDITOR
Drug use during pregnancy P.C.M. Pasker-De Jong, T.K.A.B. Eskes, P. W.J. Van Dongen and K.L. Bos
P h a r m a c o t h e r a p y during p r e g n a n c y should be as restricted as possible since the teratogenic properties of most drugs are unknown. Furthermore, p r e g n a n t w o m e n m a y be more prone to side-effects of drugs. Recently, a 33-year old p r e g n a n t woman, gravida 3, p a r a 2, 35 weeks pregnant, was referred to our Obstetrical D e p a r t m e n t because of pancytopenia and anticipated complications after p r e m a t u r e contractions earlier in pregnancy. She complained of fatigue after an influenzaqike illness. At physical e x a m i n a t i o n we saw a w o m a n in general distress, very anaemic (haemoglobin 3.6 retool/l) and with an underfilled v a s c u l a r system. She said t h a t she had not eaten for a month. H e r nutritional status was bad and she was depressed. Folate deficiency and p n e u m o n i a were diagnosed. P a n c y t o p e n i a was present. On admittance, she brought with her a plastic b a g full of medical drugs, prescribed to her by her general practitioner from w h o m she had received the p r e n a t a l care up to then. We checked the prescriptions with her p h a r m a c i s t who confirmed - on a computer outprint - t h a t during her p r e g n a n c y 61 prescriptions h a d b e e n dispensed to her. Among the 33 p r e p a r a t i o n s prescribed were 5 antacids, 4 benzodiazepines, 7 antibiotics - local as well as systemic - and some other drugs, like paracetamol, iron tablets and a corticosteroid. The drugs had been prescribed because of nervousness, fears, de-
pressions, 'hysteric syndrome,' frequent headaches, genital infections and an influenza-like disorder. At 30 weeks of pregnancy, t h r e a t e n i n g p r e m a t u r e labour was t r e a t e d in another hospital. On admittance, all medications were discontinued. Of the drugs the patient h a d taken, propranolol, butylscopolamine, indometacin, paracetamol, cimetidine and nitrofurantoin m a y interfere with the folate metabolism. The pancytopenia was t h o u g h t to h a v e been of toxic origin, and to be a result of the folate deficiency. The patient was t r e a t e d with folic acid and pepcidin because she h a d intestinal bleedings and with amoxycillin because of the pneumonia. She recovered slowly. At 37 weeks, labour started and was supported with oxytocin. A h e a l t h y girl weighing 2,900 g was born, with Apgar scores of 5 at one min and 8 at five min. Although no adverse effects on the neonate were apparent, the medical drugs t h a t had been prescribed and issued to this p r e g n a n t w o m a n were not without risks. We t h o u g h t t h a t nowadays the knowledge of teratogenic properties of medications and the computerized dispensing of the prescribed medications by p h a r m a c i s t s would m a k e the present case impossible. We seem to be wrong. Although it is k n o w n t h a t p h a r m a c o t h e r a p y should be limited during pregnancy, neither physician nor p h a r m a c i s t did attend sufficiently to avert this extensive and irrational therapy.
December 1991.
P.C.M. Pasker-De Jong (correspondence): Department of Epidemiology, University of Nijmegen, P.O. Box 9101, 6500 HB Nijmegen, the Netherlands. T.K.A.B. Eskes, P.W.J. Van Dongen and K.L. Bos: Department of Obstetrics and Gynaeeology, University Hospital Nijmegen, P.O. Box 9101, 6500 HB Nijmegen, the Netherlands. Keywords: Medication errors; Pharmacists; Physicians, family; Pregnancy.
14(2) 1992
P h a r m a c e u t i s c h Weekblad Scientific edition
59
TO
THE
EDITOR
Drug use during pregnancy P.C.M. Pasker-De Jong, T.K.A.B. Eskes, P. W.J. Van Dongen and K.L. Bos
P h a r m a c o t h e r a p y during p r e g n a n c y should be as restricted as possible since the teratogenic properties of most drugs are unknown. Furthermore, p r e g n a n t w o m e n m a y be more prone to side-effects of drugs. Recently, a 33-year old p r e g n a n t woman, gravida 3, p a r a 2, 35 weeks pregnant, was referred to our Obstetrical D e p a r t m e n t because of pancytopenia and anticipated complications after p r e m a t u r e contractions earlier in pregnancy. She complained of fatigue after an influenzaqike illness. At physical e x a m i n a t i o n we saw a w o m a n in general distress, very anaemic (haemoglobin 3.6 retool/l) and with an underfilled v a s c u l a r system. She said t h a t she had not eaten for a month. H e r nutritional status was bad and she was depressed. Folate deficiency and p n e u m o n i a were diagnosed. P a n c y t o p e n i a was present. On admittance, she brought with her a plastic b a g full of medical drugs, prescribed to her by her general practitioner from w h o m she had received the p r e n a t a l care up to then. We checked the prescriptions with her p h a r m a c i s t who confirmed - on a computer outprint - t h a t during her p r e g n a n c y 61 prescriptions h a d b e e n dispensed to her. Among the 33 p r e p a r a t i o n s prescribed were 5 antacids, 4 benzodiazepines, 7 antibiotics - local as well as systemic - and some other drugs, like paracetamol, iron tablets and a corticosteroid. The drugs had been prescribed because of nervousness, fears, de-
pressions, 'hysteric syndrome,' frequent headaches, genital infections and an influenza-like disorder. At 30 weeks of pregnancy, t h r e a t e n i n g p r e m a t u r e labour was t r e a t e d in another hospital. On admittance, all medications were discontinued. Of the drugs the patient h a d taken, propranolol, butylscopolamine, indometacin, paracetamol, cimetidine and nitrofurantoin m a y interfere with the folate metabolism. The pancytopenia was t h o u g h t to h a v e been of toxic origin, and to be a result of the folate deficiency. The patient was t r e a t e d with folic acid and pepcidin because she h a d intestinal bleedings and with amoxycillin because of the pneumonia. She recovered slowly. At 37 weeks, labour started and was supported with oxytocin. A h e a l t h y girl weighing 2,900 g was born, with Apgar scores of 5 at one min and 8 at five min. Although no adverse effects on the neonate were apparent, the medical drugs t h a t had been prescribed and issued to this p r e g n a n t w o m a n were not without risks. We t h o u g h t t h a t nowadays the knowledge of teratogenic properties of medications and the computerized dispensing of the prescribed medications by p h a r m a c i s t s would m a k e the present case impossible. We seem to be wrong. Although it is k n o w n t h a t p h a r m a c o t h e r a p y should be limited during pregnancy, neither physician nor p h a r m a c i s t did attend sufficiently to avert this extensive and irrational therapy.
December 1991.
P.C.M. Pasker-De Jong (correspondence): Department of Epidemiology, University of Nijmegen, P.O. Box 9101, 6500 HB Nijmegen, the Netherlands. T.K.A.B. Eskes, P.W.J. Van Dongen and K.L. Bos: Department of Obstetrics and Gynaeeology, University Hospital Nijmegen, P.O. Box 9101, 6500 HB Nijmegen, the Netherlands. Keywords: Medication errors; Pharmacists; Physicians, family; Pregnancy.
14(2) 1992
P h a r m a c e u t i s c h Weekblad Scientific edition
59
