Cover

Drugs During Pregnancy and Lactation

Copyright

Contents

List of Contributors

Preface

Disclaimer

1 - General commentary on drug therapy and drug risks in ­pregnancy

1.1 Introduction

1.2 Development and health

1.3 Reproductive stages

1.4 Reproductive and developmental toxicology

1.5 Basic principles of drug-induced reproductive and developmental toxicology

1.6 Effects and manifestations

1.7 Pharmacokinetics of drugs in pregnancy

1.8 Mechanisms of developmental toxic agents

1.9 Causes of developmental disorders

1.10 Embryo/fetotoxic risk assessment and plausibility

1.11 Classification of drugs used in pregnancy

1.12 Paternal use of medicinal products

1.13 Communicating the risk of drug use in pregnancy

1.14 Risk communication prior to pharmacotherapeutic choice

1.15 Risk communication regarding the safety of drugs already used in pregnancy

1.16 Teratology information centers

References

2 - Specific drug therapies during pregnancy

2.1 - Analgesics, non-steroidal anti-­inflammatory drugs (NSAIDs), muscle relaxants, and antigout medications

2.1.1 Paracetamol (acetaminophen)

2.1.2 Acetylsalicylic acid

2.1.3 Pyrazolone compounds and phenylbutazone

2.1.4 Analgesic drug combination products and drugs used for osteoarthritis

2.1.5 Opioid agonists and antagonists and other centrally acting analgesics

2.1.6 Non-steroidal anti-inflammatory and antirheumatic drugs

2.1.7 Migraine therapy

2.1.8 Muscle relaxants and other analgesics

2.1.9 Antigout preparations

References

2.2 - Allergy and hyposensitization therapy

2.2.1 Antihistamines (H1-blocker)

2.2.2 Hyposensitization therapy

2.2.3 C1-Esterase inhibitor deficiency

References

2.3 - Antiasthmatic and cough ­medication

2.3.1 Selective β2-adrenergic agonists

2.3.2 Inhaled corticosteroids (ICSs)

2.3.3 Theophylline

2.3.4 Leukotriene antagonists

2.3.5 Mast cell stabilizers (inhibitors)

2.3.6 Anticholinergics

2.3.7 Omalizumab and roflumilast

2.3.8 Expectorants and mucolytic agents

2.3.9 Antitussives

2.3.10 Non-selective β-adrenergic agonists

References

2.4 - Nausea and vomiting in pregnancy

2.4.1 Treatment options

2.4.2 Complementary treatment options

2.4.3 Pharmacological treatment options

2.4.4 Dopamine antagonists

2.4.5 Pyridoxine (vitamin B6)

2.4.6 Vitamin B1

2.4.7 Serotonin antagonists

2.4.8 Glucocorticoids

2.4.9 Other antiemetics

Summary

References

2.5 - Gastro-intestinal medications, hypolipidemic agents and ­spasmolytics

2.5.1 Antacids

2.5.2 Sucralfate and pirenzepine

2.5.3 H2 receptor antagonists

2.5.4 Proton pump inhibitors

2.5.5 Bismuth salts

2.5.6 Helicobacter pylori therapy

2.5.7 Digestives and carminatives

2.5.8 Atropine and other anticholinergic spasmolytics

2.5.9 Cholinergics

2.5.10 Constipation during pregnancy

2.5.11 Antidiarrheal agents

2.5.12 Medications for inflammatory bowel disease

2.5.13 Chenodeoxycholic acid and ursodeoxycholic acid

2.5.14 Lipid lowering agents

2.5.15 Appetite suppressants, weight loss medications, and obesity

References

2.6 - Anti-infective Agents

2.6.1 Penicillins and β-lactamase inhibitors

2.6.2 Cephalosporins

2.6.3 Carbapenems and monobactams

2.6.4 Erythromycin and other macrolides

2.6.5 Clindamycin and lincomycin

2.6.6 Tetracyclines

2.6.7 Sulfonamides and trimethoprim

2.6.8 Quinolones

2.6.9 Nitrofurans and drugs for urinary tract infections

2.6.10 Nitroimidazole antibiotics

2.6.11 Aminoglycosides

2.6.12 Glycopeptide and polypeptide antibiotics

2.6.13 Other antibiotics

2.6.14 Tuberculosis and pregnancy

2.6.15 Local antibiotics

2.6.16 Malaria prophylaxis and treatment in pregnancy

2.6.17 Azole antifungals

2.6.18 Amphotericin B

2.6.19 Echinocandins

2.6.20 Flucytosine

2.6.21 Griseofulvin

2.6.22 Terbinafine

2.6.23 Topical antifungal agents

2.6.24 Anthelmintics

2.6.25 Herpes medications

2.6.26 Antiviral drugs for hepatitis

2.6.27 Antiviral drugs for influenza

2.6.28 Antiretroviral agents

2.6.29 Overview of the antiretroviral medications

2.6.30 Nucleoside and nucleotide reverse transcriptase inhibitors (NRTIs)

2.6.31 Non-nucleoside reverse transcriptase inhibitors (NNRTIs)

2.6.32 Protease inhibitors (PIs)

2.6.33 Entry inhibitors

2.6.34 Integrase inhibitors

2.6.35 Hyperthermia

2.6.36 Long-distance travel and flights

References

2.7 - Vaccines and immunoglobulins

2.7.1 Thiomersal as a preservative for vaccines

2.7.2 Cholera vaccination

2.7.3 Diphtheria and tetanus vaccination

2.7.4 Haemophilus influenza B (HIB) vaccination

2.7.5 Hepatitis A and hepatitis B vaccination

2.7.6 HPV vaccination

2.7.7 Influenza vaccination

2.7.8 Measles and mumps vaccination

2.7.9 Meningococcal vaccination

2.7.10 Pertussis vaccination

2.7.11 Pneumococcal vaccination

2.7.12 Poliomyelitis vaccination

2.7.13 Rabies vaccination

2.7.14 Rubella vaccination

2.7.15 Tick-borne encephalitis vaccination

2.7.16 Typhoid vaccination

2.7.17 Varicella vaccination

2.7.18 Yellow fever vaccination

2.7.19 Immunoglobulins

References

2.8 - Heart and blood medications

2.8.1 Arterial hypertension and pregnancy

2.8.2 α-Methyldopa

2.8.3 β-Receptor blockers

2.8.4 Calcium channel blockers

2.8.5 ACE inhibitors

2.8.6 Angiotensin II receptor blockers (ARBs; Sartans)

2.8.7 Dihydralazine

2.8.8 α-1 Blockers (peripherally acting adrenergic antagonists)

2.8.9 α-2 Blockers (centrally acting adrenergic antagonists)

2.8.10 Other antihypertensive medications

2.8.11 Pulmonary hypertension and pregnancy

2.8.12 Hypotension and antihypotensive drugs

2.8.13 Adrenergic agents

2.8.14 Cardiac glycosides

2.8.15 Antiarrhythmic medications

2.8.16 Coronary therapeutic drugs (cardiac vasodilators)

2.8.17 Vasocirculatory drugs and peripheral vasodilators

2.8.18 Diuretics

References

2.9 - Anticoagulants, thrombocyte aggregation inhibitors, fibrinolytics and volume replacement agents

2.9.1 Indications for anticoagulation

2.9.2 Heparins and danaparoid

2.9.3 Protamines

2.9.5 Factor Xa inhibitors

2.9.6 Inhibitors of thrombocyte aggregation

2.9.7 Vitamin K antagonists

2.9.8 Vitamin K

2.9.9 Fibrinolysis

2.9.10 Streptokinase

2.9.11 Antihemorrhagics

2.9.12 Other antihemorrhagics

2.9.13 Volume replacement substances and rheologics

References

2.10 - Epilepsy and antiepileptic medications

2.10.1 Antiepileptic therapy

2.10.2 Antiepileptic and contraceptive drugs

2.10.3 Epilepsy and fertility

2.10.4 Frequency of seizures in pregnancy

2.10.5 Risk of malformations

2.10.6 Typical malformations and other anomalies

2.10.7 Pregnancy complications

2.10.8 Mental development dysfunction

2.10.9 “Damage mechanisms”

2.10.10 Folic acid and antiepileptic drugs

2.10.11 Vitamin K and antiepileptic drugs

2.10.12 Is epilepsy teratogenic?

2.10.13 Carbamazepine

2.10.14 Clobazam and clonazepam

2.10.15 Eslicarbazepine

2.10.16 Ethosuximide and other succinimides

2.10.17 Felbamate

2.10.18 Gabapentin

2.10.19 Lacosamide

2.10.20 Lamotrigine

2.10.21 Levetiracetam

2.10.22 Oxcarbazepine

2.10.23 Phenobarbital and primidone

2.10.24 Phenytoin

2.10.25 Pregabalin

2.10.26 Rufinamide

2.10.27 Sultiame

2.10.28 Tiagabine

2.10.29 Topiramate

2.10.30 Valnoctamide

2.10.31 Valproic acid

2.10.32 Vigabatrin

2.10.33 Zonisamide

References

2.11 - Psychotropic drugs

2.11.1 Psychiatric disorder during pregnancy

2.11.2 Antidepressant treatment

2.11.3 Selective serotonin-reuptake-inhibitors (SSRI)

2.11.4 Tri- and tetracyclic antidepressants

2.11.5 Individual antidepressants

2.11.6 Antipsychotic treatment

2.11.7 Individual antipsychotic drugs

2.11.8 Lithium and other anti-manic agents

2.11.9 Anxiolytics, hypnotics, sedatives in general

2.11.10 Benzodiazepines

2.11.11 Zaleplon, zolpidem and zopiclone

2.11.12 Other anxiolytics and hypnotics

2.11.13 Psychoanaleptics

2.11.14 Anti-Parkinson drugs and restless legs syndrome

References

2.12 - Immunosuppression, rheumatic diseases, multiple ­sclerosis, and Wilson’s disease

2.12.1 Azathioprine/6-mercaptopurine

2.12.2 Selective immunosuppressants

2.12.3 Biologics

2.12.4 Multiple sclerosis

2.12.5 Interferons

2.12.6 Other immunostimulatory drugs

2.12.7 Transplantation

2.12.8 Drugs for rheumatic diseases

2.12.9 Drugs for Wilson’s disease

References

2.13 - Antineoplastic drugs

2.13.1 Malignancy and pregnancy

2.13.2 Breast cancer

2.13.3 Vinca alkaloids and analogs

2.13.4 Podophyllotoxin derivatives

2.13.5 Nitrosourea alkylators

2.13.6 Nitrogen mustard analog alkylators

2.13.7 Other alkylating agents

2.13.8 Cytotoxic anthracycline antibiotics

2.13.9 Other cytotoxic antibiotics

2.13.10 Folate antagonists

2.13.11 Purine antagonists

2.13.12 Pyrimidine antagonists

2.13.13 Taxanes and other cytostatic agents

2.13.14 Monoclonal antibodies

2.13.15 Platin compounds

2.13.16 Thalidomide and its analogs

2.13.17 Tyrosine kinase inhibitors

2.13.18 Antineoplastic drugs with endocrine effects

2.13.19 Other antineoplastic agents

References

2.14 - Uterine contraction agents, tocolytics, vaginal therapeutics and local contraceptives

2.14.1 Prostaglandins

2.14.2 Oxytocin

2.14.3 Ergot alkaloids

2.14.4 Tocolytics in general

2.14.5 β2-Sympathomimetics

2.14.6 Calcium antagonists

2.14.7 Magnesium sulfate

2.14.8 Oxytocin receptor antagonists

2.14.9 Prostaglandin antagonists

2.14.10 Other tocolytics

2.14.11 Vaginal therapeutics

2.14.12 Spermicide contraceptives

2.14.13 Intrauterine devices

References

2.15 - Hormones

2.15.1 Hypothalamic releasing hormones

2.15.2 Anterior pituitary hormones

2.15.3 Prolactin antagonists/dopamine agonists

2.15.4 Posterior pituitary hormones

2.15.5 Thyroid function and iodine supply during pregnancy

2.15.6 Hypothyroidism, triiodothyronine (T3) and thyroxin (T4)

2.15.7 Hyperthyroidism and thyrostatics

2.15.8 Glucocorticoids

2.15.9 Diabetes mellitus and pregnancy

2.15.10 Insulin

2.15.11 Oral antidiabetics (OAD)

2.15.12 Estrogens

2.15.13 Gestagens

2.15.14 Duogynon®

2.15.15 Diethylstilbestrol

2.15.16 Androgens and anabolics

2.15.17 Cyproterone and danazol

2.15.18 Mifepristone (RU486)

2.15.19 Clomiphene

2.15.20 Erythropoietin

References

2.16 - General and local anesthetics and muscle relaxants

2.16.1 Halogenated inhalational anesthetic agents

2.16.2 Ether (diethyl ether)

2.16.3 Nitrous oxide

2.16.4 Xenon

2.16.5 Occupational exposure to anesthetic gases

2.16.6 Injection anesthetics

2.16.7 Local anesthetics

2.16.8 Muscle relaxants

References

2.17 - Dermatological medications and local therapeutics

2.17.1 Typical skin changes during pregnancy

2.17.2 Antiseptics and disinfectants

2.17.3 Glucocorticoids and non-steroid antiphlogistics

2.17.4 Astringents

2.17.5 Antipruritics and essential oils

2.17.6 Coal tar and slate oil preparations

2.17.7 Local immunomodulators as therapy for atopic eczema

2.17.8 Keratolytics

2.17.9 Retinoids for acne and psoriasis therapy

2.17.10 Ultraviolet light

2.17.11 Fumaric acid preparations

2.17.12 Biologicals

2.17.13 Wart therapeutics

2.17.14 Lithium

2.17.15 Lice medications

2.17.16 Anti-scabies

2.17.17 Vein therapeutics

2.17.18 Antihidrotica

2.17.19 Eflornithine, finasteride and minoxidil

2.17.20 Repellents

2.17.21 Cosmetics

2.17.22 Eye, nose and ear drops

2.17.23 Hemorrhoid medications

2.17.24 Vaginal therapeutics

References

2.18 - Vitamins, minerals and trace elements

2.18.1 Vitamin A (retinol)

2.18.2 Vitamin B1 (thiamine)

2.18.3 Vitamin B2 (riboflavin)

2.18.4 Vitamin B3 (nicotinamide)

2.18.5 Vitamin B6 (pyridoxine)

2.18.6 Vitamin B12 (cyanocobalamin)

2.18.7 Vitamin C (ascorbic acid)

2.18.8 Folic acid

2.18.9 Vitamin D group

2.18.10 Vitamin E (tocopherol)

2.18.11 Vitamin K

2.18.12 Multivitamin preparations

2.18.13 Iron

2.18.14 Calcium

2.18.15 Fluoride

2.18.16 Strontium

2.18.17 Biphosphonates and other osteoporosis drugs

2.18.18 Iodide

2.18.19 Trace elements

References

2.19 - Herbs during pregnancy

2.19.1 The safety of herbs during pregnancy

2.19.2 Counseling a pregnant woman about herbs

2.19.3 General concepts regarding the use of herbs during pregnancy

2.19.4 Herbs used as foods

2.19.5 Essential oils that are safe during pregnancy

2.19.6 Herbs frequently used during pregnancy

2.19.7 Herbs controversially used during pregnancy

2.19.8 Herbs contraindicated during pregnancy

References

2.20 - Diagnostic agents

2.20.1 Diagnostic imaging

2.20.2 Contrast media

2.20.3 Radioactive isotopes

2.20.4 Stable isotopes

2.20.5 Dyes

2.20.6 Other diagnostic agents

References

2.21 - Recreational drugs

Introduction

2.21.1 Alcohol

2.21.2 Caffeine and other xanthines

2.21.3 Tobacco and smoking

2.21.4 Drugs of abuse in general (excluding caffeine)

2.21.5 Sedating drugs

References

2.22 - Poisonings and toxins

2.22.1 The general risk of poisoning in pregnancy

2.22.2 Treatment of poisoning in pregnancy

2.22.3 Medicines

2.22.4 Animal toxins

2.22.5 Mushrooms

2.22.6 Other plant toxins

2.22.7 Bacterial endotoxins

References

2.23 - Occupational, industrial and environmental agents

2.23.1 Solvent exposure in general

2.23.2 Formaldehyde and formalin

2.23.3 Photographic/printing chemicals

2.23.4 Pesticides

2.23.5 Phenoxyacetic acid derivatives and polychlorinated dibenzo-dioxins

2.23.6 Polychlorinated biphenyls

2.23.7 Chlorinated drinking water by-products

2.23.8 Metals

2.23.9 Hazardous waste landfill sites and waste incinerators

2.23.10 Radiation associated with the nuclear industry

2.23.11 Cell/mobile phones

2.23.12 Other sources of electromagnetic radiation

2.23.13 Electric shocks and lightning strikes

References

3 - General commentary on drug therapy and drug risk during lactation

3.1 The advantages of breastfeeding versus the risks of maternal medication

3.2 The passage of medications into the mother’s milk

3.3 Infant characteristics

3.4 Milk plasma ratio

3.5 Amount of medication in the milk and relative dose

3.6 Toxicity of medications in the mother’s milk

3.7 Medications that affect lactation

3.8 Breastfeeding support

References

4 - Specific drug therapies during lactation

4.1 - Analgesics, antiphlogistics and anesthetics

4.1.1 Paracetamol

4.1.2 Acetylsalisylic acid

4.1.3 Pyrazolone and phenylbutazone derivatives

4.1.4 Non-steroidal anti-inflammatory drugs (NSAID)

4.1.5 Selective COX-2 inhibitors

4.1.6 Other antirheumatics

4.1.7 Migraine medications

4.1.8 Opioids and opioid derivatives

4.1.9 Local anesthetics

4.1.10 Other medications used in connection with anesthesia

4.1.11 Myotonolytics and other analgesics

4.1.12 Gout therapy

References

4.2 - Antiallergics, antiasthmatics and antitussives

4.2.1 Antihistamines (H1-blocker)

4.2.2 Selective effective β2-sympathomimetics

4.2.3 Inhalable corticosteroids (ICS)

4.2.4 Leukotrien-receptor antagonists

4.2.5 Theophylline

4.2.6 Mast cell inhibitors

4.2.7 Anticholinergics for asthma treatment

4.2.8 Omalizumab

4.2.9 Mucolytics, expectorants and cold remedies

4.2.10 Antitussives

References

4.3 - Gastrointestinal drugs

4.3.1 Gastritis and ulcer medications

4.3.2 Peristaltic stimulators

4.3.3 Cholinergics

4.3.4 Anticholinergic spasmolytics

4.3.5 Laxatives

4.3.6 Agents used for chronic inflammatory bowel diseases

4.3.7 Antidiarrheals for acute diarrhea

4.3.8 Digestives and carminatives

4.3.9 Lipid reducers

4.3.10 Chenodeoxycholic acid and ursodeoxycholic acid

4.3.11 Appetite suppressants

4.3.12 Antiemetics

References

4.4 - Anti-infectives

4.4.1 Penicillins, cephalosporins and other β-lactam antibiotics

4.4.2 Erythromycin and other macrolides

4.4.3 Tetracyclines

4.4.4 Sulfonamides and trimethoprim

4.4.5 Quinolones

4.4.6 Nitrofurans and drugs for urinary tract infections

4.4.7 Nitroimidazole antibiotics

4.4.8 Aminoglycosides

4.4.9 Glycopeptide and polypeptide antibiotics

4.4.10 Other antibiotics

4.4.11 Tuberculostatics

4.4.12 Local antibiotics

4.4.13 Antimalarial medication

4.4.14 Systemic antifungal agents

4.4.15 Topical antifungal agents

4.4.16 Anthelmintics

4.4.17 Antiviral agents

References

4.5 - Vaccines and immunoglobulins

4.5.1 Maternal immunization

4.5.2 Efficacy of immunization in breastfed infants

4.5.3 Hepatitis A vaccine

4.5.4 Hepatitis B vaccine

4.5.5 Human papillomavirus vaccine

4.5.6 Influenza vaccine

4.5.7 Polio vaccine

4.5.8 Rabies vaccine

4.5.9 Rubella vaccine

4.5.10 Smallpox vaccine

4.5.11 Typhoid vaccine

4.5.12 Immunoglobulins

4.5.13 CDC recommendations

References

4.6 - Cardiovascular drugs and ­diuretics

4.6.1 β-Receptor blockers

4.6.2 Hydralazine

4.6.3 α-Methyldopa

4.6.4 Calcium antagonists

4.6.5 ACE inhibitors

4.6.6 Angiotensin-II receptor-antagonists (sartan)

4.6.7 Other antihypertensives

4.6.8 Antihypotensives

4.6.9 Digitalis

4.6.10 Antiarrhythmics

4.6.11 Vasodilators and circulatory drugs

4.6.12 Diuretics

References

4.7 - Anticoagulants, thrombocyte aggregation inhibitors and fibrinolytics

4.7.1 Heparin and danaparoid

4.7.2 Thrombin- and factor Xa-inhibitors

4.7.3 Thrombocyte aggregation inhibitors

4.7.4 Vitamin K-antagonists

4.7.5 Fibrinolytics

4.7.6 Antihemorrhagics

4.7.7 Volume expanders

References

4.8 - Antiepileptics

4.8.1 Introduction

4.8.2 Individual antiepileptics

References

4.9 - Psychotropic drugs

4.9.1 Introduction

4.9.2 Antidepressants

4.9.3 Individual antidepressants

4.9.4 Antipsychotic

4.9.5 Individual antipsychotic drugs

4.9.6 Lithium and other antimanic drugs

4.9.7 Anxiolytics, hypnotics and sedatives

4.9.8 Benzodiazepines

4.9.9 Zaleplon, zolpidem and zopiclone

4.9.10 Other anxiolytics, hypnotics and sedatives

4.9.11 Psychoanaleptics

4.9.12 Anti-Parkinson drugs

References

4.10 - Immunomodulating and antineoplastic agents

4.10.1 Azathioprine and 6-mercaptopurine

4.10.2 Selective immune suppressants

4.10.3 Monoclonal antibodies (mAb) and other biologicals

4.10.4 Interferons

4.10.5 Other immune stimulants

4.10.6 Antineoplastics

References

4.11 - Hormones and hormone antagonists

4.11.1 Pituitary and hypothalamic hormones

4.11.2 Methylergometrine (methylergonovine)

4.11.3 Bromocriptine and other prolactin inhibitors

4.11.4 Thyroid hormones and thyroid receptor antibodies (TRAb)

4.11.5 Thyrostatics

4.11.6 Iodine

4.11.7 Corticosteroids

4.11.8 Adrenaline

4.11.9 Insulin and oral antidiabetics

4.11.10 Estrogens, gestagens, and hormonal contraceptives

4.11.11 Androgens and anabolics

4.11.12 Cyproterone acetate and other sex-hormone inhibitors

4.11.13 Prostaglandins

References

4.12 - Dermatological medication and local therapeutics

4.12.1 Topical applications and cosmetics

4.12.2 Essential oils

4.12.3 Retinoids and topicals for psoriasis, dermatitis and acne

4.12.4 Photochemotherapy and fumaric acid preparations

4.12.5 Wart removal medications

4.12.6 Medications for lice and scabies

4.12.7 Eye, nose and ear drops

4.12.8 Vein therapeutics and other local therapeutics

4.12.9 Vaginal therapeutics

References

4.13 - Alternative remedies, vitamins, and minerals

4.13.1 Alternative remedies and phytotherapeutics

4.13.2 Herbal galactogogues and antigalactogogues

4.13.3 Topical treatment for breast problems

4.13.4 Vitamins, minerals, and trace elements

4.13.5 Biphosphonates

4.13.6 Exercise

4.13.7 Glucose 6-phosphate-dehydrogenase deficiency

References

4.14 - Contrast media, radionuclides and diagnostics

4.14.1 X-ray studies, ultrasound, and magnetic resonance imaging

4.14.2 Iodine-containing contrast media

4.14.3 Magnetic resonance contrast agents

4.14.4 Ultrasound contrast media

4.14.5 Radionuclides

4.14.6 Dyes

4.14.7 Other diagnostics

References

4.15 - Infections during breastfeeding

4.15.1 Common infections

4.15.2 Cytomegaly

4.15.3 Dengue virus

4.15.4 Hepatitis A

4.15.5 Hepatitis B

4.15.6 Hepatitis C

4.15.7 Hepatitis E

4.15.8 Herpes simplex

4.15.9 Herpes zoster (shingles), chicken pox (varicella)

4.15.10 HIV infection

4.15.11 Human T-lymphotropic virus (HTLV)

4.15.12 Influenza

4.15.13 Lyme disease

4.15.14 Methicillin-resistant Staphylococcus aureus (MRSA)

4.15.15 Rotavirus

4.15.16 Tuberculosis

4.15.17 West Nile virus

4.15.18 Other infectious diseases

References

4.16 - Recreational drugs

4.16.1 Alcohol

4.16.2 Amphetamines

4.16.3 Caffeine

4.16.4 Cannabis

4.16.5 Cocaine

4.16.6 Nicotine

4.16.7 Opiates, including methadone

4.16.8 Other drugs

References

4.17 - Plant toxins

References

4.18 - Industrial chemicals and environmental contaminants

4.18.1 Persistent organochlorine compounds (pesticides, polychlorinated biphenyls and dioxins)

4.18.2 Mercury

4.18.3 Lead

4.18.4 Cadmium

4.18.5 Other contaminants

4.18.6 Breastfeeding despite environmental contaminants?

4.18.7 Breastfeeding and the workplace

References

Index