Clinical and Pharmacological Principles of Safe Drug Use During Pregnancy and Breastfeeding

The article analyzes the clinical and pharmacological characteristics of medication use during pregnancy and breastfeeding. Physiological changes occurring in the maternal organism significantly affect drug absorption, distri­bution, metabolism, and elimination. Increased plasma volume, enhanced renal blood flow and glomerular filtration, and changes in hepatic enzyme activity may decrease or increase the blood concentrations of certain medications. The placenta is not an absolute barrier; therefore, many pharmacologically active substances can pass from maternal circulation into the fetal bloodstream. The fetal effects of a medication depend on the administered dose, duration of treatment, gestational age, molecular properties of the drug, and maternal metabolic status. During breastfeeding, particular attention should be paid to drug transfer into breast milk and the potential accumulation of medications in the infant’s body. The findings demonstrate the importance of an individualized assessment of the benefit to the mother and the potential risk to the fetus or infant. The lowest effective dose, appropriate medication selection, avoidance of unnecessary polypharmacy, and continuous maternal, fetal, and neonatal monitoring are essential com­ponents of safe pharmacotherapy.