Using Medications
Medication use in pregnancy is a thorny issue. There is simply not enough long-term clinical data available on most drugs to provide a 100 percent guarantee of their safety. Ideally, you should avoid all prescription and over-the-counter drugs, except for your prenatal supplements, throughout pregnancy. However, that's an unrealistic expectation given that up to 64 percent of all pregnant women take one or more prescription drugs at some point in their pregnancy. And if you have a chronic disease, such as diabetes, schizophrenia, or HIV, you have little choice but to continue your treatment.
The U.S. Food and Drug Administration (FDA) has a classification system for drugs based on the degree of known risk a medication presents to a fetus. The following chart outlines the five categories currently used for establishing drug safety in pregnancy:
Category |
Description |
Adequate, well-controlled studies in pregnant women have not shown an increased risk of fetal abnormalities. |
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Animal studies have revealed no evidence of harm to the fetus; however, there are no adequate and well-controlled studies in pregnant women. OR: Animal studies have shown an adverse effect, but adequate and well-controlled studies in pregnant women have failed to demonstrate a risk to the fetus. |
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Animal studies have shown an adverse effect, and there are no adequate and well-controlled studies in pregnant women. OR: No animal studies have been conducted, and there are no adequate and well-controlled studies in pregnant women. |
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Adequate, well-controlled, or observational studies in pregnant women have demonstrated a risk to the fetus. However, the benefits of therapy may outweigh the potential risk. |
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Adequate, well-controlled, or observational studies in animals or pregnant women have demonstrated positive evidence of fetal abnormalities. The use of the product is contraindicated, or not advised, in women who are or may become pregnant. |
The consequences of not taking a medication must also be taken into consideration when evaluating the use of a drug. Do the benefits of the drug outweigh the risks to the mother and/or fetus? Can a safer medication be substituted temporarily? Or can the drug be temporarily stopped during the period of time it is known to potentially harm the fetus? With close observation, well-researched prescribing, and careful dosing, the use of medication can proceed safely in many cases.
There are a number of drugs that are teratogens — meaning that they have been shown to cause birth defects or other developmental problems in pregnancy. Following is a partial list of some well-known offenders. This list is not all-inclusive, and you should discuss all medication use with your practitioner.
Angiotension converting enzyme inhibitors (ACE inhibitors; prescribed for high blood pressure)
Accutane (isotreinoin; prescribed for cystic acne)
Androgens (testosterone, danazol; prescribed for endometriosis)
Anticonvulsants (prescribed for seizure disorders or irregular heartbeats)
Atypical antipsychotics (prescribed for schizophrenia and bipolar disorder; linked to risk of neural tube defects)
Certain antibiotics (including streptomycin and tetracycline)
Certain anticoagulants (warfarin; to prevent blood clotting)
Tapazole (methimazole; an antithyroid drug prescribed for hyperthyroidism)
Aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs; for pain relief) during the last trimester
Chemotherapeutic drugs (used to treat cancer and skin diseases)
Diethylstilbestrol (DES; not prescribed for pregnant women after the FDA issued a warning in 1971)
Lithium (used for treatment of depression and bipolar disorder)
Thalidomide (prescribed for leprosy and inflammatory conditions; in limited use due to its high potential for causing birth defects).
Sometimes women decide to self-treat colds and other illnesses with dietary supplements and herbal and botanical remedies in pregnancy, mistakenly assuming that medicine from a botanical source is inherently safe for their fetus. Remember:
