Uso de fármacos durante el embarazo

José Sandoval Paredes, Cindy Sandoval Paz

Resumen


La información sobre seguridad de fármacos en la gestación es abundante, pero existe poca evidencia científica, por
razones éticas muy pocos ensayos clínicos se han realizado y publicado. Todo esto ha traído como consecuencia que se
sobredimensione el peligro de los fármacos en el embarazo, limitando su uso razonable en enfermedades crónicas de
gestantes, y, en el otro extremo, que se prescriba la medicación libremente desconociendo el verdadero riesgo que
implica administrarlos en el momento y en la dosis inadecuada.
La presente revisión describe la manera en que los cambios fisiológicos en el embarazo modifican considerablemente la
farmacocinética de la medicación. Se evalúa el verdadero riesgo potencial de teratogénesis de los fármacos, los criterios
específicos para considerarlos como factor etiológico. Se comenta la clasificación de la Administración de Alimentos
y Medicamentos estadounidense (FDA, por sus siglas en inglés), los criterios de su clasificación, sus limitaciones, su
limitada vigencia actual y la propuesta de nuevas reglas para etiquetar los fármacos en donde considera evaluación
clínica, exposición inadvertida y riesgo disponible.
Se realiza la descripción de los riesgos de la medicación de más frecuente uso en las patologías más comunes en el
embarazo. Se comenta la correcta manera de informar a la paciente expuesta a supuestos teratógenos, con la finalidad
de no afectar la percepción del riesgo.
Hay que considerar que los fármacos prescritos con mayor frecuencia se pueden administrar con relativa seguridad durante
el embarazo, indicando los que sean estrictamente necesarios, restringiéndolos en el primer trimestre, prefiriendo los
de seguridad comprobada, utilizando la menor dosis eficaz durante el menor tiempo posible, evitando utilizar varios
fármacos y vigilando sus efectos colaterales y complicaciones.


Palabras clave


Embarazo; fármacos; teratógenos; categoría de riesgo

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Referencias


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