Medications During Pregnancy: Are they safe?

Taking medications during pregnancy is one of the things that raises the most fear and anxiety in pregnant women. It is also the area in which there is the least amount of hard scientific data about what’s safe and what isn’t. Drugs are almost never tested on pregnant women.

Advances in medicine have enabled us to treat diseases, but that has resulted in pregnant women being exposed to medicines more than ever before. Some medicines are life saving, others are less critical.

As a general rule, if you are taking regular medication — from psychiatric drugs like Fluoxetine (Prozac?) to anti-epileptics like Phenytoin (Dilantin?) — it’s a good idea to talk to your doctor before you get pregnant to see what effect the drug will have on the fetus. If the drug is medically necessary, like anti-epilepsy or heart medication then discuss it with your physician, but don’t stop on your own; if there is marginal value, like using Tretinoin (Retin A?) for acne (a derivative of vitamin A, some forms of which can cause birth defects), then don’t take it.

There are many large reference books devoted to this topic and each drug comes with a package insert that includes information about whether the medicine is considered safe in pregnancy.

Below are a few examples of the safety of certain medications in pregnancy.

• Antibiotics — With a few exceptions, most antibiotics are safe in pregnancy.Erythromycin is often used for things like ear infections because it crosses the placenta least. Avoid tetracycline, which can stain the baby’s developing teeth, and a group called quinolones, which includes Ciprofloxacin.
• Over-the-counter medications — Never take aspirin or ibuprofen or other related drugs (the “NSAID” category) because they can affect how the heart of the baby functions and alter the baby’s blood clotting. Read labels carefully on all cold remedies and upset stomach medications.Some, like Alka Seltzer and Pepto Bismol, for example, contain aspirin and should not be used by pregnant women. Take a drug for a specific symptom, not a combination product. Remember, aspirin does not cause birth defects, so if you took a few before you got pregnant or very early on, don’t worry.

  Aspirin can cause bleeding in the third trimester. We do use low doses for some women with recurrent miscarriages and clotting abnormalities, so if your provider suggests it, be sure you understand why.

• Anti-seizure medication — All anti-epileptics are associated with birth-defect syndromes, but it’s far more dangerous for Mom to stop medication and then have a seizure.Some studies have even suggested that it’s not the medicines that are the problem alone, but that women with seizure disorders may have a higher risk of birth defects in their children.

  Many women who have been free of seizures for several years may be able to safely stop taking medication, but do that only with physician guidance. It’s best to stop anti-epileptics before getting pregnant. That way if you have a problem you can get back on them before getting pregnant.

• Birth control pills — Some people get pregnant while on the pill, usually because they missed a few. If you took the pill before you realized you were pregnant, don’t worry. It has not been shown to cause birth defects.