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Drugs During Pregnancy? What's Safe

During pregnancy, medications taken by the pregnant woman can cross the placenta and enter the developing baby’s bloodstream. A medicine’s effect on the unborn baby depends on the medication and the trimester in which the medicine is taken.

What Is Safe?

So how do you know which drugs are safest to you and your baby-to-be? The Food and Drug Administration ranks the following as the least harmful classes of drugs during pregnancy:

  • Category A

    These drugs have been tested and found to be safe during pregnancy. Category A includes drugs such as folic acid, vitamin B6, and some thyroid medicines in prescribed doses.

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  • Category B

    These drugs are frequently used during pregnancy and do not appear to cause major birth defects or other problems. Category B includes 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.

    Most pregnant women know that it’s wise to avoid taking medications during pregnancy, yet sometimes prescription drug use is warranted even for those who are expecting. Always consult your doctor about taking any medications, whether prescription or over-the-counter.

    The following overview will give you more information on what medications physicians generally recommend for their pregnant patients.

    Anesthesia: It is preferable to avoid surgery during pregnancy. However, if surgery is needed, the best time to schedule this is during second trimester (weeks 13-24), because this will not expose an early fetus to drugs, and it’s still too early to provoke a premature labor. A recent study published in the Oxford Journal suggests that regional anesthesia should be used in preference to general anesthesia where appropriate.

    Chances are you’ll visit the dentist at some point during your pregnancy. If possible, try to plan your dental visit after weeks six through nine when your baby’s internal organs are developing.

    If you are having dental surgery that requires anesthetics, these may make you jittery and can create palpitations, especially with the normal changes in the heart that accompany pregnancy. However, while this is an inconvenience, it is temporary and will not harm your baby.

    Antibiotics: Unless you have a specific allergy, drugs in the penicillin category (penicillin G, ampicillin, etc.) are safe to take during pregnancy, and the same is true for antibiotics in the cephalosporin category (Keflex, etc.). Most types of erythromycin are also safe, as is vancomycin (for those with penicillin allergies).

    Macrodantin is commonly prescribed for urinary tract infections during pregnancy. Although this antibiotic has been known to cause serious anemia in rare cases, the benefit far outweighs the risk.

    For upper respiratory infections involving sinusitis, pharyngitis, or other non-viral infections, the drug of choice is penicillin.

    Antidepressants: Many antidepressants have an excellent safety record in the second and third trimesters, so discuss your condition with your doctor who can then determine whether the risk of antidepressants outweighs the benefit.

    Asthma Medications: Pregnancy is an additional physiological challenge that can impact the severity of asthma. According to the American College of Allergy, Asthma, and Immunology well-controlled asthma is not associated with significant risk to mother or fetus. Although uncontrolled asthma is rarely fatal, it can cause serious complications to the mother, including high blood pressure, toxemia, and premature delivery.

    For the baby, complications of uncontrolled asthma include increased risk of stillbirth, fetal growth retardation, premature birth, low birth weight and a low APGAR score at birth. You should follow your obstetrician’s advice regarding the risk versus benefit.

The Food and Drug Administration offers the following classifications for prescription drugs that should not be taken during pregnancy:

  • Category C

    These are drugs that are more likely to cause problems for the mother or fetus, and 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.

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  • Category D

    These include drugs that have clear health risks for the fetus 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.

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  • Category X

    These drugs 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).

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