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An Overview: Pharmacology During Pregnancy
Pregnancy affects almost every aspect of pharmacology, including volume of distribution, protein binding, absorption, and metabolism. Consequently, when giving drugs to pregnant patients, the maternal cardiac care team must consider these changes in the maternal handling of drugs as well as how the drug will affect the fetus—not only potential teratogenesis but also the pharmacologic effects on the baby.
Volume of Distribution
A major effect of pregnancy is on the volume of distribution of many drugs. Starting at 6 to 8 weeks’ gestation, maternal blood volume surges by 40% to 50%, with a concomitant increase in total body water, significantly increasing the volume of distribution for hydrophilic drugs. Another effect of hemodilution is the reduced peak concentration of hydrophilic drugs.
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