One. What factors lead to fetal malformation During the whole pregnancy, the fetus may be affected by teratogens. In the first three months of pregnancy, teratogenic substances are most likely to cause fetal abnormalities at this time. (1) Drugs: At present, it is known that about 2% ~ 3% of congenital malformations are caused by drugs. Drugs that easily cause deformity include male hormones, alcohol, certain antibiotics (such as tetracycline), anticoagulants, anticancer drugs, tranquilizers and so on. (2) Chemical pollution: For example, lead and mercury are common teratogenic substances, which easily lead to fetal growth retardation and neurological and intellectual disorders. This kind of pollution is common in rivers polluted by industrial wastewater, and we should stay away from it. (3) Radioactive substances are another teratogen. Generally, chest X-ray irradiation is not enough to cause fetal malformation, but the more cumulative dose, or the closer the irradiation site is to the uterus, the higher the risk of malformation. (4) Whether the caffeine contained in coffee or tea and the radiation of computer monitor can cause deformity has not been confirmed yet. Two. The relationship between pregnant women's medication and fetal malformation Generally speaking, the first two weeks after the formation of fertilized eggs are medically called "embryo sac period", which is mainly the cell division and proliferation period. During this period, it is often affected by drugs and other toxic substances, which often leads to embryo sac death and abortion. From the fourth week after pregnancy (counting from the first day of the last menstruation), the embryo began to enter the stage of organ differentiation, and by the first week of pregnancy, the organ differentiation of the embryo was basically completed. During this period, drugs and adverse environmental factors can often cause fetal malformation. After 0/2 weeks of pregnancy, it is mainly due to the influence of drugs or other adverse factors, which mainly causes the abnormality of fetal physiological function. In addition, the dosage and duration of drugs used during pregnancy are also important factors affecting the fetus. The details are as follows: L. Early pregnancy. Improper medication will hinder embryonic development. 2 ~ 4 months of pregnancy is the most critical period for the occurrence and development of fetal heart. During this period, the placenta of the fetus has formed, and drugs can enter the carcass through the placental barrier, causing abnormal development and function of fetal organs, and even causing intrauterine death. 2, the second trimester of pregnancy. Because most organs of the fetus have been developed and stereotyped, even improper medication will not cause deformity, but will lead to organ dysfunction. This is because although the fetal organs have been differentiated and stereotyped, their functions are still not perfect, and the fetal liver lacks detoxification enzymes, which makes its detoxification function for various drugs insufficient. Fetal blood-brain barrier permeability is high, and many drugs are easy to accumulate in the brain. Moreover, the filtration function of fetal kidney is low and drug excretion is slow. Make drugs accumulate in the body for a long time; Cause organ dysfunction, such as deafness and insensitivity. The harm of commonly used drugs to the fetus is as follows: among commonly used anti-inflammatory drugs, gentamicin and kanamycin can cause fetal hearing damage, erythromycin can damage fetal liver function, tetracycline can not only affect fetal liver function, but also inhibit bone development and enamel dysplasia, sulfonamides can cause fetal jaundice and thrombocytopenia, and chloramphenicol can reduce fetal leukopenia, resulting in gray baby syndrome. Aspirin and salicylic acid in antipyretic and analgesic drugs can cause fetal bone abnormalities, platelet and coagulation factor deficiency, jaundice and so on. Taking a large number of sedatives such as phenobarbital, metoclopramide and diazepam during pregnancy can delay fetal development. Chlorpheniramine and diphenhydramine cause fetal limb shortening; Hormone drugs such as estrogen, progesterone and testosterone. Can lead to genital deformities. If pregnant women suffer from hypertension and need to take antihypertensive drugs, they should choose drugs that do not affect placental hemoperfusion, such as hydralazine and reserpine. , can inhibit fetal development and should be banned. Pregnant women can have laxatives for diarrhea, and strong laxatives such as senna and rhubarb are prohibited to avoid miscarriage or premature birth. Some potent Chinese medicines should be avoided if they are added with water or water. In short, during pregnancy, drugs should be used less or not, and the application of any drugs should be strictly controlled under the guidance of doctors. Reasonable use, do not abuse, in case of harm to mother and baby. According to the toxic effects of drugs on the fetus, drugs are divided into five categories (A, B, C, D, E). Among them, drugs A and B have no obvious teratogenic and toxic effects on the fetus. Drugs belonging to this category include vitamin B, vitamin C, folic acid and vitamin E, some commonly used antibiotics such as penicillins, cephalosporins and erythromycin ointment, and acetaminophen antipyretics such as "Baifuning" and Tylenol. Class C drugs, confirmed by animal experiments, have a certain teratogenic effect on the fetus, but there are many drugs belonging to this class, such as remifentanil, rifampicin, gentamicin, propafenone, aspirin, etc., so they should be used with caution during pregnancy because there is no controlled test. Class d and class x drugs have definite teratogenic effects in animal experiments and human bodies. These drugs, especially class X drugs, must be avoided during pregnancy. These drugs include anti-tumor drugs, sex hormone drugs or birth control pills, and some antibiotics such as tetracycline, streptomycin and kanamycin. Of course, the teratogenic or toxic effects of drugs on the fetus are not only related to the toxic effects of drugs themselves, but also related to the number of days of pregnancy when taking drugs, the dosage of drugs and the time of continuous taking drugs. Pregnant women's medication has an impact on the fetus, so some people don't need any medicine prescribed by doctors. Some diseases that are not treated in time will accelerate the harm to pregnant women's health, and then affect the fetus. Therefore, it is inevitable for pregnant women to use drugs with caution, and the following eight principles should be paid attention to. 1, any medication should be carried out under the guidance of doctor Yamatonokusushi. 2. Never use more drugs that can be used less; If it works, don't use it. 3. When drugs must be used, try to choose drugs that are harmless to the fetus or have little impact; If teratogenic drugs must be used for a long time because of treatment needs, pregnancy should be terminated. Don't abuse drugs, and don't listen to "folk remedies and secret recipes" to prevent accidents. 5. Avoid using advertising drugs or new drugs that you don't know. 6, according to the therapeutic effect, try to shorten the course of treatment, timely reduction or withdrawal. 7. Pay attention to the words "pregnant women should use it with caution, do not use it, and do not use it" on the package when taking medicine. 8. After pregnant women take teratogenic or possibly teratogenic drugs by mistake, they should consult a doctor to consider whether to terminate pregnancy according to their pregnancy time, dosage and duration, combined with their age, parity and other factors. Three. Precautions for pregnant women to use external drugs Now, with the popularization of medical knowledge, women all know that they should pay special attention to the use of drugs during pregnancy and lactation, but some people do not pay so much attention to the use of external drugs. Relevant data show that women should also be cautious when using external drugs during pregnancy, because some external drugs can be absorbed into the blood through the skin, causing fetal or infant poisoning and causing damage to the nervous system organs of the fetus or infant. The commonly used drugs for external use are: 1. Sassoon Jing: Its component is clotrimazole, which is mostly used for fungal infections of skin and mucosa, such as tinea corporis, tinea cruris, tinea manus and pedis, etc. Animal experiments show that it is not only embryotoxic. Dakening cream: containing miconazole nitrate. Generally, there is local stimulation. If the skin is locally sensitive, it is prone to contact dermatitis, or burning sensation, erythema, peeling and blistering due to local stimulation. If the above reactions occur during medication, the drug should be stopped in time to avoid aggravating skin lesions or infections. 2. Baiduobang Ointment (mupirocin): It is an antibiotic ointment for external use and is widely used for skin infections. However, many experts believe that it is best not to use this medicine during pregnancy. Because the polyethylene glycol in this ointment will be absorbed and accumulated by the whole body, it may cause a series of adverse reactions. 3. Acyclovir Ointment: It is an antiviral drug for external use. Antiviral drugs generally inhibit the replication of viral DNA (ribonucleic acid), but at the same time they also inhibit the DNA polymerase of human cells, thus affecting the replication of human DNA. Therefore, it is prudent to use various external antiviral drugs during pregnancy. 4. Cortisol drugs: mostly used for skin diseases. These drugs have anti-inflammatory and antiallergic effects, such as treating urticaria, eczema, drug eruption, contact dermatitis and so on. However, when pregnant women use it in a large area or use it for a long time, it can lead to the decline of adrenal cortex function of infants, and it can be absorbed through the skin and distributed in milk in a small dose. In addition, such drugs can also cause amenorrhea and menstrual disorder in women, so it is best not to use them for women who want to have children. In short, pregnant and lactating women should use oral drugs or topical drugs under the guidance of doctors to ensure the safety and effectiveness of drugs. Four. Chinese herbal medicine is not absolutely safe for pregnant women. Since thalidomide caused fetal malformation, many western medicines have been found to have adverse effects on the fetus. Therefore, many pregnant women are cautious about taking western medicine, but they think it is safe to eat Chinese herbal medicine. That was not the case. In recent years, eugenic genetic research has confirmed that some Chinese herbal medicines have adverse effects on pregnant women and fetuses. Such as safflower, immature bitter orange, cattail pollen and musk. Chinese herbal medicine can excite the uterus, which can easily lead to fetal ischemia and hypoxia, fetal dysplasia and deformity, and even abortion, premature delivery and stillbirth. Chinese herbal medicines such as rhubarb, mirabilite, spurge, pokeweed, croton, Daphne genkwa, morning glory, kansui, etc. , can stimulate the intestine, reflexively cause strong uterine contraction, and even lead to miscarriage and premature delivery. Some Chinese herbal medicines are poisonous, such as Mylabris, Rhizoma Arisaematis, Radix Aconiti Lateralis, Herba Artemisiae Scopariae, Fructus Zanthoxyli, Scolopendra, Radix Kansui, Flos Genkwa, Cinnabaris, Realgar, Radix Euphorbiae, Phytolacca acinosa and Croton. Their alkaloids and chemical constituents are very complex, and some of them can directly or indirectly affect the growth and development of the fetus. Especially in the first three months of pregnancy, in addition to western medicine, Chinese herbal medicine should also be used with caution to avoid teratogenesis. Realgar, a traditional Chinese medicine, is definitely teratogenic, and pregnant women should definitely avoid taking it orally. Cinnabar contains osmotic mercury salt, which can accumulate in pregnant women, leading to microcephaly, deafness, strabismus and mental retardation. What pregnant women need to pay attention to is that many Chinese herbal medicines with toxic and side effects often appear in Chinese patent medicines in the form of formulas. Therefore, we should be wary of proprietary Chinese medicines containing the above Chinese herbal medicines and avoid taking proprietary Chinese medicines that are prohibited and used with caution by pregnant women. Of course, pregnant women should be treated in time when they are sick, and don't be afraid of medical treatment. What's more, only a few of thousands of Chinese herbal medicines have adverse reactions. However, when you see a doctor, you should explain to the doctor that you are pregnant, and ask the doctor to weigh the pros and cons and try to choose safe drugs without side effects. Five. Classification of contraindications and careful use of traditional Chinese medicine in pregnant women 1. Contraindications: croton, morning glory, Mylabris, lead powder, mercury, Euphorbia, musk, Achyranthes bidentata, centipede, etc. 2. Use drugs with caution: aconite, verbena, pangolin, realgar, borax, etc. Drugs that cannot be used alone: angelica tail, Carthamus tinctorius, Radix Curcumae, Fructus Aurantii Immaturus, Areca catechu, Magnolia Officinalis, Calculus Bovis, Akebia Akebia, Talcum, etc. 3. Taboo Chinese patent medicines: Niuhuang Jiedu Pill, Dahuoluo Pill, Xiaohuoluo Pill, Zhibaodan, Liushen Pill, Da Die Pill, Jin Shu Huoluo Pill, Suhexiang Pill, Niuhuang Qingxin Pill, Zi Xue Pill, Heixi Pill, Chuangchuang Shunqi Pill, Compound Angelica Injection, Fengshi Da Die Wine, Ten Drips, Xiaojindan, Yuzhen Powder, Shixiao Powder, etc. 4. Use Chinese patent medicines with caution: Huoxiang Zhengqi Pill, Fangfeng Tongsheng Pill, Shangqing Pill, Shedan Chenpi Powder, etc. It can be seen that taking Chinese medicine during pregnancy must be applied under the guidance of a doctor and must not be misused, otherwise it will lead to injury. Six. Pregnant women should pay attention to the route of administration. Due to specific physiological changes, women's absorption of different dosage forms may change during pregnancy. Oral administration: Oral administration is the most commonly used method for pregnant women. During pregnancy, due to the decrease of digestive juice secretion and gastrointestinal peristalsis, the gastric emptying time was prolonged from normal 50 minutes to 80 ~ 130 minutes, and the time of passing through the small intestine was also prolonged, which delayed the peak time of drug blood concentration and increased the amount of drug absorbed by the small intestine. Intramuscular injection: intramuscular injection is faster and more complete than oral administration, but the drug absorption is delayed due to the slow blood circulation of lower limbs during pregnancy. Aerosol inhalation: Aerosol inhalation of drugs is often used to treat lung diseases. During pregnancy, the cardiac output and respiratory capacity per minute increased by 40% and 50% respectively, so the absorption of spray was greatly increased. External use: External use includes daubing, washing, dropping, gargling, etc. During pregnancy, due to the increase of blood supply to skin and mucosa, the absorption rate will be accelerated and the absorption amount will be improved to varying degrees. Therefore, pregnant women should not only pay attention to the adverse effects of drugs on the fetus, but also increase or decrease the dose according to the different routes of administration. Concert for more than an hour will not affect the hearing of the fetus.