MEDICATION IN PREGNANCY

Is it safe to take medicine while you are pregnant?

It can be hard to plan exactly when you will get pregnant, in order to avoid taking any medicine. Most of the time, medicine a pregnant woman is taking does not enter the foetus. But sometimes it can, causing damage or birth defects. The risk of damage being done to a foetus is the greatest in the first few weeks of pregnancy, when major organs are developing. But researchers also do not know if taking medicines during pregnancy also will have negative effects on the baby later.

Many drugs that you can buy over-the-counter (OTC) in drug and discount stores, and drugs your health care provider prescribes are thought to be safe to take during pregnancy, although there are no medicines that are proven to be absolutely safe when you are pregnant. Many of these products tell you on the label if they are thought to be safe during pregnancy. If you are not sure you can take an OTC product, ask your health care provider.

Some drugs are not safe to take during pregnancy. Even drugs prescribed to you by your health care provider before you became pregnant might be harmful to both you and the growing foetus during pregnancy. Make sure all of your health care providers know you are pregnant, and never take any drugs during pregnancy unless they tell you to.

Also, keep in mind that other things like caffeine, vitamins, and herbal teas and remedies can affect the growing foetus. Talk with your health care provider about cutting down on caffeine and the type of vitamins you need to take. Never use any herbal product without talking to your health care provider first.

The Food and Drug Administration (FDA) has a system to rate drugs in terms of their safety during pregnancy. This system rates both over-the-counter (OTC) drugs you can buy in a drug or discount store, and drugs your health care provider prescribes. But most medicines have not been studied in pregnant women to see if they cause damage to the growing foetus. Always talk with your health care provider if you have questions or concerns.

The FDA system ranks drugs as:

• Category A - drugs that have been tested for safety during pregnancy and have been found to be safe. This includes drugs such as folic acid, vitamin B6, and thyroid medicine in moderation, or in prescribed doses.

• Category B - drugs that have been used a lot during pregnancy and do not appear to cause major birth defects or other problems. This includes drugs such as some antibiotics, acetaminophen (Tylenol), aspartame (artificial sweetener), famotidine (Pepcid), prednisone (cortisone), insulin (for diabetes), and ibuprofin (Advil, Motrin) before the third trimester. Pregnant women should not take ibuprofen during the last three months of pregnancy.

• Category C - drugs that are more likely to cause problems for the mother or foetus. Also includes drugs for which safety studies have not been finished. The majority of these drugs do not have safety studies in progress. These drugs often come with a warning that they should be used only if the benefits of taking them outweigh the risks. This is something a woman would need to carefully discuss with her doctor. These drugs include prochlorperzaine (Compazine), Sudafed, fluconazole (Diflucan), and ciprofloxacin (Cipro). Some antidepressants are also included in this group.

• Category D - drugs that have clear health risks for the foetus and include alcohol, lithium (used to treat manic depression), phenytoin (Dilantin), and most chemotherapy drugs to treat cancer. In some cases, chemotherapy drugs are given during pregnancy.

• Category X - drugs that have been shown to cause birth defects and should never be taken during pregnancy. This includes drugs to treat skin conditions like cystic acne (Accutane) and psoriasis (Tegison or Soriatane); a sedative (thalidomide); and a drug to prevent miscarriage used up until 1971 in the U.S. and 1983 in Europe (diethylstilbestrol or DES).

Aspirin and other drugs containing salicylate are not recommended during pregnancy, especially during the last three months. In rare cases, a woman's health care provider may want her to use these type of drugs under close watch. Acetylsalicylate, a common ingredient in many OTC painkillers, may make a pregnancy last longer and may cause severe bleeding before and after delivery.

Whether or not you should continue taking medicine during pregnancy is a serious question. But, if you stop taking medicine that you need, this could harm both you and your baby. An example of this is if you have an infection called toxoplasmosis, which you can get from handling cat feces or eating infected meat. It can cause problems with the brain, eyes, heart, and other organs of a growing foetus. This infection requires treatment with antibiotics.

For pregnant women living with HIV, the Centers for Disease Control and Prevention (CDC) recommends the drug zidovudine (AZT). Studies have found that HIV positive women who take AZT during pregnancy decrease by two-thirds the risk of passing HIV to their babies. If a diabetic woman does not take her medicine during pregnancy, she increases her risk for miscarriage and stillbirth. If asthma and/or high blood pressure are not controlled during pregnancy, problems with the foetus may result. Talk with your health care provider about whether the benefits of taking a medication outweigh the risk for you and your baby.

While some herbal remedies say they will help with pregnancy, there have been no studies to figure out if these claims are true. Likewise, there have been very few studies to look at how safe and effective herbal remedies are. Echinacea, Gingko biloba, and St. John's Wort have been popular herbs, to name a few. Do not take any herbal products without talking to your health care provider first. These products may contain agents that could harm you and the growing foetus, and cause problems with your pregnancy.