Medication Safety in Pregnancy & Lactation

First-line analgesic and antipyretic in all trimesters of pregnancy. Extensive human cohort data demonstrate no significant increase in major congenital malformations at therapeutic doses (< 3-4 g/day).

First-line pharmacological agent for nausea and vomiting of pregnancy in Canada. Specifically approved by Health Canada for NVP with massive reproductive safety database.

Highly effective antiemetic reserved for refractory NVP or hyperemesis. Historical debate regarding oral cleft risk has been largely resolved by recent large cohort studies showing baseline absolute risk remains extremely low.

Contraindicated at >= 20 weeks gestation, and strictly contraindicated in the third trimester (>= 28 weeks). Compatible and preferred postpartum during lactation.

Preferred first-line SSRI in pregnancy and lactation. Untreated maternal depression and anxiety carry established risks (poor nutrition, cortisol dysregulation, preterm birth, postpartum depression).

First-line antihypertensive agent of choice throughout pregnancy. Reduces maternal cardiovascular complications without causing uterine hypoperfusion.

Standard of care for preeclampsia prophylaxis in women with moderate-to-high risk criteria. Begun between 12 and 16 weeks gestation, taken nightly at bedtime, continued until 36-37 weeks.

Safe and widely used antibiotic class in all trimesters. Penetrates bacterial cell wall without human teratogenicity.

First-line oral antihypertensive for urgent blood pressure control and maintenance in pregnancy. Extensive registry data confirm no teratogenicity.

Longest pediatric safety track record of any obstetric antihypertensive with child neurodevelopmental follow-up to age 7. Mild potency and maternal sedation/depression are limiting factors.

Drug of choice for prevention and treatment of eclamptic seizures (superior to phenytoin and diazepam). Significantly reduces cerebral palsy risk in infants born before 32 weeks.

Parenteral vasodilator for rapid reduction of acute dangerous hypertensive crisis in labour & delivery triage. Administer 5-10mg IV push slowly q20-30min (max 20mg).

Gold standard first-line uterotonic for both prevention and treatment of postpartum hemorrhage. Stimulates rhythmic myometrial contractions.

Potent uterotonic and cervical priming agent. Heat-stable, making it vital for resource-constrained settings. First-trimester exposure causes Mobius syndrome and terminal transverse limb defects.

Parenteral second-line uterotonic administered 250 mcg IM or intramyometrially q15-90min (max 8 doses). High efficacy in refractory uterine atony. Causes intense bronchoconstriction—STRICTLY CONTRAINDICATED IN ASTHMA.

Produces sustained, tetanic uterine smooth muscle contraction and peripheral arterial vasoconstriction. Administer 0.2mg IM. STRICTLY CONTRAINDICATED IN HYPERTENSION, PREECLAMPSIA, AND CORONARY ARTERY DISEASE.

Readily crosses placenta due to poor inactivation by 11-beta-HSD2. Stimulates type II pneumocyte synthesis of pulmonary surfactant. Administer 12mg IM q24h for 2 doses.

Anticoagulant of choice in pregnancy. High molecular weight prevents placental crossing; completely safe for fetus. Negligible risk of heparin-induced thrombocytopenia (HIT) compared to unfractionated heparin.

Gold standard pharmacological treatment for maternal hyperglycemia. Does not cross the placenta in clinically significant amounts, while effectively eliminating fetal hyperinsulinemia, macrosomia, and neonatal hypoglycemia.

Crosses the placenta freely with umbilical cord levels equal to maternal circulation. Extensive RCT data show no increase in congenital anomalies, though long-term child adiposity follow-up studies suggest slightly higher BMI at age 9 compared to insulin offspring.

First-line pharmacotherapy for Intrahepatic Cholestasis of Pregnancy. Displaces hydrophobic hepatotoxic bile acids, enhances biliary clearance, and relieves pruritus in 60-70% of patients. Dose: 10-15 mg/kg/day divided BID or TID.

Bactericidal beta-lactam covering methicillin-susceptible staphylococci and streptococci. Dose: 2g IV (3g if weight > 120 kg) administered 15-60 min prior to surgical incision.

Broad-spectrum aminopenicillin with excellent transplacental penetration into amniotic fluid. First-line for maternal Listeria bacteremia and neonatal early-onset sepsis empiric coverage.

Bactericidal against gram-negative aerobes (E. coli, Klebsiella). Once-daily dosing (4.5-5 mg/kg IV q24h) achieves superior peak bactericidal action with low maternal-fetal nephrotoxicity.

Broad-spectrum parenteral cephalosporin with once-daily dosing (1-2g IV/IM). Highly effective for acute maternal pyelonephritis. Caution in hyperbilirubinemic neonates as it displaces bilirubin from albumin.

Synthetic lysine analogue that competitively inhibits plasminogen activation. The landmark WOMAN Trial (Lancet 2017) demonstrated a 31% reduction in maternal death from bleeding when given within 3 hours of birth. Dose: 1g IV over 10 min, repeatable once after 30 min if bleeding continues.

First-line oral agent for lower urinary tract infections in pregnancy with concentrated urine excretion and negligible systemic absorption. Avoid in term labour (>=37w) and G6PD deficiency due to theoretical neonatal hemolysis risk.