Medications and Pregnancy
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When a woman asks if it's safe to take a particular drug during pregnancy, there is rarely a definite yes or no answer. The key to taking medications during pregnancy—or when you're trying to get pregnant—is weighing the benefits of the medicine against the potential risks to the fetus.
Be Proactive and Ask Questions
When possible, think ahead. It’s best to address questions about medications and vitamins before you are pregnant. Ask your doctor about the over-the-counter medications you currently use. These include drugs for everyday conditions, such as heartburn, allergies, or headaches. In addition, check with your doctor about any prescription medications you currently take. Both types of medications may need to be either discontinued or changed before you get pregnant.
Women With Chronic Conditions Have Special Needs
Not long ago, many women with chronic conditions, such as ]]>lupus]]> or ]]>diabetes]]> , considered pregnancy to be too risky. However, because of advances in the fields of high risk obstetrics and internal medicine, many of these women now deliver healthy babies. Sandra Gangell, of the Pregnancy Risk Network of People, Inc., encourages women with chronic health problems to assemble a healthcare team to help them manage their disease processes and medications during this important time. Ideally, the team should be formed before conception. She also states that enlisting a teratology specialist is particularly important, as these doctors specialize in the understanding of how medications and other substances effect a developing fetus. Ronald J. Ruggiero, PharmD, of the University of California San Francisco, agrees with Gangell. He notes that obstetricians can't be expected to know the effects of all medications used for chronic conditions.
Members of the team may include:
- An obstetric care provider who specializes in high risk pregnancies
- The doctor managing the chronic condition
- The primary care provider (if not managing the chronic condition or the pregnancy)
- A teratology specialist
- A genetic counselor
The Role of Teratology Specialists
The Organization of Teratology Information Services (OTIS) provides expert information about prenatal exposures to medications, chemicals, and other substances. OTIS member organizations don't prescribe or recommend treatments; they provide objective information about the following:
- Medications a woman took before she realized she was pregnant
- Medications prescribed for an illness that occurs during pregnancy
- Medications for chronic conditions
FDA Safety Rating
The US Food and Drug Administration (FDA) currently requires that drugs be categorized according to their risk to pregnant women.. However, Gangell and Ruggiero have stated that the categories are not detailed enough to be useful. The FDA is currently working on a new approach to assess the safety of medications for pregnant women.
Evaluating the Risks and Benefits
In some cases, such as with women have ]]>asthma]]>, ]]>depression]]>, diabetes, ]]>high blood pressure]]>, or ]]>HIV]]>, stopping medication can be significantly more harmful to the fetus than taking the drugs during pregnancy. In these types of cases, OTIS can provide information about a specific drug and the risk to the fetus, based on timing during the pregnancy. Some drugs are potentially harmful early in the pregnancy, but not later on. Conversely, others present a greater risk around the time of delivery. OTIS can also inform you about the risk/benefit profile of medications that can help manage your condition during your pregnancy.
"Don't stop taking medicine for a chronic condition if a home pregnancy test is positive," warns Gangell. Check first with your healthcare provider.
According to Gangell, substances that pose high risk during pregnancy include the following:
- ACE inhibitors
- ]]>Aspirin]]> (This depends on the dose and the trimester; beware of aspirin in combination with certain over-the-counter medications.)
- Non-steroidal anti-inflammatory (NSAIDs) medications
- Tegison or Soriatane
Note on Herbs and Supplements
Dr. Ruggiero warns pregnant women not to take herbal remedies or supplements, because there are no reliable studies about their effects during pregnancy. Since they are not regulated the way conventional medications are, there is no way to gauge the purity or actual dose of the substance you're taking. There may be many alternative and complementary therapies that are safe and/or helpful in pregnancy. But you need to do your research to find out if there is safety in pregnancy information, and physicians recommend that you discuss these modalities with them as well.
An excellent resource about both drugs and complementary modalities is the Mother Risk Program hosted by the Hospital for Sick Children in Toronto, Canada.
Organization of Teratology Information Services (OTIS)
US Department of Health & Human Services
Canadian Association of Family Physicians
Allaire AD, Moos MK, Wells SR. Complementary and alternative medicine in pregnancy: a survey of North Carolina certified nurse-midwives. Obstet Gynecol. 2000;95:19-23.
Gibson PS, Powrie R, Star J. Herbal and alternative medicine use during pregnancy: a cross-sectional survey. Obstet Gynecol. 2001;97:S44-S45.
Meadows M. Pregnancy and the drug dilemma. Food and Drug Administration website. FDA Consumer Magazine. May-June 2001. Available at: http://www.fda.gov/fdac/features/2001/301_preg.html.
Scialli AR. The Organization of Teratology Information Services (OTIS) registry study. Journal of Allergy and Clinical Immunology. 1999;103:373-376.
Last reviewed January 2009 by ]]>Jeff Andrews, MD, FRCSC, FACOG]]>
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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