This is a very complex subject.
Patients are often given too little information.
Absolute proof of medication safety or danger is often not available.
See REASONABLY SAFE MEDICATIONS in pregnancy below
COUNSELING DRUG EXPOSURE: If you have been exposed to drugs during pregnancy and wish to know possible risks to your baby, You must carefully weigh the evidence (or the lack of evidence), regarding a drug’s safety (See the OTIS, SafeFetus, MotherRisk and Dart database websites below). In most cases, the information available is limited and it may be truly unclear whether a particular drug or chemical may cause birth defects. In such cases the decision must be based on your need for the drug versus your willingness to accept largely unknown risks. Fortunately, it is still correct to say that most drugs or chemical exposures (with some notable exceptions!) do not pose an observable risk to the fetus. If you would like further Information regarding drugs in pregnancy, consider searching on the Links Provided or Consider a consultation with EVMS.
It should be pointed out that many other substances (cigarettes, alcohol, and miscellaneous chemicals at home or at work) might contribute to problems such as birth defects and delayed growth of the baby. Also it is also important to realize that your baby has a 2-3% risk of major birth defects even in the absence of drug exposure.
BEFORE 5 WEEKS PREGNANCY: from the last menstrual period there is a phenomenon sometimes called the “ALL OR NOTHING EFFECT”. This means that with drug exposure there tends to be either a miscarriage or else no effect at all.
FROM THE 5TH TO 12TH WEEKS PREGNANCY: from the last menstrual period the fetus is most sensitive to the effect of of drugs during this time. the infant is most sensitive to drug exposure causing a birth defect.
AFTER 12 WEEKS PREGNANCY: from the last menstrual period The baby’s “blueprint” is established and drugs generally pose a clearly lower risk to the fetus.
You should consider the near infinite combinations of drugs and substances to which you may be exposed and be aware that extremely little is known about the effect of these combinations. This information has been given to you with the hopes that you will ask questions and seek further information.
Finally, it is entirely up to you to choose how to use this information.
1. You may either choose to accept the risks (often hard to define accurately)
2. Seek a second opinion (Eastern Virginia Medical School) – provides the highest level of insight regarding risk.
3. Ask our opinion (the available information is helpful but incomplete)
4. Do Personal Research (see the Websites above)
5. Choose other personal options.
Taking certain medications during pregnancy can cause serious birth defects. Examples are thalidomide (also known as Thalamid®) and isotretinoin (also known as Accutane®). Such medications should be avoided by all women who are or might become pregnant.
NECESSARY RISK: Sometimes a pregnant woman takes medications before she realizes she is pregnant or must take a medication to treat health conditions such as asthma, epilepsy (seizures), high blood pressure, or depression. If untreated, these conditions could harm a pregnant woman or her unborn baby. It is important to discuss which medications are needed during pregnancy and which are likely to be the safest to take during pregnancy. Furthermore it is necessary to balance the possible risks and benefits of any medication being considered.
UNFORTUNATELY: There is little or limited information about the safety of most medications during pregnancy—including over the counter medications. Each medicine must be separately considered. Pregnant women usually are not included in FDA studies of drug safety because of the possible risks to the unborn baby. The effects depend on many factors, such as:
- How much medication was taken.
- When during the pregnancy the medication was taken.
- Other health conditions a woman might have.
- Other medications a woman takes.
Websites to look up Drug and Medication Safety in Pregnancy
Mother To Baby – Click on link Free Counselors available Monday through Friday, from 9 a.m. to 5 p.m. EST
Safe Fetus – Complete database of fetal risk during pregnancy and breastfeeding – according to the FDA.
Dart– A sophisticated database of the reproductive toxicology literature.
REASONABLY SAFE MEDICATIONS*: when taken according to the package directions the following medications do not appear to pose an observable risk to the fetus and are commonly used by physicians treating patients in the United States. They are safest after 12 weeks of pregnancy.
Prenatal Vitamins with DHA – No known risk to fetus.
Allergy: Benadryl (diphenhydramine), Plain Claritin or Zyrtec taken at normal doses. (Do NOT take Claritin D or Zyrtec D).
Cold and Flu: Tylenol (acetaminophen) for aches and pains, Chlortrimeton for runny nose, Saline nasal drops or spray, Warm salt/water gargle, Dr. Smith’s Cherry throat lozenges, Vicks vapor rub, hot chicken soup, rest. AFTER 13 weeks of pregnancy then Tylenol Cold multi symptom – Non-Drowsey or Night Time versions for symptom management (warning drowsy!)
Constipation: Prunes (refrigerated), bran cereal, Colace, Metamucil, Miralax.
First Aid Ointment: Bacitracin, J&J First-Aid Cream, Neosporin, Polysporin
Heartburn: Avoid eating/drinking before laying down, Maalox or Mylanta at normal doses, Zantac 150mg by mouth twice a day.
Headache: Tylenol (acetaminophen), Tylenol plus caffeine (1-2 cups), Tylenol plus Metaclopramide, Tylenol plus codeine, Tylenol plus butalbitol (Fioricet)
Hemorrhoids: Keep BM soft, use tucks pads and preparation H with hydrocortisone after each BM. (no suppositories!)
Rashes: Benadryl cream, Caladryl lotion or cream, Hydrocortisone cream or ointment
Nausea Early Pregnancy: (click here for more nausea info) Sliced lemons in a baggie, suck on atomic fireballs, Reliefband device, ginger root (250 milligram capsules 4 times a day), and vitamin B6 (pyridoxine, 25 milligrams two or three times a day) work well. Sipping the thick syrup from inside a can of peaches, pears, mixed fruits, pineapples, or orange slices may also help.
Backache: Rest 24-48 hours, consider Maternity Support Belt, consider Chiropractic manipulation (holds a good track record) Tylenol, warm shower, wear flat running shoes, avoid heavy lifting.
Pain relief in labor: Epidurals are most effective, but immersion in a warm bath can also relieve tension. Relaxation and breathing techniques, emotional support, and self-hypnosis are widely used in labor. Acupuncture can also work for some women.
MOST HERBAL SUBSTANCES HAVE NOT BEEN PROVEN SAFE DURING PREGNANCY.
AVOID THE FOLLOWING: (INCOMPLETE LIST) thought to cause birth defects and encourage early labor. Arbor vitae, beth root, black cohosh, blue cohosh, cascara, chaste tree berry, Chinese angelica (dong quai), cinchona, cotton root bark, feverfew, ginseng, golden seal, juniper, kava kava, licorice, meadow saffron, pennyroyal, poke root, rue, sage, St. John’s wort, senna, slippery root, tansy, white peony, wormwood, yarrow, yellow dock, and vitamin A (large doses can cause birth defects).
AVOID THESE ESSENTIAL OILS: Calamus, mugwort, pennyroyal, sage, wintergreen, basil, hyssop, myrrh, marjoram, and thyme.