During the course of your pregnancy, you will be told to be well aware of anything that you consume to protect the baby from potential harm, such as the medications. However, there is an increasing number of women taking medications during pregnancy. A study in Malaysia found that 62% of its respondents used at least one medication during their pregnancy and 30.8% of them took the medications during the first trimester.
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Understand the risk associated with the medication
To help doctors and pharmacists guide their decisions in selections of medications for pregnant patients, the Food and Drug Administration (FDA) has come up with a drug risk classification for pregnancy.
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As you can see, Category A and B are considered rather safe for pregnant women, category C is akin to a grey area, it’s best to avoid medications in category D and category X is a big no-no for pregnant women.
Most information provided in this classification is derived from animal studies and uncontrolled studies in humans such as postmarketing surveillance reports. Very few good studies have been conducted in pregnant women as it is unethical to do so, hence animal studies are the best shot we have here.
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Nonetheless, this pregnancy risk category is not perfect. First off, all new drugs approved by FDA will automatically be classified as Category C. Also, there are no FDA regulations requiring further studies or seeking more data; therefore, changes in the classification are rare. In addition, the classification is often not changed when new data become available. For all these reasons, the true risks of some medications may not be accurately reflected by this classification system.
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What are the common medications taken by pregnant women?
Over-the-counter (OTC) products are commonly used by pregnant women for minor ailments, such as allergies, cough, constipation, pain relief and indigestion. Nevertheless, a significant of pregnant women are on prescription drugs as well due to pre-existing or newly diagnosed conditions, such as epilepsy, high blood pressure and diabetes.
Here are some examples of the medications commonly taken by pregnant women:
|
Health issues |
Medications |
|
Allergies |
|
|
Cough |
|
|
Constipation |
Bulk-forming laxatives such as Fybogel® |
|
Pain relief |
Paracetamol (Panadol®, Uphamol®, pregnancy category: B ) |
|
Indigestion |
|
|
Skin conditions |
|
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These medications are a big NO-NO!
As mentioned above, medications in the risk category X is off-the-table for pregnant women, as animal studies involving those medications demonstrated birth defects. Some examples are:
|
Medications |
Reasons |
|
Blood cholesterol-lowering medications such as atorvastatin and simvastatin |
These medications inhibit the enzyme HMG-CoA reductase, thereby reducing level of cholesterol in the blood. However, this enzyme is also important for foetal development. A few conflicting studies were noted on this conclusion, however. Nonetheless, statins are still considered as pregnancy category X as of now. |
|
Methotrexate (commonly used for autoimmune diseases such as rheumatoid arthritis and certain cancers) |
Methotrexate inhibits dihydrofolate reductase (DHFR), an enzyme that participates in the production of the genetic material of body cells. It is useful for treating autoimmune disease and cancer, where cell deaths are favoured. However, if used during pregnancy, it can cause birth defects. |
|
Synthetic vitamin A derivatives such as isotretinoin (commonly used for treating severe acne) |
High doses of vitamin A can cause malformations on the central nervous system, heart, thymus and craniofacial structure of the foetus. |
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Risk vs Benefit: the grey area
In most of the incidences, however, doctors have to weigh the risk and benefits of prescribing medications in pregnant women. For instance, the use of phenytoin in a pregnant woman who has epilepsy requires the doctor to have careful considerations.
Firstly, most of the epilepsy patients have already got their condition under controlled on a certain medication at a certain dose, the decision of switching phenytoin to other medication is not favourable. However, phenytoin is a pregnancy category risk D medication, and the risks posed to the pregnant patient may outweigh its benefits. Management of epilepsy in pregnancy is, therefore, a challenging task. Hence, epilepsy patients are encouraged to discuss with their doctors should they desire to become pregnant.
Image credit: Epilepsy Foundation
Always talk to your healthcare professionals
In a nutshell, if you’re pregnant, you’re encouraged to talk to your doctor or a pharmacist on any medical decision. Being pregnant does not mean that you must refrain yourself from any medication even if you’re unwell, it also certainly does not mean that all medications are safe for you.
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