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The American Academy of Pediatrics classifies the drug as compatible with breastfeeding (14). No fetal growth was observed during serial ultrasound examinations from 30 to 32 weeks. However, the short elimination half-life and the very low blood concentrations probably indicate that any exposure will not be clinically significant. In an earlier study, pneumograms were used to quantify abnormal sleeping ventilatory patterns in infants of substance-abusing mothers (68). Tests in the mother and infant shortly after delivery were consistent with hypothalamic­pituitary­adrenal axis suppression with low basal serum cortisol levels (40). Hydrocortisone is frequently prescribed during human pregnancy and case reports and other references have described the use of this agent or its precursor, cortisone, during pregnancies that produced an infant with a congenital malformation. The Council on Scientific Affairs of the American Medical Association and the American Council on Science and Health have each published reports on the consequences of maternal alcohol ingestion during pregnancy (7,8). If a pregnant woman requires long-term topical corticosteroid therapy, the use of a less-potent agent should be considered. The analgesic effects of the narcotic agents were similar, but buprenorphine caused a significant increase in maternal vomiting (14­16). In humans, the in vitro half-life in blood is slightly longer, approximately 6 minutes, and the in vivo half-life, although it has not yet been determined, is expected to be no longer than this time (1). Four of the infants died, and the other seven had serious neurodevelopmental disabilities (50). Among the 94 completed pregnancies, there were 37 normal males, 34 nonvirilized females, and 23 virilized females. In contrast to zidovudine (see Zidovudine), no metabolite was detected in the placenta (10). The molecular weight (about 836 for the solvent-free form), moderate serum binding (89%­92%), and long elimination half-life (95 hours) suggest that the drug will be excreted into breast milk. Data from one review indicated that 40% of the infants exposed to anticancer drugs were of low birth weight (20). These included closely set eyes, flat nose with single nasopharynx, polydactylia, atrial septal defect, patent ductus arteriosus, absent gallbladder and thyroid, and collapsed fontanel. Normal pregnancy in a patient with -thalassaemia major receiving iron chelation therapy with deferasirox (Exjade). Apnea and/or abnormal pneumograms were observed in 20 (14%) of 138 infants whose mothers tested positive for cocaine at delivery (4). Until such data are available, use of other anticoagulants, such as the low-molecular-weight heparins, should be considered. Thirteen days after completion of therapy, she delivered a 3200-g female infant with Apgar scores of 6 and 2 at 1 and 5 minutes, respectively. Human serum binding is 89%­92%, most of which is to albumin (82%) and lipoproteins. Guanfacine is not approved for the treatment of preeclampsia, but one study has been located that describes the use of the agent for this purpose. Treatment of multidrug-resistant tuberculosis during pregnancy: a report of 7 cases. The effect of dobutamine hydrochloride on ventricular function and oxygen transport in patients with severe preeclampsia (abstract). Although a causal link between the bone defects and fluoroquinolones could not be determined, the authors suggested that future studies should look for this association (15). The heart rate of the 3690-g male infant returned to a reactive pattern 5 days after delivery. Ibandronate was not carcinogenic in long-term (104-week) studies in male and female rats, or in male and female mice studied up to 78 weeks. In 1161 neonates born at gestational ages of 24­34 weeks, 400 were exposed to antenatal betamethasone and 761 were not exposed (controls).

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It is a metabolite of another second-generation antihistamine, terfenadine (no longer available). Moreover, golimumab crossed to the fetus in monkeys and, because the placentas in monkeys are similar to those in humans, the antibody should be expected to cross to the human fetus. The patient received 425 mg during a 6-day period for the treatment of hypertension. Additional 28 cases of major malformations reported retrospectively to the manufacturer were mentioned, but no details were given other than the fact that the malformations lacked similarity and were not indicative of a pattern of anomalies (12). However, another prostaglandin analog, misoprostol, when used unsuccessfully in the 1st trimester as an abortifacient, has been associated with cranial nerve defects in the fetus. The amounts of caffeine in breast milk after maternal ingestion of caffeinated beverages are probably too low to be clinically significant. Dexamethasone, in divided doses of 1 mg/day, was administered from early in the 1st trimester (5th week and 10th week) to term. Seizures occurred at least once during pregnancy in 59% of the women, but they did not correlate with either malformations or developmental delay in the offspring (22). Placental transfer and fetal disposition of 23-dideoxycytidine and 23-dideoxyinosine in the rhesus monkey. Therefore, until data relating to milk concentrations are available, women receiving conivaptan should probably not breastfeed. Moreover, the case reports above suggest that the wild toxins do not cross the human placenta in the last half of pregnancy. In a surveillance study of Michigan Medicaid recipients involving 229,101 completed pregnancies conducted between 1985 and 1992, 1080 newborns had been exposed to dexchlorpheniramine during the 1st trimester (F. Ethionamide was teratogenic in rats and rabbits at doses higher than those used in humans (1). Erythropoietin and cord blood haemoglobin in the regulation of human fetal erythropoiesis. Studies in pregnant rabbits with nonmaternal toxic doses also failed to demonstrate embryo or fetal harm (1). Because the effect of this exposure on a nursing infant is unknown, combined with the lack of data on the amount of drug that may be in milk, women who are taking cevimeline should probably not breastfeed. A total of 38 cycles were administered during pregnancy with a median of two cycles per woman. Plasma clearance of caspofungin is primarily from distribution, rather than by excretion or by metabolism. She had taken the tablets periodically over the past 9 years and throughout her pregnancy. In the first part of the study, the investigator polled obstetric department heads of 50 medical schools. High doses impaired fertility in male and female rats, including dose-related irreversible toxicity of male rat reproductive organs (6). No significant difference in 24-hour heart rate or sleep time was observed between the two phases of the study. The relatively low molecular weight (about 276) suggests that the drug will be excreted in breast milk. In addition, large retrospective studies showing no association between diazepam and cleft lip/palate have been published (22­25). Although the authors noted the small size of their study, and the absence of a comparative group with other antiepileptic drugs, they concluded that gabapentin did not appear to increase the risk for major malformations (19). The investigators considered combinations of genotype, assuming typical breastfeeding schedules and maternal doses of 2. Although diarrhea in a nursing infant is a potential effect, the drug is probably compatible with breastfeeding. Ocular defects consisting of persistent hyperplastic primary vitreous in one eye and changes similar to those observed in retinopathy of prematurity in the other eye were described in a case report of an infant exposed throughout gestation to cocaine and multiple other abuse drugs (56). No effect on prostacyclin production was shown with aspirin (6­8) or magnesium sulfate (9). In a surveillance study of Michigan Medicaid recipients involving 229,101 completed pregnancies conducted between 1985 and 1992, 18 newborns had been exposed to ethosuximide during the 1st trimester (F. Oral doses of 6 mg/kg/day in pregnant rabbits produced defects of the ribs in a small percentage of exposed fetuses, indicating a minimal teratogenic response (9). Another study used pregnant rats and observed dose-related growth restriction, multiple congenital defects, and increased mortality (5).

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The American Academy of Pediatrics classifies estradiol as compatible with breastfeeding (7). It is unknown if the ability to respond to these challenges returns to normal after clearance of basiliximab (2). The investigators concluded that the three agents lacked the specific in vitro characteristics of valproate (5). Additionally the scientific literature suggests a possible association of occupational exposure to certain cytotoxic agents during the first trimester of pregnancy with fetal loss or malformation. However, the extensive metabolism and protein binding will decrease the amount of parent drug available for transfer at the maternal:fetal interface. Although follow-up of the remaining newborns had not been sufficiently long to exclude completely the presence of congenital malformations, these outcomes do not appear to be different from those expected in a nonexposed population. Blood pressures were reduced in both groups, but the difference between them was not significant. The results of one of these studies (14) have been discussed in the monograph for cyclophosphamide (see Cyclophosphamide). Glucocorticoid activity in cord serum: comparison of hydrocortisone and betamethasone regimens. A prospective multicenter study published in 2008 compared pregnant women exposed to a new macrolide (azithromycin, clarithromycin, or roxithromycin) with two comparison groups (19). Because the cells are injected intradermal they should not be in the systemic circulation and would not be present in breast milk. Approximately 5 months later (2 months after restarting cabergoline), she again became pregnant and cabergoline was stopped (gestational age not specified). The birth defects included hydrocephalus, sacral or coccygeal agenesis, digital and muscle hypoplasia, joint contractures, short stature, short perineum, and pilonidal sinus. On day 9, caffeine was detectable in the sera of only two infants, decreasing from 0. There were 22 birth defects (17 in the 1st trimester and 5 in the 2nd/3rd trimesters). A group of 599 children with oral clefts was compared with 590 controls without clefts. The sedative, analgesic, and hemodynamic controlling properties of dexmedetomidine have been reported in three pregnant women in labor (5­7). Because of the nature of the indication, opportunities for use of this drug during breastfeeding are probably very rare. The case above that observed seizures may or may not have been related to bupropion. A 25-year-old woman with dermatitis herpetiformis was treated with dapsone throughout most of her pregnancy and continued this therapy while breastfeeding her infant (5). Studies conducted on very-low-birth-weight infants (500­1500 g) at 2 years of age indicated that, compared with nonexposed controls, exposed infants received antenatal betamethasone therapy that was associated with a significant improvement in survival, improved growth, and a decrease in early respiratory morbidity (53). Fujii Y Prevention of emetic episodes during cesarean delivery performed under regional anesthesia in. Chlordiazepoxide readily crosses the placenta at term in an approximate 1:1 ratio (11­13). Significant hepatic enzyme changes were measured in both the dams and pups, but the clinical significance of the changes is unknown. Much lower mean levels were measured in pooled human milk in an English study examining preterm (26 mothers, at 29­34 weeks) and term (35 mothers, at 39 weeks) patients (103). This reaction is characterized by tremors, increased muscle tone with spasticity, and hyperactive deep tendon reflexes. The outcomes of these pregnancies included 4 spontaneous abortions, 5 elective abortions, 4 pregnancies lost to follow-up, and 37 normal newborns (3 premature; 2 sets of full-term twins) (11). Because of the lack of family histories, an association with familial holoprosencephaly or maternal neurologic problems could not be excluded (9). If the mother or infant demonstrates symptoms of opioid toxicity, such as sedation, lethargy, or poor milk intake, breastfeeding should be stopped. The agent is embryocidal in animals and, in some species, produced minor skeletal variations at the highest dose tested (1­3).

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The effects of a number of non-steroidal anti-inflammatory compounds on parturition in the rat. Three women became pregnant during clinical trials and, although they were excluded from the study, continued to receive commercially available filgrastim (12). A 1997 paper described 20 cases from the literature of electric shock during pregnancy with healthy newborn outcomes occurring in only 5 cases (1). The tree, which may grow to a height of 30­40 m (approximately 98­131 feet), has fanshaped leaves and is indigenous to China, Japan, and Korea (2,3,5). In a 2006 report, a 33-year-old woman with severe psychotic depression was treated with fluvoxamine 200 mg/day and quetiapine 400 mg/day (9). Physical development and medical history of children who were treated antenatally with corticosteroids to prevent respiratory distress syndrome: a 10- to 12-year follow-up. A clinical trial of intravenous Apresoline in the management of toxemia of late pregnancy. Reproductive significance of changes in the endometrial cavity associated with exposure in utero in diethylstilbestrol. Of the 2048 women, from a total sample of 104,339, who had received benzodiazepines, 80 had received 10 or more prescriptions for these agents. Cerquaglia C, Verrecchia E, Fonnesu C, Giovinale G, Marinaro A, De Socio G, Manna R. Breast-feeding practices in rural Karnataka (India) with special reference to lactation failure. Moreover, the woman should be informed of the risk of anaphylaxis that has occurred in 3. Subsequent examinations of three of the above infants revealed normal growth and development after several months (4­6). Maternal and fetal and tissue levels of, ceftriaxone following preoperative prophylaxis in emergency cesarean section. Two other potential problems of lesser concern involve the modification of bowel flora and possible interference with the interpretation of culture results if a fever workup is required. However, fetal lymph nodes were not examined and the toxicity of the antibody in the 2nd and 3rd trimesters, the periods when increasing amounts of monoclonal antibodies are expected to cross the placenta was not studied (1). The percentage decrease (95% confidence interval) for pregnant women was 30% (24%­36%). In a case report, a nursing infant developed two grossly bloody stools while his mother was receiving gentamicin and clindamycin (25). The mother had no unusual bleeding at delivery and the repair of a mediolateral episiotomy was uneventful. The molecular weight (about 394 for the free base) and long plasma elimination half-life suggest that the drug will cross to the embryo­fetus. The tocolytic activity of formoterol was about 1000 times that of ritodrine (2,3). Amoxicillin or erythromycin for the treatment of antenatal chlamydial infection: a meta-analysis. Droperidol has been used for the treatment of severe nausea and vomiting occurring during pregnancy (5,6). These data do not support an association between the vaginal use of the drug and congenital defects. A large retrospective study found a protective effect with folate administration during pregnancy, leading to a conclusion that deficiency of this vitamin may be teratogenic (36). Ensayo con cefalexina en el tratamiento de infecciones urinarias en pacientes embarazadas. In the American/Canadian study, folic acid (the most commonly used daily dose was 0. There was no evidence of drug-induced malformations or developmental delay in surviving offspring. These effects appeared to be caused directly or indirectly by the diuretic action of the drug.

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Because fluconazole inhibits the cytochrome P450 pathway responsible for phenytoin metabolism, authors of a 1999 study reasoned that the drug combination could provide a test of the hypothesis. Although there are no human data, the authors of the 1994 study concluded that the three newer agents may be safer than zidovudine to use in early pregnancy (4). The pregnancy outcomes were compared with seven women with more complicated (increased relapses) multiple sclerosis who were treated with interferon beta-1a throughout gestation. Treatment of Trichomonas in pregnancy and adverse outcomes of pregnancy: a subanalysis of a randomized trial in Rakai, Uganda. Based on an ingestion of 1000 mL of milk per day, the mean infant doses of fluoxetine and norfluoxetine were 0. Chromosomal aberrations were noted in three infants after in utero exposure to the drug, but the relationship to azathioprine and the clinical significance of the findings are questionable (14,38). As a group, second- generation antihistamines are less sedating than first-generation agents. Potent topical corticosteroids also can cause structural anomalies after dermal application (1). An infusion pump was implanted under general anesthesia with an initial dose of 150 mcg/day. The metabolic fate of decitabine is not known, but the terminal-phase halflife is about 0. Because it occurs naturally in all humans, it is difficult to separate the effects of its administration from effects on the fetus induced by endogenous epinephrine, other drugs, disease states, and viruses. The cause of death was thought to be caused by progressive multiple placental infarctions and fetal hypotrophy. However, the rates of perinatal deaths and congenital malformations did not differ between 3007 infants born to women heavily exposed to hexachlorophene in 31 hospitals and 1653 infants born to women working in 18 hospitals where the antiseptic was not used at all or was used only sporadically (19). Other than slight vaginal bleeding in the 1st trimester, there were no maternal or fetal complications. Severe anuria and hypotension, which is resistant to both pressor agents and volume expansion, may occur in the newborn following in utero exposure to candesartan cilexetil. There was no evidence of neurologic defect in the lower limbs or of hydrocephalus. If the relationship was causal, the absolute risk was estimated to be about 1% (21). Although the hypertension was probably caused by ritodrine, it is not known whether the corticosteroid was a contributing factor. All infants were delivered at term, had clear amniotic fluid, Apgar scores of 7 or higher, and were healthy with no signs of fetal distress either at birth or during the first 3 days after birth. Moreover, while in the circulation, basiliximab impairs the response of the immune system to antigenic challenges. Reviews have concluded that, in general, inhalational anesthetics are freely transferred to fetal tissues (7,8) and, in most cases, the maternal and fetal concentrations are equivalent (8). Bromide concentrations in three of the four infants were 3650, 2000, and 2420 mcg/mL on days 6, 5, and 5, respectively (4­6). Six of the 17 had received prior chemotherapy (carboplatin or cisplatin plus paclitaxel in three; cisplatin plus cyclophosphamide in two; melphalan in one). The molecular weight (about 90,000) suggests that transfer of the agent across the placenta will be limited, but the elimination half-life will place it at the maternal­fetal interface for a prolonged period. The American Thoracic Society recommends avoidance of cycloserine during pregnancy, if possible, due to the lack of information on the fetal effects of the drug (3). In pregnant rats, doses producing plasma concentrations similar to those in humans resulted in an increase in fetal resorptions. All diagnostic test results were negative and the seizures did not respond to phenytoin, phenobarbital, clonazepam, lidocaine, or pyridoxine. Prolongation of a preterm pregnancy complicated by death of a single twin in utero and disseminated intravascular coagulation: effects of treatment with heparin. As observed in previous studies, maternal blood pressure (average systolic blood pressure increase 10 mmHg) and heart rate (average pulse increase 15 beats/minute) rose slightly immediately after the shock, but no maternal hypoxia was measured. The American Academy of Pediatrics classifies cefadroxil as compatible with breastfeeding (5).

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However, maternal nausea and diarrhea appear to be very common, although underreported. Normal pregnancy outcomes of 15 women treated for leprosy were noted in a 1996 letter (N = 13) (11) and in a 1997 report (N = 2) (12). However, an earlier study concluded that adverse effects occurred after even short-term exposure (44). Several reports have described the use of enoxaparin during pregnancy without maternal or fetal complications (4­15). Use before this carries a small risk of female masculinization and hypospadias and/or ambiguous genitals in males. However, leukemia can be fatal, so if a woman requires dasatinib and informed consent is obtained, treatment should not be withheld because of pregnancy. Fetal breathing movements increased significantly during the 3rd hour after regular coffee, rising from 144 breaths/hour to 614 breaths/hour (p <0. After the last steady-state dose, the mean time to eliminate efalizumab was 25 days (range 13­35 days) (1). The incidence of preterm delivery (defined as <38 weeks) in the three groups was 17% (4 of 23; 1st trimester use only), 31% (16 of 52; cocaine use throughout pregnancy), and 3% (1 of 40; drug-free controls) (24). It is well known that newborns exposed directly to high doses of chloramphenicol may develop the gray syndrome (2,3). Placental alterations, intrauterine growth retardation and teratogenicity associated with enalapril use in pregnant rats. A commentary in 2001 considered several factors (pKa, molecular weight, lipid solubility, elimination half-life, and protein binding) that could limit glyburide from crossing the placenta (12). Over a 24-month period (September 1986­August 1988), the incidence of positive urine screens for cocaine in women at delivery rose steadily, starting at 4% in the first 6-month quarter and increasing to 12% in the final quarter. It is not known if glimepiride crosses the placenta, but the molecular weight (about 491) is low enough that transfer to the fetus should be expected. Cephalosporins are usually considered safe to use during pregnancy (see other cephalosporins for published human experience). Specific data were available for six defect categories, including (observed/expected) 4/0. Two of the five mothers in the multiple drug use group suffered the complication after injection of a "speed ball" (heroin plus cocaine) (5). Animal reproduction studies have not been conducted with drotrecogin alfa (activated) (4). As a quaternary ammonium compound, it is ionized at physiologic pH and transplacental passage in significant amounts would not be expected. Birth weight, 1892 g, and length, 43 cm, were at the 20th percentile for gestational age. Others have questioned whether an indefinite recommendation to avoid pregnancy is practical or necessary (15,16). In three cases, dapsone was used for the treatment of dermatitis herpetiformis or its variant, herpes gestationis (4,5). Transplacental transfer of cefuroxime in uncomplicated pregnancies and those complicated by hydrops or changes in amniotic fluid volume. In addition, both are highly bound (>90%) to plasma proteins and have an elimination halflife of about 22 hours (1,2). The disorders treated were mainly systemic lupus erythematosus, asthma, and infertility. As of June 1986, a total of 51 pregnancies had occurred during treatment with etretinate (1,7,8). A man, who had received etoposide for acute nonlymphoblastic leukemia in a cumulative dose of 3193 mg/m2, fathered two children, one of whom had a unspecified birthmark (16). In adults, the most common adverse effects are nausea, anemia, thrombocytopenia, vomiting, pyrexia, leukopenia, diarrhea, fatigue, constipation, neutropenia, and ecchymosis (1). Although the systemic absorption of capreomycin in a neonate has not been studied, <1% of an oral dose is absorbed by adults, so the risk, if any, to a nursing infant appears to be minimal. In a surveillance study of Michigan Medicaid recipients involving 229,101 completed pregnancies conducted between 1985 and 1992, 19 newborns had been exposed to clonazepam during the 1st trimester (F. Moreover, the recommended limit is controversial and is thought by some to be inappropriately low.

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Other congenital anomalies reported in infants exposed to diazepam include absence of both thumbs (two cases), spina bifida (one case), and absence of left forearm and syndactyly (one case) (30­32). Both low-dose (10,000 U/day) and high-dose heparin have been implicated, but the latter is more often related to this complication. Oligohydramnios, intrauterine growth restriction, and fetal death may be late effects of exposure to alternating current (3). The concentrations of clonazepam in the serum ranged from 51to 104 nmol/L (about 16­33 ng/mL), whereas those in the milk ranged from <10 to 34 nmol/L (about 3­11 ng/mL). The main active constituents are thymoquinone, dithymoquinone, thymohydroquinone, and thymol (1,2). Consistent with the molecular weight (about 327), clozapine crosses the placenta, at least at term. Increased postimplantation loss, decreased fetal weights, and decreased fetal ossification were noted, but these doses also produced maternal toxicity (reduced body weight gain and food consumption) and mortality. In addition, the molecular weight of amprenavir (about 506) is low enough that excretion into breast milk should be expected (see Amprenavir). The studies reported favorable control of glucose levels with relatively few patients requiring a change to insulin therapy. The drug types included in the study were gastric acid suppressors, including H2 blockers, prostaglandins, proton pump inhibitors, combinations for eradication of Helicobacter pylori, and drugs for peptic ulcer and gastroesophageal reflux disease. Although she had been told to take fluconazole 400 mg/day, nontherapeutic serum levels documented that the patient was not compliant with these instructions. Nevertheless, the milk concentrations are very low and there appeared to be no systemic absorption by the one infant that was breastfed. A major portion of this probably resulted from in utero exposure because the elimination half-life of clonazepam in neonates is thought to be prolonged. In rabbits, which are more sensitive to the effects of bumetanide than other test species, doses 3. They concluded, therefore, that ergotamine exposure during pregnancy, especially early in gestation, was highly likely, and that this drug and others used for the prevention or treatment of the disease were probably not teratogenic (12). At 20 months of age, he was nearly totally blind (probable optic atrophy) and developmentally slow. Except for respiratory distress due to prematurity and hyperkalemia that required treatment, the infant did well. It was used by the Native Americans before colonization of the continent and was a common medicine in the United States in the late 19th and early 20th centuries (6). The effect of maternal cardiac disease and digoxin administration on labour, fetal weight and maturity at birth. Both unfractionated and low-molecularweight heparin have been studied in pregnancy and probably are the preferred agents for prophylaxis against deep vein thrombus after surgery in a pregnant patient. In a surveillance study of Michigan Medicaid recipients involving 229,101 completed pregnancies conducted between 1985 and 1992, 395 newborns had been exposed to beclomethasone during the 1st trimester (F. However, in an infant exposed during the 4th­7th weeks of gestation to conjugated estrogens, multiple anomalies were found: cleft palate, micrognathia, wormian bones, heart defect, dislocated hips, absent tibiae, bowed fibulae, polydactyly, and abnormal dermal patterns (5). The infant expired at 36 hours of age secondary to cardiac tamponade induced by 7 mL of clear sterile transudate in the pericardial space. The studies found increased risks for some birth defects, but the absolute risk appeared to be small. A minimal relationship was found between congenital heart disease and doxylamine (Bendectin) use in early pregnancy in another 1985 report comparing 298 cases with 738 controls (18). In one study, significantly lower folate levels were measured in the blood of low-birth-weight neonates than in that of normal-weight infants (18). The control group (N = 10) received the same bolus and continuous infusion, but without the buprenorphine. No studies have been found, however, that evaluated its potential to interfere with the normal lactation process. However, continuous infusions of doxapram probably allows for placental passage to the embryo­fetus. The handling of cytotoxic agents by women who are pregnant, attempting to conceive, or breast feeding. Depending on the day of gestation that treatment started, the percentage of young with cleft palate ranged from 2. Moreover, until adequate human data are available, the safest course is to avoid the drug during organogenesis (20­55 days after conception or 34­ 69 days from the first day of the last menstrual period).

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Because of the risk of toxicity in a nursing infant, the safest course would be to hold nursing for 1­2 hours for each ounce of alcohol consumed, thereby allowing the alcohol level in milk to decrease. Between 1996 and 1998, 206 women contacted a teratogen information service regarding their exposure to echinacea products (primarily E. Fiocchi R, Lijnen P, Fagard R, Staessen J, Amery A, Van Assche F, Spitz B, Rademaker M. Clobazam, a benzodiazepine, is usually used in combination with other anticonvulsants. Although adverse effects have been suggested, a direct cause-and-effect relationship has not been proven. A 1990 case report suggested that structural kidney defects may be a consequence of enalapril therapy (13). The major malformations included cleft lip and/or palate, microphthalmia, anal atresia and hypospadias, cystic kidneys, esophageal atresia and kidney defects, limb reductions, diaphragmatic hernia, neural tube defects, pulmonary stenosis, and cardiac defects. She conceived again several months later and eventually delivered a healthy full-term, 3000-g female infant. The results showed that these agents do not increase the risk of major congenital defects, preterm delivery, low birth weight, and pregnancy-induced hypertension. Celecoxib was not mutagenic or clastogenic in Chinese hamster ovary cells or clastogenic in an in vivo micronucleus test in rat bone marrow. The manufacturer reports that fluvastatin is present in breast milk at a milk:plasma ratio of 2 (1). This exposure during pregnancy and lactation had no effect on the development and maturation of the immune system in offspring (2,3). Other studies have discovered that 60% of their patients with abruption were folate deficient, but their numbers were too small for statistical analysis (82). The molecular weight (about 306) is low enough that passage to the fetus should be expected. Fetal exposure after this time has been associated with teratogenicity and severe toxicity in the fetus and newborn, including death. In addition, high maternal serum levels may be obtained from close, frequent exposure to chemicals used in photographic developing. She had been amenorrheic prior to epoetin alfa therapy; her menses returned 17 months after start of treatment. No adverse effects were observed in the infants and all had normal Denver developmental quotients (31). The American Academy of Pediatrics classifies cefazolin as compatible with breastfeeding (9). A prospective cohort study evaluated a large group of pregnancies exposed to antidepressants in the 1st trimester to determine if there was an association with major malformations (53). Successful pregnancy after high dose chemotherapy and marrow transplantation for treatment of aplastic anemia. The use of corticosteroids, including dexamethasone, for the treatment of asthma during pregnancy has not been related to a significantly increased risk of maternal or fetal complications (28). In studies, both in vitro and in vivo, conducted in mice and rats, formoterol was a potent inhibitor of uterine contractions. A comparative study of the use of epoprostenol and dihydralazine in severe hypertension in pregnancy. Congenital defects have been reported in three infants delivered from one mother who was treated during pregnancy with 250­500 mg/day of chloroquine for discoid lupus erythematosus (15). The molecular weight (about 374) of the drug is low enough for placental transfer, but the clinical significance of this is unknown because the agent is rapidly hydrolyzed and undergoes enzymatic degradation in the plasma. The feeding difficulties had resolved by 48 hours of age and the other symptoms by 60 hours of age. However, cases of posttransplant lymphoproliferative disorder (a premalignant or malignant proliferation of B lymphocytes) have been reported in clinical trials. The antibiotic has not been associated with an increased risk of pyloric stenosis. Data from the Swedish health registries provided 3262 cases among 1,413,811 infants born in 1983­1996.