Betadine in pregnancy in the 1st, 2nd and 3rd trimester

An effective local iodine-based drug with a wide spectrum of antiseptic activity, Betadine, is not the most desirable remedy for pregnant women precisely because of its active substance. Iodine penetrates well into tissue cells and systemic blood flow, accumulates in the body, easily overcomes the placental barrier, and its excess can negatively affect the thyroid gland. Nevertheless, Betadine is prescribed during pregnancy. Let's consider in what cases it is advisable.

The antiseptic properties of iodine have been used for a very long time - the 53rd element of the periodic table is capable of destroying not only bacteria and fungi, it is active against protozoan and intracellular microorganisms. Pathogens are not able to develop resistance to elemental iodine for a very short time before their destruction (less than a minute). Compared to an alcohol solution of iodine, Betadine contains a softer form of it - povidone-iodine. The compound with the polymer polyvinylpyrrolidone allows the action of elemental iodine to be extended over time, that is, it makes it prolonged and dosed. Iodine, contacting the epithelium of the skin and mucous membranes, is gradually released in small quantities from the complex with the polymer and destroys pathogenic microorganisms. The irritating effect is minimized, so the drug is usually well tolerated. And the speed of action is one of the positive qualities of the drug.

Betadine when planning pregnancy allows you to get rid of specific and non-specific mono- and mixed infections of the genital tract. When planning to have a child, a competent woman should visit a gynecologist, get examined and, if necessary, undergo treatment before pregnancy, and Betadine, in the absence of allergy to iodine and thyroid diseases, is a completely suitable drug for this.

Conception may not occur during treatment with Betadine, since suppositories inhibit sperm activity, but this is not something to strive for during the course of treatment.

Can Betadine be used during pregnancy?

Sometimes it is prescribed to expectant mothers. And they immediately have a question about the advisability of the appointment. There are discrepancies in the instructions, manufacturers warn about penetration through the placental barrier and call for caution. Some prohibit its use from the second month, others - from the third, some - from the second trimester. This is due to the periods of development of the circulatory system. In the first two weeks of their development (the so-called yolk period), the mother and child do not yet have a single circle of blood circulation, so iodine will not be able to have a significant effect on the child's body, even if it is present in the mother's systemic bloodstream. Then allantoic circulation begins to develop, expanding the access of substances circulating in the mother's blood to the fetus. It will work completely only by the end of the eighth week (second month) of pregnancy. However, the most adequate exchange of all substances, both useful and toxic, begins with the onset of placental circulation. This corresponds to the second trimester.

Pregnant women should not use Betadine because of the potential for iodine-induced goiter and hypothyroidism in the fetus and newborn. The risk is especially high when Betadine is used repeatedly.[ 1 ],[ 2 ]

Therefore, it is better to treat the detected infections at the very beginning of pregnancy, and they often manifest themselves precisely at this period due to physiological immunosuppression. This will be the safest for the child.

During pregnancy, various situations may also arise, including fresh infections. In this case, it is worth listening to the doctor's opinion, although you can and even should ask him questions about the advisability of prescribing Betadine. Let him explain his point of view, convince you of the need to use the drug.

As a consolation, it can be said that manufacturers do stipulate the possibility, in special cases, of using suppositories for a short time under supervision in the first trimester or applying an ointment (solution) to small areas of the body surface, provided that the woman has no general contraindications to this drug.

Indications Betadine in pregnancy

Betadine is a local antiseptic, so it is used in the form of a solution for this purpose to disinfect a small surface of the skin and mucous membranes [ 3 ]. As a one-time measure in the absence of another safer antiseptic, it is quite acceptable for use by pregnant women. Iodine enters the systemic bloodstream with prolonged use.

Betadine ointment can be used independently once for disinfection of small abrasions, scratches and other small wounds, in ophthalmology [ 4 ]. For long-term treatment of bacterial, fungal, viral skin lesions, a doctor's consultation is necessary.

Indications for the use of Betadine suppositories may include thrush during pregnancy, bacterial vaginosis, trichomoniasis, genital herpes, mixed infections [ 5 ]. Self-administration by pregnant women is strictly not recommended.

Release form

Medicines with the trade name Betadine are available in several forms for external use: suppositories, solution, ointment.

Pharmacodynamics

The active ingredient of all forms of the drug is povidone-iodine. This substance is a combination of iodine molecules with a polymer that acts as a storage facility, releasing iodine in portions into the tissues that come into contact with the drug and to which it is applied. The antiseptic effect of the released iodine extends to bacteria, viruses, protozoa, fungi and their spores. The majority of iodine-sensitive microbes die within the first 15-30 seconds of contact with its molecules, which react with the hydroxyl and sulfide groups of amino acids of pathogenic microorganisms, destroying their protein structures and inactivating enzymes, which leads to the death of pathogenic microflora.

Pathogenic microorganisms do not develop resistance to iodine even with prolonged use. The povidone-iodine complex does not have a pronounced local irritant effect inherent in an alcohol solution, therefore it is better tolerated. It is hydrophilic and easily washed off with water. The color intensity of the preparation changes as it interacts with the affected surface - discoloration indicates a decrease in antiseptic ability.

Long-term therapy and/or use of Betadine for large damaged areas is not suitable for pregnant women, as in such cases, large amounts of iodine may enter the systemic circulation, be retained, and rapidly increase in blood concentration, which may cause significant changes in the thyroid hormonal status of the unborn child. Therefore, the use of all forms of the drug by pregnant women should be short-term and cover a small area.

Pharmacokinetics

The drug is absorbed more intensively from mucous membranes and damaged skin. The half-life of an intravaginal suppository is on average about two days. But the rate of absorption and excretion by the kidneys largely depends on the molecular weight of povidone-iodine, and it fluctuates significantly, so iodine may be retained in the body.

Dosing and administration

Expectant mothers are most often prescribed a course of treatment with Betadine suppositories for colpitis during pregnancy. Unlike many other drugs prohibited in the first trimester, Betadine is used in the early stages of pregnancy (according to the instructions - in the first eight weeks). During this period, there is no big belly, half-open cervical os and other features inherent in later stages. Therefore, the question: how to insert Betadine suppositories during pregnancy, is irrelevant. Answer: as usual.

These are intravaginal suppositories, meaning they are inserted deep into the vagina. It is more convenient to do this procedure lying down.

Betadine in the first trimester of pregnancy is prescribed in the minimum effective dose, i.e. once a day at night. The course of treatment is usually a week, but can be even shorter. For example, with candidiasis, one or two times a day is sometimes enough. Due to colored discharge (elimination of candle residues), it is recommended to use disposable sanitary pads during the treatment period.

In severe cases, a doctor may prescribe a twice-daily administration in the morning and evening. In this case, it is necessary to lie in bed for at least an hour in the morning after the administration.

Before insertion, suppositories are removed from the packaging and, according to the instructions, moistened with water. According to many women, unmoistened suppositories are better inserted.

Betadine should not be prescribed categorically in the 2nd trimester of pregnancy. During this period, placental circulation (shared with the mother) has formed. The accumulation of iodine in the mother's blood can have negative consequences for the health of the unborn child, for example, causing a sensitization reaction in the fetus or iodine-induced hyperthyroidism.

Betadine suppositories are not prescribed in the 3rd trimester of pregnancy for the same reason.

It is allowed to lubricate an abrasion (scratch) with ointment or solution for disinfection at any stage.

Contraindications

Betadine in all forms is not used to treat pregnant women, starting from the third month of pregnancy. It is contraindicated for nursing mothers, since it penetrates into breast milk and its concentration there is much higher than in the blood. It is not recommended to prescribe the drug to infants, since iodine is well absorbed through the skin and quickly enters the blood, which increases the risk of transient hypothyroidism. [ 6 ] Betadine is prohibited for patients with hyperfunction and neoplasms of the thyroid gland, autoimmune thyroiditis, thyrotoxicosis and other pathologies, bullous polymorphic dermatitis, impaired renal function, allergic reaction to iodine.

Side effects Betadine in pregnancy

An allergic reaction to iodine-containing preparations is not uncommon. In most cases, it may manifest itself as itchy rashes and/or swelling at the site of application, but there have also been isolated rare cases of anaphylaxis [ 7 ]. In addition, people with sensitive skin may develop a reaction resembling a chemical burn [ 8 ]. In such cases, treatment with Betadine is stopped immediately.

The instructions say that in adult patients with normal thyroid function, iodine retention in the body does not cause clinically significant symptoms of hyperthyroidism, and the retention and accumulation of this element is caused only by long-term treatment. However, judging by the reviews, this is an understatement. Many women who used Betadine suppositories quickly began to feel a rush of blood to the head, tachycardia, unreasonable anxiety, a metallic taste in the mouth, their blood pressure rose, their hands trembled, and they began to have problems with sleep. Some had symptoms of hypothyroidism. Considering that the thyroid gland can generally malfunction in pregnant women, the likelihood of side effects from it increases.

The same instructions indicate such a side effect as kidney dysfunction, which is absolutely not what a future mother needs. Water-electrolyte imbalance and blood acidification may be observed.

Of course, side effects do not arise from a single use of ointment or solution for disinfecting a scratch. They are caused by a course of Betadine suppositories.

There are many reviews about discharge after Betadine during pregnancy. Normal discharge when using suppositories should be in the morning. The manufacturer warns about this and recommends using pads during treatment. The suppository dissolves in the vagina, but its components, mixed with mucus, flow out onto underwear or a pad in the form of a reddish-brown substance with a specific smell of iodine. Some increase in itching during therapy with vaginal suppositories is also normal.

Some complain of an exacerbation of thrush - white thick discharge with a sour smell. Suppositories are intended for the treatment of candidiasis, and the appearance of such discharge is explained by repeated infection, which could be caused by sexual contact with an infected partner during treatment. Not too abundant whitish discharge without odor and itching is considered a normal variant.

Betadine suppositories alone are not enough to treat trichomoniasis and some other combined infections, so greenish-gray, foamy, purulent discharge may be a sign of an untreated infection or re-infection. You should see a doctor with this problem.

Overdose

An acute toxic reaction to an excess dose of iodine in the body is manifested by the following symptoms: [ 9 ]

• digestive tract – hypersalivation, metallic taste and pain in the mouth, heartburn, dyspeptic symptoms;
• organs of vision – lacrimation, redness, itching in the eyes, swelling of the eyelids;
• all kinds of skin reactions (most often vesicular rash and swelling, accompanied by itching);
• kidneys - urinary retention, hypernatremia, metabolic acidosis
• anaphylactic shock and dysfunction of various organs.

The probability of an overdose in a pregnant woman who follows the doctor's recommendations is negligible. However, when the first symptoms of an overdose appear, the first pre-medical aid is to drink milk or starch diluted in water, as well as to seek medical attention.

Interactions with other drugs

The active ingredient of povidone-iodine suppositories exhibits antiseptic activity only in an acidic environment (pH value from 2 to 7).

When treating a wound surface, Betadine ointment or solution should not be applied immediately after hydrogen peroxide or antiseptics with silver ions, cyclotaurolidine, since they mutually inhibit each other's activity, and sequential use with antiseptics that contain octenidine leads to the appearance of dark necrosis spots at the site of combined use.

The active substance is incompatible with drugs containing mercury; it is not recommended to prescribe it to patients who take normotimics containing lithium salts.

The oxidizing properties of povidone-iodine distort the results of urine tests for traces of blood or glucose content, as well as fecal occult blood tests, and some thyroid function tests.

In addition, for the effectiveness of Betadine dosage forms, it is necessary to observe storage conditions: ointment and solution are stored at room temperature no more than 25℃, suppositories - in the medium-temperature chamber of the refrigerator (above 0℃). The expiration date of the drug is indicated on the packaging. This data should also not be neglected, especially by pregnant women.

Analogues

Reviews of Betadine suppositories are very different, and this is not surprising. Reactions to drugs depend on the individual sensitivity of the woman, and many people do not tolerate iodine. Doctors, judging by the reviews of pregnant women, often prescribe these suppositories during periods when the manufacturer already prohibits use, for example, at 12 or 15 weeks. Considering that the pharmaceutical company is not a philanthropist, and even it considers the use of the drug after the third month dangerous, then you should not hesitate to ask the doctor questions about why he prescribes suppositories during the prohibited period.

In addition, many doctors believe that Betadine during pregnancy is a thing of the past: too many intolerances and side effects. There are safer and hypoallergenic analogues. For example, Pimafucin suppositories are considered safe for pregnant women, many prefer to prescribe Hexicon suppositories with the active ingredient - the antiseptic chlorhexidine. They do not have an irritating effect, and it seems - a clinically significant systemic one. They are also used with caution, but at any time. However, they are not effective against thrush. [ 10 ], [ 11 ]

Miramistin suppositories are recommended for thrush during pregnancy on forums, although the instructions say that no studies have been conducted to confirm their safety. Manufacturers write in the instructions that Miramistin suppositories, such as Tamistol, are best used rectally by expectant mothers. This active ingredient is effective against many pathogens and treats thrush well.

In general, a lot depends on individual tolerance, so the treatment of a pregnant woman should be decided by a doctor. Maybe more than one. You can consult a homeopath or a herbalist. In addition, the main thing is not to overdo it. White discharge may indicate a “too clean” vagina, where there are only lactobacilli, which, without the restraining factors of 5% opportunistic flora in the microbiocenosis, begin to multiply intensively. Such a vaginal ecosystem is called cytological vaginosis or Doderlein syndrome [ 12 ]. There is no specific treatment for the syndrome. Its therapy is aimed primarily at normalizing (reducing) the acidity of the vaginal environment. In this case, the use of antimycotics is inappropriate. Suppositories with lactobacilli and intimate hygiene products with high acidity, fermented milk products (for a while) are excluded. Sitz baths with a solution of baking soda may be prescribed - a weak alkali neutralizes increased acidity (in case of candidiasis, such treatment will not bring results).

In general, pregnant women should follow the commandment "do no harm". If the smear is clean, then you can slow down, wash yourself more often (do not douche) and change your underwear, stop inserting different suppositories, stick to a diet - exclude spicy, salty, limit sweets. And after a while, the discomfort will decrease by itself. By the way, adequate gynecologists give exactly such recommendations.