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Trong thời kỳ mang thai có nên sử dụng thuốc không?

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   Câu hỏi: Trong thời kỳ mang thai có nên sử dụng thuốc không?
 Trả lời:

Các bà mẹ mang thai không nên tự ý mua thuốc điều trị, nhất là những thuốc nằm trong nhóm kháng sinh, nhóm tác động trên hệ thần kinh, hệ tim mạch, hệ hô hấp. Vì những thuốc này dễ gây ra biến đổi thai nhi hoặc dễ gây ra biến đổi hoạt tính co bóp của cơ tử cung gây hai biến chứng đáng ngại là quái thai và sảy thai.

Các thuốc “cấm”:

Hai đặc điểm mà chúng ta cần đặc biệt lưu tâm đó là khả năng làm quái thai ở đứa trẻ và khả năng dẫn tới nguy cơ xảy thai ở bà mẹ. Đây mới là hai tiêu chuẩn ít được bàn nhưng lại là những tiêu chuẩn vàng để cân nhắc trong chiến lược điều trị. Và cũng dựa trên hai tiêu chuẩn này mà người ta vạch ra những thuốc cấm không được dùng trong quá trình mang thai cũng như những thuốc cần thận trọng xem xét.

Đầu tiên là chúng ta phải lưu ý tới các thuốc chống chỉ định tuyệt đối với thai kỳ. Mức chống chỉ định tuyệt đối đến mức người ta phải dùng từ “cấm” để thấy rõ mặt lưu ý vô cùng quan trọng này.

Là một thuốc kháng sinh hữu dụng cho các nhiễm trùng đường ruột, metronidazole tỏ ra là một kháng sinh tốt trong điều trị nhiễm trùng tiêu hoá. Song khi thử độ an toàn của thuốc, người ta thấy có những trường hợp xuất hiện đột biến và quái thai trên động vật thực nghiệm. Khảo cứu ở những trường hợp phụ nữ có thai mà sử dụng loại thuốc này, người ta thấy thuốc còn làm giảm cân nặng thai nhi và rút ngắn thời gian thai kỳ. Đứa trẻ sinh ra sớm hơn so với ngày quy chuẩn. Chính vì những tác dụng không tốt trên thai kỳ như vậy mà metronidazole không được chỉ định cho các bà mẹ mang thai. Các kháng sinh thông dụng khác như aminoglycosid trị bệnh đường hô hấp cũng cùng chung một số phận.

Griseofulvin là một thuốc chống nấm vẫn được dùng trong điều trị bệnh nấm da, nấm móng. Tuy nhiên có những bằng chứng rõ ràng rằng griseofulvin gây quái thai trên cả động vật thực nghiệm và trên người, đặc biệt khi dùng với liều cao. Thuốc này gây dị tật trên chân và tay ở đứa trẻ, trẻ được sinh ra có thể bị khuyết thiếu một hay nhiều chi thể.

Là một thuốc chống giun ký sinh trong lòng ruột khá hữu hiệu, mebendazol được chỉ định trong các trường hợp tẩy giun. Nhưng loại thuốc này lại gây ra quái thai rõ rệt trên động vật thực nghiệm và người ta xếp thuốc này vào nhóm chống chỉ tuyệt đối cho phụ nữ mang thai, nhất là trong giai đoạn đầu vì những sự cố trên bào thai.

Chung một tác hại là làm thay đổi quá trình biệt hoá thai nhi dẫn đến nguy cơ quái thai, các thuốc chống động kinh như diphenylhydantoin (vẫn được gọi là phenytoin) cũng không được dùng đối với bà mẹ mang thai. Trong khi đó, thuốc trị đau nửa đầu ergotamine thì cấm dùng cho phụ nữ có thai là do chúng làm tăng cơn co bóp tử cung dẫn đến sảy thai. Đây là những thuốc tác động trên hệ thần kinh mà không được xem xét sử dụng trong thai kỳ.

Một thuốc làm tăng co bóp tử cung mạnh mẽ đáng lưu ý là mifepriston. Thuốc này làm co bóp tử cung mạnh đến nỗi chúng ngăn cản quá trình trứng làm tổ, ngăn cản trứng bám dính vào thành tử cung, vì thế chúng chống thụ thai và chống mang thai. Bà mẹ dùng thuốc này có nguy cơ bị sảy thai là rất lớn. Tác dụng co bóp tử cung của chúng mạnh đến nỗi chúng là thuốc để tránh thai khẩn cấp.

Một thuốc chống nôn làm giảm triệu chứng thai nghén thalidomid cũng là một thuốc “đen” với thai kỳ. Vì chúng gây ra ngộ độc thai nhi, thai nhi bị đột biến và gây thai chết lưu nên chúng không được dùng cho các bà mẹ. Mức độ độc thai nhi đến nỗi chúng đã gây ra thảm hoạ vào những năm 60 của thế kỷ trước.

Vì những bằng chứng còn đang được nghiên cứu thêm hay những tác dụng phụ còn đang nghi ngờ, các thuốc sau được xếp vào hàng cần cân nhắc, đó là các kháng sinh như thiamphenicol, kháng sinh trị lao rifampicin. Trong nhóm thuốc tim mạch có hai thuốc cần lưu tâm là thuốc hạ huyết áp aldomet và các thuốc ức chế beta. Nằm trong nhóm thuốc tác dụng trên hệ thần kinh, thuốc an thần dòng benzodiazepin, barbiturat, phenothiazin không được khuyên dùng ở bà mẹ mang thai. Trong khi điều trị nhiễm độc thai nghén, chúng ta cũng không nên dùng thuốc lợi niệu nhóm thiazid. Nếu phải dùng thuốc giãn phế quản để điều trị hen ở những bà mẹ có tiền sử dị ứng thì nên tránh thuốc theophylin.

Những lưu ý:

Vì thuốc có những mặt trái nhất định trên cả mẹ và con nên chúng ta cần hết sức thận trọng khi dùng thuốc cho bà mẹ mang thai. Cụ thể là:

Thứ nhất, phải chẩn đoán và điều trị hết sức chặt chẽ với bà mẹ mang thai. Đâu là những rối loạn bệnh lý do mầm bệnh bên ngoài thực sự, đâu là những rối loạn bệnh lý nhất thời do thai gây ra để có hướng sử dụng thuốc đúng. Chỉ nên quyết định dùng thuốc với các mầm bệnh bên ngoài môi trường xâm nhập.

Thứ hai, tuyệt đối không dùng những thuốc cấm dùng trong thai kỳ. Hãy lưu ý thận trọng với những thuốc cảnh báo, không nên dùng khi còn đang tranh cãi.

Thứ ba, các bà mẹ mang thai không nên tự ý mua thuốc điều trị, không được tự ý mua thuốc uống, nhất là những thuốc nằm trong nhóm kháng sinh, nhóm thuốc tác động trên hệ thần kinh, hệ tim mạch, hệ hô hấp. Vì những thuốc này dễ gây ra biến đổi thai nhi hoặc dễ gây ra biến đổi hoạt tính co bóp của cơ tử cung gây hai biến chứng đáng ngại là quái thai và sảy thai.

Và cuối cùng, không nên dùng thuốc “ẩu” với bà mẹ mang thai. Hãy nhớ, hạn chế tối đa dùng thuốc trong thai kỳ.

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