Therapeutic Problems in Pregnancy

You should also tell your doctor or midwife if you smoke, drink alcohol or take illegal drugs, even if you only take them occasionally or socially. Effects of medication, drugs or substances during pregnancy Generally a drug, substance or medication can cause harm by: The potential for harm to the pregnancy and unborn baby depends on a range of factors including: Harmful drugs, substances and medications Some drugs, substances or medications may be harmful during pregnancy, depending on the amount and frequency of use.

These unknown substances can also be harmful to the pregnancy or fetus. Birth defects and medicines taken during pregnancy The risk of a birth defect for any baby is about four per cent, regardless of the circumstances during pregnancy. This means that even a woman who strictly avoids drugs and medications while pregnant may still have a baby with a birth defect.

Most medicines are not harmful to a developing baby. Teratogenic drugs and medicines Numerous drugs or drug groups may cause birth defects in a developing fetus, including: ACE angiotensin converting enzyme inhibitors used to treat high blood pressure or congestive heart failure angiotensin II antagonists, also used to treat high blood pressure or congestive heart failure Isotretinoin an acne drug alcohol cocaine high doses of vitamin A lithium male hormones some antibiotics some anticonvulsant medications some cancer-fighting medications some drugs that treat certain rheumatic conditions some thyroid medications Thalidomide the blood-thinning drug warfarin the hormone diethylstilbestrol DES.

This list is not complete. For example, the teratogenic effects of illegal drugs such as cannabis or amphetamines are not clear, because of the lack of medical studies. Pregnancy risk classification for medicines Medicines in Australia are given a risk category by the Australian Drug Evaluation Committee for drugs used in pregnancy, according to their safety information.

This category applies only to recommended doses. A — medications that have been taken by a large number of pregnant women without any proven increase risk of birth defect B — medications that have been taken by only a limited number of pregnant women. Human data is lacking and they are further categorised based on available data from animal studies B1 — animal studies have not shown any increased risk B2 — animal studies are limited, but there does not seem to be any increased risk B3 — animal studies show an increased risk, but it is not clear if this risk applies to humans C — medications that, due to their effects, may cause harm to the fetus without causing birth defects.

These effects may be reversible D — drugs that have caused or may cause birth defects. However, the health benefit may outweigh the risk X — drugs that have a high risk of birth defects and should not be used during pregnancy. See your doctor or pharmacist for further information and explanation. Medicines that may be necessary during pregnancy Good health in the mother is vital to ensure healthy development and growth of her unborn baby. Women with pre-existing medical conditions such as asthma, epilepsy, high blood pressure, thyroid conditions or diabetes must continue treatment with appropriate medications during pregnancy.

Sometimes, a prescription medication has the potential to cause harm to the baby. However, stopping the prescribed medication could also pose a threat to both the mother and her baby. If a pregnant woman who has asthma stops taking her medication, there is a risk of slowing the growth of her unborn baby. If a pregnant woman who has epilepsy stops her anti-epileptic medications, she may have an increased risk of having seizures, and complications to her pregnancy and unborn baby. Poorly managed maternal diabetes increases the health risk for the unborn baby.

In some cases, your doctor may be able to prescribe a similar medication that is considered safer to use during pregnancy.

Illnesses such as an acute respiratory infection like pneumonia or complications during pregnancy such as pre-eclampsia may be treated with prescription drugs. Do not stop taking or alter the dose of a prescribed medicine without the knowledge and consent of your doctor. Untreated, some illnesses or pregnancy complications may risk the health of the mother or baby, or both. Discuss any concerns you may have about medicines with your doctor or midwife. Smoking and alcohol during pregnancy Some pregnant women may be unaware that smoking and consuming alcohol and caffeinated drinks during pregnancy could risk the health of their unborn baby.

Babies have a greater risk of low birth weight, prematurity and sudden unexpected death in infants SUDI. However, heavy use greater than seven cups of coffee per day may be associated with an increased risk of low birth weight. Alcohol consumption during pregnancy Drinking alcohol during pregnancy has been associated with miscarriage, babies who are small for their gestational age and intellectual impairment in children known as fetal alcohol syndrome. No completely safe level of alcohol consumption has been determined for pregnant women.

The National Health and Medical Research Council recommendations for women who are pregnant, or might soon become pregnant, are that: Not drinking alcohol is the safest option.

Drug Use in Pregnancy; a Point to Ponder!

The risk of harm to the fetus is highest when there is high, frequent, maternal alcohol intake. The risk of harm to the fetus is likely to be low if a woman has consumed only small amounts of alcohol before she knew she was pregnant or during pregnancy. The level of risk to the individual fetus is influenced by maternal and fetal characteristics and is hard to predict. A standard drink contains 10 g of alcohol. Illegal drugs and pregnancy Since illegal drug use is a secretive activity, our knowledge on the effects of these drugs during pregnancy is limited.

Substances with some known effects include: Drugs used to treat heroin and other opioid dependence Methadone and buprenorphine are prescription drugs, sometimes called pharmacotherapies. They are used to help treat heroin and opioid dependency. The risks to the fetus and pregnancy associated with heroin use are greatly reduced with both of these treatments.

The benefits of pharmacotherapy are reduced if you continue to use heroin or other drugs. Recommendations for use of medication, drugs and substances during pregnancy Be guided by your doctor, but general recommendations include: Limit yourself to less than mg of caffeine per day which roughly equates to one espresso-style coffee or two cups of instant coffee per day, or four cups of medium strength tea or hot chocolate per day, or six cups of cola per day. See your doctor or seek drug counselling if you need help to quit smoking, alcohol or other drugs.

Be advised by your doctor or pharmacist. Using alternatives to medications during pregnancy Whenever possible, use non-drug alternatives to manage minor health concerns during pregnancy. Avoid heartburn by eating small, frequent snacks rather than three large meals. Use salt-water nasal sprays to treat nasal congestion. Avoid foods or smells that trigger nausea. References National clinical guidelines for the management of drug use during pregnancy, birth and the early development years of the newborn, , NSW Department of Health, for Australian Government. Clinical and Molecular Teratology, vol.

Australian guidelines to reduce health risks from drinking alcohol, , National Health and Medical Research Council, Australian Government. American Journal of Obstetrics and Gynecology, vol. Send us your feedback. Rate this website Your comments Questions Your details. Excellent Good Average Fair Poor. Next Submit Now Cancel. Please note that we cannot answer personal medical queries.

If you are looking for health or medical advice we recommend that you: Enter your comments below optional. Did you find what you were looking for? Your feedback has been successfully sent. Pregnancy and birth basics Stages of pregnancy Fertility issues and options Keeping healthy during pregnancy Health concerns during pregnancy Preparing for birth Preparing for a newborn Pregnancy and birth basics Childbirth - pain relief options Understanding your pain relief options can help you cope better with the pain of childbirth Pregnancy — labour Labour is divided into three stages.

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Pregnancy - premature labour Sometimes, babies arrive early. Contraception after giving birth After having a baby, you need to choose an effective method of contraception if you don't want to have another baby straight away If you want to get pregnant, timing is everything If you are trying for a baby, to increase your chances of conceiving, it helps to know when you are at your most fertile, and when is the best time to have sex Folate for pregnant women Even women who aren't planning to have a baby should increase their folate intake in case of unplanned pregnancy Contraception - emergency contraception It is best to take emergency contraception as soon as possible, ideally within 24 hours of having unprotected sex, but it still works well within 96 hours four days The categorisation system does not take into account the rare circumstance of an idiosyncratic reaction in the neonate to a medicine that crosses the placenta.

The pregnancy categorisation system only applies to recommended therapeutic doses in women. It cannot be assumed that the classifications assigned to individual medicines are valid in situations such as:.

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While some medicines are genuinely teratogenic, and carry a category X, for most medicines the risk of developing birth defects is also dependent on:. Thus, a low dose, limited topical application of a medicine for a particular indication may have a less restrictive category such as A compared to a more restrictive category for the same medicine given long-term or at higher doses orally for a different indication. The categorisation of medicines for use in pregnancy does not follow a hierarchical structure. Due to legal considerations in Australia, sponsor companies have, in some cases, applied a more restrictive category than can be justified on the basis of the available data.

For pharmaceutical products containing two or more active ingredients, the categorisation of the combination is based on the active ingredient with the most restrictive pregnancy categorisation. Drugs which have been taken by a large number of pregnant women and women of childbearing age without any proven increase in the frequency of malformations or other direct or indirect harmful effects on the fetus having been observed.

Drugs which have been taken by only a limited number of pregnant women and women of childbearing age, without an increase in the frequency of malformation or other direct or indirect harmful effects on the human fetus having been observed. Studies in animals are inadequate or may be lacking, but available data show no evidence of an increased occurrence of fetal damage.

Studies in animals have shown evidence of an increased occurrence of fetal damage, the significance of which is considered uncertain in humans. Drugs which, owing to their pharmacological effects, have caused or may be suspected of causing, harmful effects on the human fetus or neonate without causing malformations. These effects may be reversible. Accompanying texts should be consulted for further details.

Drugs which have caused, are suspected to have caused or may be expected to cause, an increased incidence of human fetal malformations or irreversible damage. These drugs may also have adverse pharmacological effects. Drugs which have such a high risk of causing permanent damage to the fetus that they should not be used in pregnancy or when there is a possibility of pregnancy. This database is intended to provide information to health professionals planning the medical management of pregnant patients or patients intending to become pregnant.

It is not presented as medical advice to health professionals or the public. The use of any medicine during pregnancy requires careful consideration of both risks and benefits by the treating health professional. Any decision about taking a medicine during pregnancy should:. This database must not be used as the sole basis of decision making in the use of medicines during pregnancy.

College of Pharmacy, Vallabh Vidyanagar , India. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

This article has been cited by other articles in PMC. Abstract Pregnancy is a special physiological condition where drug treatment presents a special concern because the physiology of pregnancy affects the pharmacokinetics of medications used and certain medications can reach the fetus and cause harm. Teratogenic drugs, physiology of pregnancy, FDA categories of drugs, drug use in pregnancy. Category Description A Adequate, well-controlled studies in pregnant women have not shown an increased risk of fetal abnormalities.

B Animal studies have revealed no evidence of harm to the fetus; however, there are no adequate and wellcontrolled 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. C 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. D Studies, adequate well-controlled or observational, in pregnant women have demonstrated a risk to the fetus.

However, the benefits of therapy may outweigh the potential risk. X Studies, adequate well-controlled or observational, in animals or pregnant women have demonstrated positive evidence of fetal abnormalities. The use of the product is contraindicated in women who are or may become pregnant. Open in a separate window. FDA categorization of drugs for use in pregnancy. Drug Comments Vitamin A and its derivatives including isotretinein, accutane and etretinate.

Significant risk of spontaneous abortion[ 20 ] and risk of many significant anomalies[ 21 ] ACE inhibitors May cause kidney damage in the fetus when used in II and III trimester, decrease in the amount of amniotic fluid and deformities of face, limbs and lungs[ 7 ] Anticoagulants- warfarin Use during I trimester produces defects like nasal hypoplasia and a depressed nasal bridge; termed as Fetal warfarin Syndrome.

Estrogen and Androgens Genital tract malformations[ 8 ]. Thyroid preparations- Methimazole Overactive and enlarged Thyroid gland Carbimazole Overactive and enlarged Thyroid gland Radioactive iodine Underactive Thyroid gland in fetus Propylthiouracil Safe[ 7 ].

Anticonvulsants- Carbamazepine Risk of birth defects Phenytoin, Phenobarbitone Bleeding problem in the newborn which can be prevented if pregnant woman takes Vit.

PHYSIOLOGICAL CHANGES IN PREGNANCY

K by mouth every day for a month before delivery or if the newborn baby is given an injection of Vit. K soon after birth[ 7 ]. Risk of birth defects. Trimethadione Increased risk of miscarriage in the women Sodium valproate Increased risk of birth defects in fetus; including a cleft palate and abnormalities of the heart, face, skull, hands or abdominal organs[ 7 ]. Antidepressants- Lithium Birth defects mainly of the heart , lethargy, decreased muscle tone, underactivity of Thyroid gland and nephrogenic diabetes insipidus in the new born.

Ebstein's anomaly tricuspid valve malformation has been reported in a number of foetuses exposed to this drug[ 7 ]. NSAIDs Aspirin and other Salicylates Delay in start of labor, premature closing of ductus arteriosus, jaundice, brain damage in the fetus and bleeding problems in the woman during and after delivery and in the newborn[ 7 ]. Antibiotics- Tetracycline Slowed bone growth, permanent yellowing of the teeth and increased susceptibility to cavities in the body[ 7 ]. Chloramphenicol Gray Baby Syndrome[ 7 ]. Ciprofloxacin Possibility of joint abnormalities seen in animals [ 7 ] Kanamycin and Streptomycin Damage to fetus's ear resulting in deafness risk of ototoxicity [ 7 ] Sulfonamides Jaundice and brain damage in newborn[ 7 ] Antineoplastic agents- Busulfan Birth defects such as less than expected growth before birth, underdevelopment of lower jaw, cleft palate, abnormal development of skull bones, spinal defects, ear defects and club foot[ 7 ].

Chlorambucil Cyclophosphamide Methotrexate Oral Hypoglycemic drugs A very low level of sugar in the blood of newborn. Inadequate control of diabetes in the pregnant woman[ 7 ] Chlorpropamide Tolbutamide. SOCIAL DRUGS In addition to counseling pregnant women regarding use of various prescribed and non-prescribed medications during pregnancy, other substances that are also used by some women during pregnancy should not be overlooked. Footnotes Sachdeva, et al.: Risk and benefit of drug use during pregnancy. Int J Med Sci.

Medications in pregnancy and lactation. Amer J Maternal Child Nursing. Take two Aspirin or not? Risk of medication use during pregnancy. Difficulties in the study of adverse fetal and neonatal effects of drug therapy during pregnancy.

Heparin therapy during pregnancy. Risks to the fetus and mother.

Mother and Child Glossary; [updated on Jul 9]. Maternal Physiology during Pregnancy.

Current obstetrics and gynaecological diagnosis and treatment. Merck Research Lab; Drug use in specific patient populations: Shargel L, Mutnick A, editors. Lippincott William Wilkins; Yankowitz J, Niebyl JR, editors. Drug therapy in pregnancy. Hansen W, Yankowitz J. Pharmacologic therapy for medical disorders during pregnancy. Placental transfer of drugs. Pharmacokinetic changes during pregnancy and their clinical relevance. Drug utilization pattern during pregnancy in North India.

Prescription drug use in pregnancy. Am J Obstet Gynaecol. Drugs in pregnancy and lactation.

Drug Use in Pregnancy; a Point to Ponder!

Splinter MY, Sagraves R. Prenatal use of medications by women giving birth at a university hospital. A study of drug utilization during pregnancy in the light of known risks. Int J Risk Safety Med. Drugs in Pregnancy and Lactation. Text book of Therapeutics, Drug and Disease Management. Obstetrics Handbook for Maternal Health. Niche Laboratories Ltd; Drug effects on the fetus and breastfed infants. Which medications are safe in pregnancy? Pregnancy and the drug dilemma. Koren G, Pastuszak A.

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N Eng J Med. Support Center Support Center. Please review our privacy policy. Adequate, well-controlled studies in pregnant women have not shown an increased risk of fetal abnormalities. Animal studies have revealed no evidence of harm to the fetus; however, there are no adequate and wellcontrolled studies in pregnant women. 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.

Animal studies have shown an adverse effect and there are no adequate and well-controlled studies in pregnant women. No animal studies have been conducted and there are no adequate and well-controlled studies in pregnant women. Studies, adequate well-controlled or observational, in pregnant women have demonstrated a risk to the fetus.