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Pharmacogenetics and Other Reasons Why Drugs Can Fail in Pregnancy: Higher Dose or Different Drug?

Haas, David M. MD, MS; D'Alton, Mary MD

doi: http://10.1097/AOG.0b013e3182698538
Current Commentary

Changes in maternal physiology during pregnancy can alter the absorption, distribution, and clearance of many drugs. When presented with a clinical situation in which it does not appear that a prescribed drug is working, clinicians must either change drugs or increase the dose of the current drug to achieve the desired clinical effect. A case highlighting antihypertensive medication in pregnancy and the effect of changed drug-metabolizing enzymes is presented. Understanding pregnancy's effect on drug-metabolizing enzymes, transporters, and receptors can help clinicians make individualized pharmacotherapeutic decisions for patients. Pharmacogenetics potentially can aid clinicians in treating pregnant women in the future as more data are generated and individualized therapeutic models are constructed.

Indiana University School of Medicine Department of Obstetrics and Gynecology, Indianapolis, Indiana; and Columbia University School of Medicine Department of Obstetrics and Gynecology, New York, New York.

Corresponding author: David M. Haas, MD, MS, 1001 W. 10th Street, F5102, Indianapolis, IN 46202; e-mail:

Supported by a grant from the Eunice Kennedy Shriver National Institute of Child Health and Human Development to the Obstetric-Fetal Pharmacology Research Units Network #5U10HD063094 and #5K23HD055305.

The views expressed in this article represent the authors and not those of the National Institutes of Health.

Financial Disclosure The authors did not report any potential conflicts of interest.

© 2012 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.