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Drugs in Pregnancy and Lactation, Sixth Edition
Book Reviews
anatomy course. Its format appears to rely on the user’s having at least a modicum of knowledge about the material being summarized. Therefore, it can also serve as a quick clinical refresher for junior physicians and generalists. doi:10.1016/S1083-3188(03)00003-2
Drugs in Pregnancy and Lactation, Sixth Edition. Gerald G. Briggs, Roger K. Freeman, & Sumner J. Yaffe. ISBN 0-7817-3203-4, Lippincott Williams & Wilkins, Philadelphia, 2002, 1595 pp. Reviewed by Rebecca Collins, MD, Department of Pediatrics, University of Kentucky Medical Center, Lexington, Kentucky, USA.
Any health care professional who deals with children or women in the childbearing ages (physicians, genetic counselors, pharmacists, and nurses) will likely possess a previous edition of this book. It is one of the bestknown books regarding current knowledge of drugs in pregnancy and lactation. The fact that it is in its sixth edition verifies this. As so clearly pointed out in the introduction of the book, studies conducted in recent years indicate that drug consumption during pregnancy is increasing. A recent World Health Organization (WHO) international study involving 14,778 pregnant women from 22 countries revealed 86% of these women took medications during pregnancy. They received an average of 2.9 prescriptions. This was surpassed during the intrapartum period, where 79% of women received an average of 3.3 drugs. Also we know the rates of breastfeeding have more than doubled in the last 30 years in the United States. Knowing this information makes it imperative that health professionals be knowledgeable and have access to accurate and complete information regarding effects of maternal drugs on the developing fetus and nursing infant. We must remember that the decision to administer a drug should be made only after a collaborative decision between the woman and her physician of the risk-benefit ratio. This reference book reviews over 900 drugs, including prescription drugs, some herbal drugs, and drugs of abuse. The book is divided into five sections: Introduction, Instructions, Reference Guide, Appendix, and Index. The introduction is a thorough review of the history of what is currently known about drugs during pregnancy and nursing. Examples such as DES and thalidomide and the difficult lessons learned are included. The limitations of current knowledge on the direct effects of drugs on fetuses and why there are limitations is also
121
stressed. The unknown, more subtle long-term effects of drugs during lactation, such as alterations in behavioral changes that occur years after drug exposure, are pointed out. As physicians, it would seem to be the “safest thing” to say that all pregnant women should not take any medications, and all nursing women should wean their infants if medications are required. But we know this is not practical and not even safe in some situations during pregnancy. One might propose that weaning a suckling infant would be safer than risking medicating a nursing mother (and, therefore, baby), but that means we would be condoning substituting breast milk with formula, and with all the advantages of breast milk that have been discovered, we again may be doing more harm than good. The next section includes instructions for use of the Reference Guide. Each monograph contains six parts—generic name, pharmacological class, risk factors, fetal risk summary, breastfeeding summary, and references. A letter is assigned to each drug, which designates the risk level (A,B,C,D,X) that has been assigned by the manufacturer and by the authors. If there is a discrepancy, this is noted. Also included is whether the American Academy of Pediatrics considers a drug to be compatible with nursing. The main section has references to over 900 drugs. As I reviewed a number of these, I found the book very “user friendly.” It takes seconds to find the drug alphabetically by the American generic name. All trade and foreign names have been included in the index. There is also an appendix that classifies drugs by pharmacological categories (antihistamines, anti-infectives, etc.) By each drug, the risk factor is noted in bold print, so if locating that information is all that is required, it can be done quickly. If more in-depth evidence is desired, the monographs are very thorough in their review of the literature. Zoloft (sertraline), for example, includes the results of 11 studies of use during pregnancy and 7 during lactation. The results are summarized by the authors. This book, in comparison to other reference books on this matter, seems to be more thorough regarding references. In summary, for any health professional who deals with women of childbearing age or children, a thorough and complete reference book on drugs in pregnancy and lactation is a requirement. The advantages of this book are the ease in which it can be used as a reference tool and its thoroughness. At a time when more and more drugs are being used during pregnancy, and breastfeeding rates are increasing in initiation and duration, we must offer the most up-to-date knowledge to our patients. doi:10.1016/S1083-3188(03)00002-0
anatomy course. Its format appears to rely on the user’s having at least a modicum of knowledge about the material being summarized. Therefore, it can also serve as a quick clinical refresher for junior physicians and generalists. doi:10.1016/S1083-3188(03)00003-2
Drugs in Pregnancy and Lactation, Sixth Edition. Gerald G. Briggs, Roger K. Freeman, & Sumner J. Yaffe. ISBN 0-7817-3203-4, Lippincott Williams & Wilkins, Philadelphia, 2002, 1595 pp. Reviewed by Rebecca Collins, MD, Department of Pediatrics, University of Kentucky Medical Center, Lexington, Kentucky, USA.
Any health care professional who deals with children or women in the childbearing ages (physicians, genetic counselors, pharmacists, and nurses) will likely possess a previous edition of this book. It is one of the bestknown books regarding current knowledge of drugs in pregnancy and lactation. The fact that it is in its sixth edition verifies this. As so clearly pointed out in the introduction of the book, studies conducted in recent years indicate that drug consumption during pregnancy is increasing. A recent World Health Organization (WHO) international study involving 14,778 pregnant women from 22 countries revealed 86% of these women took medications during pregnancy. They received an average of 2.9 prescriptions. This was surpassed during the intrapartum period, where 79% of women received an average of 3.3 drugs. Also we know the rates of breastfeeding have more than doubled in the last 30 years in the United States. Knowing this information makes it imperative that health professionals be knowledgeable and have access to accurate and complete information regarding effects of maternal drugs on the developing fetus and nursing infant. We must remember that the decision to administer a drug should be made only after a collaborative decision between the woman and her physician of the risk-benefit ratio. This reference book reviews over 900 drugs, including prescription drugs, some herbal drugs, and drugs of abuse. The book is divided into five sections: Introduction, Instructions, Reference Guide, Appendix, and Index. The introduction is a thorough review of the history of what is currently known about drugs during pregnancy and nursing. Examples such as DES and thalidomide and the difficult lessons learned are included. The limitations of current knowledge on the direct effects of drugs on fetuses and why there are limitations is also
121
stressed. The unknown, more subtle long-term effects of drugs during lactation, such as alterations in behavioral changes that occur years after drug exposure, are pointed out. As physicians, it would seem to be the “safest thing” to say that all pregnant women should not take any medications, and all nursing women should wean their infants if medications are required. But we know this is not practical and not even safe in some situations during pregnancy. One might propose that weaning a suckling infant would be safer than risking medicating a nursing mother (and, therefore, baby), but that means we would be condoning substituting breast milk with formula, and with all the advantages of breast milk that have been discovered, we again may be doing more harm than good. The next section includes instructions for use of the Reference Guide. Each monograph contains six parts—generic name, pharmacological class, risk factors, fetal risk summary, breastfeeding summary, and references. A letter is assigned to each drug, which designates the risk level (A,B,C,D,X) that has been assigned by the manufacturer and by the authors. If there is a discrepancy, this is noted. Also included is whether the American Academy of Pediatrics considers a drug to be compatible with nursing. The main section has references to over 900 drugs. As I reviewed a number of these, I found the book very “user friendly.” It takes seconds to find the drug alphabetically by the American generic name. All trade and foreign names have been included in the index. There is also an appendix that classifies drugs by pharmacological categories (antihistamines, anti-infectives, etc.) By each drug, the risk factor is noted in bold print, so if locating that information is all that is required, it can be done quickly. If more in-depth evidence is desired, the monographs are very thorough in their review of the literature. Zoloft (sertraline), for example, includes the results of 11 studies of use during pregnancy and 7 during lactation. The results are summarized by the authors. This book, in comparison to other reference books on this matter, seems to be more thorough regarding references. In summary, for any health professional who deals with women of childbearing age or children, a thorough and complete reference book on drugs in pregnancy and lactation is a requirement. The advantages of this book are the ease in which it can be used as a reference tool and its thoroughness. At a time when more and more drugs are being used during pregnancy, and breastfeeding rates are increasing in initiation and duration, we must offer the most up-to-date knowledge to our patients. doi:10.1016/S1083-3188(03)00002-0