Paracetamol in pregnancy

Paracetamol is the most widely used anti-inflammatory drug during pregnancy. But the safety of this drug and its possible harm to the fetus are also widely discussed. As for the harm of the drug or its benefit during pregnancy, the approach to this issue is strictly individual, but in order to understand the general issues of prescribing the drug in this case, it is necessary to know some features of its pharmaceutical effect and metabolism of the drug.

[ 1 ], [ 2 ], [ 3 ], [ 4 ], [ 5 ]

Indications for the use of paracetamol during pregnancy

Paracetamol, due to its pronounced effect on the thermoregulation center, is widely used as an antipyretic. During pregnancy, the indication for lowering body temperature is not less than 38.5 degrees. Also, the indication for using the drug is a headache of moderate intensity, muscle pain, pain in the spine with osteochondrosis or other neurological pathology, inflammatory diseases of the respiratory system, infectious diseases with severe intoxication syndrome. Paracetamol for headaches during pregnancy can be taken if the headache is associated with an inflammatory disease or intoxication syndrome, otherwise it is better to give preference to antispasmodics. Children's paracetamol during pregnancy can be taken for the same indications and in the same dosage as regular paracetamol, only the release form and the concentration of the drug in the volume of syrup or suspension differ.

Pharmacodynamic properties of the drug

The drug is available in tablets, rectal suppositories, syrup, and suspension. All these drugs expand the availability of paracetamol for various purposes.

Paracetamol is a drug from the group of non-steroidal anti-inflammatory drugs, which has many therapeutic effects. The most pronounced property of paracetamol is its antipyretic effect, and it also has an analgesic effect, anti-inflammatory, mild antispasmodic. The mechanism of action of the drug is its central effect: paracetamol penetrates the blood-brain barrier and irritates the thermoregulation center in the hypothalamus, reducing its excitability and reaction to an increase in body temperature. Due to this, the thermoregulation center becomes less sensitive and the body temperature decreases. Its analgesic effect is achieved by reducing the activity of the synthesis of inflammation mediators and prostaglandins, thereby reducing the irritating property of these substances on tissues and blood vessels. This is how the antispasmodic effect of the drug is realized. The dosage of the drug during pregnancy should not exceed the average therapeutic dose, it is better to take no more than 1500 milligrams of paracetamol per day.

Pharmacokinetic properties of the drug

As a result of taking the drug orally, there is a rapid absorption of the active substance in the duodenum, and the maximum concentration of the drug in the blood is determined after half an hour of administration. The effect occurs after one and a half to two hours, which is necessary to overcome the blood-brain barrier. After entering the blood, paracetamol enters the liver, where it is metabolized. The active substances that are part of paracetamol, after metabolism are able to induce the synthesis of methemoglobin, which is a toxic substance and due to this effect, the toxic effect of the drug is realized. When paracetamol enters the blood, it binds to plasma proteins by a quarter, which contributes to a short half-life of the drug. No direct teratogenic effect of paracetamol has been identified, but it is able to penetrate the fetoplacental barrier, which explains its potential threat to the fetus.

Basic principles of paracetamol use during pregnancy

Pregnancy is a period when another life develops in a woman's body and at this time it is necessary to be very careful about nutrition and taking any pharmacological drugs. The process of organogenesis begins in the first trimester, and then the growth and differentiation of tissues continues, which also requires increased attention to taking any medications. The fetus is an agent foreign to the woman's body, because it contains 50% of information from the father. The woman's immune system perceives it as an antibody to some extent, therefore, until the formation of its placenta with an individual barrier and blood flow, a state of relative immunosuppression develops. This condition of a pregnant woman contributes to a change in all reactions of the female body, which could have been normal before. That is, the reactions of pharmacological transformation of drugs also occur differently, which can thus significantly affect the child. This is especially true for the first trimester of pregnancy, when there is no placenta yet, as an individual defense mechanism. This is associated with the peculiarities of the use of paracetamol at different stages of pregnancy.

Can paracetamol be taken during pregnancy and is it harmful to the child? Many women ask this question when they need to treat a pathology. In the instructions for paracetamol, you can see a clause that says that paracetamol should be taken with caution during pregnancy. This is due to some features that you need to know before you start taking the drug.

The state of relative immunosuppression of the pregnant woman's body contributes to the more rapid development of diseases, especially upper respiratory tract pathology, usually of viral etiology. In this case, there is a pronounced intoxication syndrome in the form of a rise in body temperature, headache, muscle pain, general malaise. In this case, these symptoms are best relieved by drugs from the group of non-steroidal anti-inflammatory drugs. As for the drug, paracetamol has the most pronounced effect here. The use of paracetamol during pregnancy in this case has the mildest effect of all drugs in this group, therefore, if it is necessary to use these drugs, preference is given to paracetamol.

There are some peculiarities of paracetamol use at different stages of gestation. This is connected with the development of the fetus in the mother's body. Paracetamol should not be taken in the early stages of pregnancy, particularly in the first trimester. During this period, the process of formation of the child's main vital organs occurs, as well as the formation of the placenta, which is a barrier to harmful factors. Therefore, taking any medications, including paracetamol, in the first trimester of pregnancy is strictly not recommended. Although it does not have a pronounced teratogenic effect, the possible harm is high. As for taking paracetamol during pregnancy in the second trimester, here the fetal tissue also grows, but there is a formed placenta, which in some way protects the child. Therefore, if there are indications, paracetamol can be taken in the second trimester. But this issue should be approached differentially, because an increase in temperature to subfebrile numbers does not require taking paracetamol, you can use folk remedies. If we are talking about a significantly expressed intoxication syndrome with an increase in body temperature above 38.5, then it is necessary to take an antipyretic. Paracetamol during pregnancy in the third trimester has the least harm, since all the organs of the child are formed, and we are talking about the fact that toxic products have a stronger effect on the fetus than paracetamol. Therefore, taking paracetamol in the third trimester is the most favorable option.

In any case, when talking about the harm or benefit of the drug during pregnancy, it is necessary to know that any medication carries a potential threat to the child and there must be certain indications for its use. Therefore, the question of using paracetamol during pregnancy in any case should be decided by the doctor on an individual basis.

[ 6 ], [ 7 ], [ 8 ], [ 9 ]

Contraindications to taking paracetamol during pregnancy and features of side effects

Paracetamol is contraindicated during pregnancy in case of acute disorders or serious pathologies of the liver and kidneys, as well as in the presence of allergic reactions in the anamnesis or allergy to additional components of the drug. Local forms of paracetamol in the form of rectal suppositories cannot be used in the presence of erosions or other inflammatory lesions in the rectum. Side effects of paracetamol are possible in the form of suppression of hematopoiesis with a decrease in the level of leukocytes, erythrocytes, platelets, as well as impaired renal function with renal colic and asymptomatic pyuria. Other side effects may manifest themselves in the form of allergic reactions with skin rash, nausea and vomiting, stool disorders, abdominal pain, drowsiness and dizziness.

Side effects of paracetamol during pregnancy when used in the first trimester are possible violations of fetal tissue differentiation and placentation disorders. Overdose of paracetamol can cause its toxic effect on the liver.

The storage conditions for paracetamol are as follows: shelf life is two years. Store at a relative temperature below 25 degrees, avoiding direct exposure to high and low temperatures, and also exclude high humidity.

Reviews of paracetamol during pregnancy speak of its effective antipyretic properties, but also of its pronounced analgesic effect. They prove that the use of children's paracetamol in a smaller dosage of 200 milligrams is not so harmful to the child, so they prefer this form. If the pain is severe, then the use of paracetamol, according to reviews, very effectively reduces it.

Paracetamol can be used during pregnancy if there are clear indications for use, when the pain or intoxication syndrome is expressed significantly and affects the mother's body. Having studied the main pharmacological features of paracetamol, we can say for sure that the drug does not have a pronounced proven effect on the body of the unborn child. At the same time, taking the drug is contraindicated in the first trimester, since in the process of laying the fetal organs, any effect, even with local treatment, can be teratogenic. Therefore, paracetamol can be used during pregnancy, since it has a pronounced antipyretic and analgesic effect, but it should be used only in the second and third trimester and as prescribed by a doctor.

[ 10 ], [ 11 ], [ 12 ]