The management of pregnant women with medical conditions always requires a balancing of risks. With regard to the use of medications, the clinician must consider the risks of not treating the mother versus the risks of exposing the developing fetus to a particular drug or combination of drugs. The former can be reasonably projected from clinical acumen and a brief online search. Building an overview of the latter requires the evaluation of published and unpublished reports of human and animal studies on a variety of therapeutic alternatives in various stages of pregnancy and during lactation. In this eighth edition of Drugs in Pregnancy and Lactation, Briggs and colleagues have gathered this information and present the data on several levels. Drug monographs are listed in alphabetical order with a clear indication of their pharmacological class and Food and Drug Administration fetal risk factor. Each well-structured entry contains sections on fetal risk and breastfeeding. These brief literature reviews of animal and human exposure detail pharmacokinetic properties and biological outcomes. The authors provide summarized data, their interpretation and an overall recommendation.
Occasionally attempts are made to relate changes to developmental biology. Each entry concludes with a brief summary and relevant references. Drugs in wider use and those with a more extensive literature base are afforded longer and more detailed notes. Records have been meticulously updated since the last edition, notably sections on the newer anticonvulsant and biological agents. A search for the safest alternative is facilitated by the appendix that compiles drugs by pharmacological class with an indication of the drug's risk category.
Usefully the latest edition includes access to a searchable online version of the book, making the recommended retail price of US$129 or £70 comparatively reasonable and the title much more accessible in day-to-day clinical practice than the 2144 page hardcover book or the separately available CD-ROM. This indispensible reference ought to be in every antenatal clinic and family doctor's surgery.