1. Blackburn, Susan PhD, RN,C, FAAN

Article Content

Drugs for Pregnant and Lactating Women, by C.P. Weiner and C. Buhimschi. New York: Churchill Livingstone; 2004. 1101 pages. Also available as CD-ROM PDA software.


Many women take prescribed and over-the-counter drugs during pregnancy or while breastfeeding. For many drugs there is scant information on use during pregnancy and lactation and FDA pregnancy categories are often confusing and limited in helping with prescribing decisions. This book presents information on over 729 generic drugs (approximately 1500 trade names). Both prescribed and over-the-counter drugs are included. Drugs are presented alphabetically by generic name. The text is available as text only, text plus CD-ROM PDA software, CD-ROM PDA software only, or as downloadable PDA software. The authors indicate that the electronic versions will be updated quarterly.


Information on each drug is divided into 10 sections: name, class, indications, mechanisms of action, dosage with qualifiers, maternal considerations, fetal considerations, breastfeeding safety, references, and summary. The name section lists both the generic name and trade names(s) of agents used in the United States. Both generic and trade names are listed in the index. In the index, trade names are in bold type making them easy to identify. Indications are the major indicator especially as it applies to the pregnant or lactating women. Dosage information includes contraindications and cautions as they apply to women of childbearing age. These include drug interactions and cautions in using the drug if the woman has another disorder other than that for which the agent is prescribed.


The most useful sections are the 3 summarizing maternal, fetal, and lactation considerations. These sections identify what is known and not known about use of the specific agent with the specified populations. For the majority of the agents there are few, if any, adequate reports or well-controlled studies. In the section on maternal consideration, maternal side effects are listed. If pregnancy-physiologic adaptations, such as changes in renal function, hepatic processing, or volume of distribution, are known to alter handling of the agent, these changes and effect on dosing are described. The sections on fetal considerations and breastfeeding safety indicate if the drug is known to cross the placenta or into breast milk. Selected references are provided for each drug.


The final summary section includes the FDA pregnancy category for the drug, a rating of safety in lactation (developed by the authors), whether the drug is not recommended for use in pregnancy and lactation, and alternative drugs within the same class that may be safer. One of the appendices contains a list of pregnancy registries for women with specific conditions (such as epilepsy, asthma, psychotic disorders, and rheumatoid arthritis) who are taking a variety of drugs, those for women taking a specific agent, and those for lactating women taking certain groups of medications.


This book is a comprehensive resource for clinicians working with pregnant and lactating women. The authors state that the purpose of their book is to provide an "[horizontal ellipsis] easy-to-use, reader friendly resource containing the key information required by caregivers to make prescribing decisions." They do so. The material presented on each drug is easy to access and read. A problem with any pharmacology text is the currency of the material. The authors indicate that they will be updating the content frequently, although this can be costly in print versions to purchase new texts. For the clinician the CD-ROM PDA software version may be more useful and cost-effective since free quarterly updates will be available.