妊娠期常用药物对胎儿的影响与风险防控

Effects and the risk prevention and control of drugs commonly used in pregnancy on fetus

妊娠期用药对胎儿利弊并存.妊娠期常用药物包括：（1）血液和造血系统药物,以叶酸和铁剂为主,妊娠早期应用叶酸可减少胎儿神经管畸形及多种风险,但也可能影响胎儿骨骼形成.补充铁剂可有效降低母体贫血、新生儿低出生体重和早产风险.（2）消化和代谢系统药物,包括止吐药,抗酸药,镁、钙等矿物质,胰岛素和降糖药.维生素B6、H 1受体拮抗剂、三甲氧苯酰胺和甲氧氯普胺具有安全的止吐作用,但吩噻嗪类对胎儿具有致畸风险.（3）全身用抗感染药物,除临床多用的青霉素G、氨苄西林、哌拉西林、美洛西林外,还有难以通过胎盘屏障的大环内酯类,如罗红霉素、红霉素、阿奇霉素,应慎用对胎儿有毒性的克拉霉素和螺旋霉素.（4）皮肤病用药,应首选局部用药,包括炉甘石洗剂、抗真菌药、抗生素软膏和皮质类固醇软膏,对胎儿影响较小.妊娠期用药风险防控措施包括孕期安全用药教育、加强医务人员与妊娠期患者的沟通、为孕妇提供安全用药咨询和个体化用药建议.

Medication treatment during pregnancy has both pros and cons on the fetus. The drugs commonly used in pregnancy include：（1）Blood and hematopoietic system drugs,which are folic acid and iron-containing drugs mainly. Folic acid can reduce fetal neural tube deformity and multiple risks in early pregnancy,but it may also affect fetal bone formation. Iron supplement can effectively reduce the risk of maternal anemia,low birth weight and premature birth. （2）Digestive and metabolic system agents,which include antemetic,antacids,magnesium,calcium and other minerals,insulin and antidiabetic drugs. Vitamin B6 ,H 1-receptor antagonists,trimethobenzamide and metoclopramide are safe and effective on morning sickness,but phenothiazine has the risk of teratogenic effects on fetus. （3）Systemic anti-infection agents, which include penicillin G,ampicillin,piperacillin,mezlocillin etc. Roxithromycin,erythromycin and azithromycin are commonly used because the macrolides are difficult to cross the placental barrier. Clarithromycin and spiramycin should be used with caution because of the toxicity to the fetus. （4）Skin disease agents are mainly for local application,including calamine lotion,antifungal agents,antibiotic ointment and corticosteroid ointment,which have less effect on the fetus. The measures for risk prevention in pregnancy drugs use include improving education on safe medication during pregnancy,strengthening the communication between the pregnant women and the medical staff,providing the counseling of safe medication and the individual administration.