'The effects of neurologic and psychiatric drugs on the fetus and nursing infant: A handbook for health care professionals', by J. M. Friedman and Janine E. Polifka. Pp xv + 369. Price £34. Baltimore: John Hopkins University Press, 1998. ISBN 0 8018 5962 X.
Doctors, pharmacists and other health professionals may be asked about the appropriate care of pregnant women who have been inadvertently exposed to medicines in the early stages of pregnancy or who require drug therapy during pregnancy or breastfeeding. It is often difficult to find good evidence on which to base management decisions in these cases.
Psychiatric disorders are fairly common among women of childbearing potential, as are neurological conditions such as migraine and epilepsy, and many of these require chronic treatment over many years.
This book has been compiled in an attempt to guide health professionals by summarising the available evidence on the effects of commonly used psychiatric and neurologic drugs in pregnancy and breastfeeding. It consists of an introductory chapter reviewing aspects of teratogenic risk assessment followed by monographs on over 200 therapeutic drugs and illicit substances. The monographs are partly derived from the TERIS database, a computerised system developed in Seattle, which is intended to facilitate teratogenic risk assessment by health professionals. Each monograph contains a teratogenic risk rating, a synopsis of the relevant literature on exposure in pregnancy, a summary on risks in breastfeeding, and key references. The two-part risk rating, based on a consensus among seven experts in clinical teratology, estimates the extent of risk and rates the quality and quantity of data on which this is based. For example, for phenytoin the magnitude of risk is stated as "small to moderate" and this is based on data described as "fair to good". The summaries on risk to the breastfeeding infant contain an estimate of the amount of drug ingested by a nursing infant as a percentage of the mother's dose, together with the recommendations of the American Academy of Paediatrics where available. In general the information in this section is less comprehensive than I would have liked.
The book is easy to use and the drug coverage is fairly extensive and current. Drug monographs are presented alphabetically by generic name but there is no index of the monographs included. The appendix actually lists all agents covered in the TERIS database, which could be confusing to some readers.
This book is well researched, user friendly and good value. It will be particularly useful for pharmacists practising in, or with an interest in, psychiatry, obstetrics and drug information. However, those with easy access to the TERIS database (available on the Reprorisk system of the Micromedex database) will already have most of this information available to them.
Reviewer - Anne Lee. Anne Lee is principal pharmacist in the area drug information centre at Glasgow Royal infirmary