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112 Part III: Epochal Hematology Chapter 7: Hematology of the Fetus and Newborn 113

TABLE 7–8. Hematologic Effects of Maternal Drugs on the Fetus and Newborn
Drug Effect Certainty* Mechanism Reference
Antiretroviral agents Decreased Established Unknown—only seen with combination of zido- 318
in combination hemoglobin vudine, lamivudine + nelfinavir
Aspirin Bleeding; kernicterus Established; Interference with platelet function 123, 224, 228
potential
Displacement of bilirubin from albumin 317
Diazoxide Bleeding Questionable Thrombocytopenia 307
Nalidixic acid Hyperbilirubinemia Potential Oxidant damage to hemoglobin 315
Nitrofurantoin Hyperbilirubinemia Potential Oxidant damage to hemoglobin 314, 316
Phenytoin (Dilantin/ Bleeding Suspected Depletion of vitamin K–dependent coagulation 288
phenobarbital) factors by hepatic enzyme induction and factor
degradation
Rifampin/isoniazid Bleeding Suspected Depletion of vitamin K–dependent coagulation 313
factors
Sulfonamides Kernicterus Established Displacement of bilirubin from albumin 317
Thiazides Bleeding Suspected Thrombocytopenia 308, 309
Warfarin (Coumadin) Bleeding Established Known depletion of vitamin K–dependent coagu- 288, 289
lation factors by blocking carboxylation
*Certainty reflects the level of confidence in the data, assigned in increasing order from potential through questionable, suspected, and
established.
Data from Haley TJ, Berndt WO: Handbook of Toxicology. Washington, DC: Hemisphere Publishing; 1987.

HEMATOLOGIC EFFECTS OF MATERNAL DRUGS dehydrogenase-deficient infants who acquired the drugs from breast
ON THE FETUS AND NEWBORN milk. 315,316 Alternatively, sulfonamides may cause displacement of bil-
317
irubin bound to albumin and heighten the risk of kernicterus. Sali-
Hemostatic Effects cylates, phenylbutazone, and naproxen may have a similar effect at very
A number of maternally administered pharmacologic agents have been high plasma concentrations. Ideally, all these medications should be
317
implicated in hematologic abnormalities of the fetus or newborn (Table avoided during pregnancy unless their indication outweighs the poten-
7–8). Maternal aspirin ingestion results in impaired platelet aggregation tial risk to the fetus and newborn.
but does not foster neonatal bleeding. Other agents taken by the mother,
including diazoxide and thiazides, might be associated with neonatal
thrombocytopenia. 307–309 REFERENCES
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reflect an assessment of the need for this specific drug, and also the risk 7. Fujiwara Y, Browne CP, Cuniff K, Goff SC, Orkin SH: Arrested development of embry-
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