See also:

• Baby on the Way? Keep Smoking at Bay
• The Dangers of Drinking for Two: Alcohol and Birth Defects

When planning to start a family, you may question the safety of over-the-counter or prescription drugs. It is important to know the risks of taking certain medications.

When possible, think ahead. It is best to address questions about medications and vitamins before you are pregnant. Ask your healthcare provider first 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 healthcare provider about any prescription medications you are taking. Both types of medications may need to be either discontinued or changed before you get pregnant.

FDA Safety Rating

Because of fear of harming the unborn baby, drug companies cannot test new medication on pregnant women. We learn about these effects in women who take over-the-counter medication or must stay on their prescription medications while they are pregnant.

Currently, the US Food and Drug Administration (FDA) requires that drugs be categorized according to their risk to pregnant women. The FDA uses Pregnancy Exposure Registries to help women and health professionals learn about the effects of medications on pregnancy. These registries record reported incidents of negative or positive reaction of medications in pregnant women. You can register and find information at the FDA website.

The Role of Teratology Specialists

What is teratology? It is the study of birth defects and abnormal development of the fetus during pregnancy. The Organization of Teratology Information Services (OTIS) MotherToBaby website provides expert information about prenatal exposures to medications, chemicals, and other substances. OTIS member organizations do not 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

Chronic Conditions

Do not stop taking any medications, herbs, or vitamins until your healthcare provider says that it is okay. Stopping medication may be more harmful than taking medication. Some chronic conditions that require regular medications include:

• Systemic lupus erythematosus (SLE)
• Diabetes
• Asthma
• Depression
• High blood pressure
• HIV

Not long ago, many women with chronic conditions, such as SLE 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.

In some cases, such as when women have asthma, depression, diabetes, high blood pressure, or HIV, stopping medication may 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.

It may be a good idea to work with a teratology specialist who can help you coordinate a healthcare team to help you manage your medical condition along with your pregnancy.

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 genetic counselor

Risks and Benefits

There are several common medications that do not cause birth defects. Others may involve risk, but there is no evidence to support it. Keep in mind that the benefits of taking some medications outweigh the risk of potential harm to the fetus. The FDA classifies risk to pregnancy on the following scale based on fetal harm:

• A—controlled studies show no risk
• B—risk unlikely
• C—risk cannot be ruled out
• D—positive evidence of risk (maternal benefit may outweigh fetal risk in serious or life threatening situations)
• X—contraindicated in pregnancy (positive evidence of serious fetal harm)

Here are some of the medications that involve risk

• C—Methamphetamine
• D—Streptomycin
• D—ACE inhibitors
• D—Aspirin (not recommended except for certain conditions.)
• D—Lithium
• D—Propylthiouracil
• D—Tetracycline
• D—Warfarin
• X—Accutane
• X—Methotrexate
• X—Soriatane
• X—Thalidomide

Non-steroidal anti-inflammatory drugs (NSAIDs) should be avoided in the third trimester. It is best to stop using alcohol, tobacco products, and illicit drugs if you plan on becoming pregnant, suspect pregnancy, or are already pregnant.

If you are taking prescription or over the counter medications, or need to start new ones, check with your healthcare provider to see what options you have available.

Herbs

Most medical professionals warn pregnant women not to take herbal remedies 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 know all the substances present and the purity or actual dose of the substance you are taking. There may be many alternative and complementary therapies that are safe and/or helpful in pregnancy. Nevertheless, you need to do your research to find out if there is information about their safety in pregnancy, and healthcare providers recommend that you discuss this with them, as well.

Medications and pregnancy are a complicated pair. If you are pregnant, or thinking about it, have a talk with your healthcare provider so you know what is safe for you and your baby.