ABSTRACT
During pregnancy, therapeutic drug monitoring has different meaning than before or after gestation, as any consideration of maternal health must incorporate potential effects on the unborn baby. Pregnancy is associated with a variety of physiological changes which may affect the natural course of diseases, the way the body handles drugs, or both. This chapter focuses on possible alterations in drug therapy that may have to take place in pregnancy to deal with pharmacokinetic and pathophysiological changes. Changes in hepatic elimination patterns during pregnancy are less consistent. Hepatic blood flow appears to be unchanged during pregnancy. The decrease in drug protein binding may account for higher clearance rates of drugs in pregnancy, as it is the free fraction which is accessible to the metabolizing systems. During pregnancy there is a gradual decrease in the concentration of maternal albumin and an increase in the concentration of fetal albumin.
