New Vision (Kampala)

22 January 2013

Uganda: Pregnancy Caution - Why You Need to Go Slow On Medication

When Shakira went for a check-up, the doctor told her the baby was fine and she was due anytime. But days later, she could not feel the foetus move. An ultra sound scan revealed the foetus had died.

She wondered what could have caused the death, as a postmortem had not been done. However, her doctor suspected it could have resulted from the medication she constantly took during the pregnancy to curb headaches. But this is just an assumption.

According to Dr. Evelyn Nabunya, a gynaecologist at Mulago Hospital, some medications should be avoided during pregnancy as they can enter the baby's bloodstream.

"Medicine particles are small enough to cross the placental barrier the way nutrients a baby needs for development cross. However, the effect any medicine has on the developing baby depends on the medicine and the period during which the medicine is taken in.

So, should women endure the pain and discomfort that may come with pregnancy for the safety of their babies?

Dr. Robert Busingye, a gynaecologist at Nakasero Hospital, explains that some medicines can be dangerous during the first three months (trimester) of pregnancy, but may be safe in the second or third trimesters.

The first trimester is the period of greatest risk for the baby because during this stage, the baby's organs are developing. Therefore, medicines taken during this time can affect a baby's development and may result in congenital (birth) defects.

Some medicine can also cause a miscarriage.

During the second trimester, the medicine may interfere with the growth of a baby, resulting in a low birth weight, he says.

"The second trimester is the safest period in which to take medication. Medicine taken in the final three months of pregnancy may cause complications such as breathing difficulty after the baby has been born.

This is because the medicine remains in the baby's body after birth and the newborn may not be able to cope with the medicine in the bloodstream the way his mother would.

Nabunya says pregnant women are usually given food supplements such as folic acid and iron to help increase blood supply and improve cell formation for the baby.

Pregnant women are likely to suffer from malaria, given that their immunity is compromised. So they would need anti-malarials. However, according to the malaria drug policy in Uganda, artemisinin-combination therapies, the usually recommended malaria therapy, is not given to pregnant women because it may affect the unborn bab's health.

Instead, Sulfadoxine/Pyrimethamine is given, says Dr. Albert Okui, the national programme manager of the Malaria National Control Programme at the health ministry.

The current policy states that all pregnant women, even if they do not have signs of malaria, should take three tablets of Sulfadoxine-Pyramethamine once between four and six months of pregnancy and three tablets between seven and nine months.

However, when malaria is severe, the parenteral quinine is given. After the first trimester, artemisinin-combination therapies like Coartem may be given. To avoid getting the wrong drugs, women are advised not to buy drugs over-the-counter because they can pose health hazards.

According to Dr. Wilberforce Kabweru of Naguru Hospital, nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and aspirin can also cause serious blood flow problems in the baby if used during the last three months of pregnancy (after 28 weeks). Aspirin is said to increase risks of bleeding in the unborn child and mother, such as at birth.

Septrin, an antibiotic, is not used in the first three months of pregnancy because of the risk it may pose to the foetus. It can, however, be used after the first trimester, though it should be avoided in the third trimester because it may cause the red blood cells of the foetus to break down.

"Though pregnant women are not advised to take some medications, especially if not prescribed by a health specialist, some conditions can only be treated with medicine, or a mother risks harming the unborn child," Kabweru adds.

For example, if not treated, a urinary tract infection may affect the kidneys, resulting in preterm labour and low birth weight. One therefore, needs antibiotics to cure the infection.

Way forward

It is important to consult a doctor before taking any medication and whether the benefits outweigh the risks.

Pregnant women living with HIV are given ARVs to prevent transmission of the virus to their unborn babies.

According to Dr. Stephen Watiti of Mild May Uganda, some ARVs like Efavirenz can cause congenital malformations, yet an HIV+ pregnant woman must take ARVs.

Likewise, if a diabetic woman does not use her medicine during pregnancy, she raises the risks of a miscarriage, stillbirth, and birth defects.

If asthma and high blood pressure are not controlled during pregnancy, problems with the foetus may occur.

In addition to supplements, The Sexual and Reproductive Health Policy Guidelines for Uganda recommends drugs for intestinal parasites and two tetanus toxoid vaccines as essential drugs during pregnancy.

Pregnant women are also given vaccination shots to protect them from dangerous diseases.

"Some diseases like headaches or flu can be prevented and cured by drinking plenty of fluids, eating a balanced diet and exercising," Kabweru says.

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