Pyrimethamine is in pregnancy category C. Data on the use of pyrimethamine in pregnant women are limited. Pyrimethamine is commonly used in combination with sulfadiazine and folinic acid for treatment of fetal toxoplasmosis during the 2nd and 3rd trimesters. In malaria prevention interventions for which the World Health Organization (WHO) has determined that the benefit of treatment outweighs the risk, WHO allows use of pyrimethamine in combination with sulfadoxine in the 2nd and 3rd trimesters. Available evidence suggests avoiding pyrimethamine during the 1st trimester and supplementing pyrimethamine with folinic acid in pregnant women.
The etiology of ICP is multifactorial, including genetic, hormonal, and exogenous factors. This condition is due to abnormal biliary transport resulting in saturation of the hepatic transport system. Recurrent familial ICP has been described as a heritable defect in the multidrug resistance 3 ( MDR3 ) gene, which encodes for a canalicular phospholipid translocator involved in bile duct secretion of phospholipids. A study demonstrated that the heterozygote genotype for the MDR3 gene predisposes women to developing ICP, but the expression of the disease is influenced by female sex hormone levels and metabolites. [ 33 ] Mutations in the MDR3 gene may account for up to 15% of cases of ICP.
Man made (synthetic) corticosteriods are used to treat a large number of conditions and symptoms. Corticosteriods are used as a replacement therapy when the body is not naturally producing enough of its own of natural corticosteriods. They are also used to treat conditions where there is inflammation, autoimmune conditions or allergy symptoms. Corticosteriods can be taken orally as a systemic treatment to treat the body as a whole or it can be applied to the affected area for a local effect as creams, inhalations, nasal sprays, eye drops, ear drops or injections. Examples of conditions they treat are