Medicines in pregnancy: what is safe and what should you watch out for?
During pregnancy, most women pay special attention to a proper diet, give up stimulants or other harmful factors, and carefully choose their forms of physical activity. It results, of course, from the common knowledge about the enormous influence of the intrauterine environment on the quality of development of a growing human being. We know how important a future mother's good health is for the optimal development of her child.
Most of the factors that may harm the proper course of pregnancy are known. Among them, a large group of drugs are drugs that, as chemicals, can not only cross the placenta, but also affect the developing fetus in a more unpredictable way than we would expect in an adult. We invite you to read this article. You will learn, among other things, which drugs can be safely used during pregnancy and whether there are any drugs that are prohibited, e.g. in the first trimester of pregnancy.
Pregnancy and treatment
Treatment of sometimes trivial diseases common in the population can be a big challenge for pregnant women. It is known that a huge group of drugs cannot be used by pregnant women. This is due not only to their direct impact on the fetus developing in the uterus and the possibility of damaging the organs that are forming, but also to the change in pharmacokinetics, i.e. the way in which various drugs are metabolized in the mother's body.
Safety of drug use during pregnancy and breastfeeding
The FDA - the American Food and Drug Administration, to facilitate making therapeutic decisions, has created a classification of drugs, dividing them into categories, depending on the safety of their use during pregnancy and breastfeeding. This division is largely based on the experience of clinicians over the years.
FDA drug classification:
- Category A: Controlled studies performed in pregnant women did not show any harmful effects of drugs on the fetus;
- B category: Animal studies have shown no or no risk to the fetus but have not been confirmed in pregnant women;
- Category C: In animal studies, there was an adverse effect on the fetus, but no controlled studies in pregnant women are available;
- Category D: There is a documented risk of harm to the unborn child;
- Category X: The documented foetotoxicity in humans and the risk of use in a pregnant woman outweighs any possible benefit.
Drugs of categories A and B can safely used in pregnant women. However, in the case of category C drugs, they are only used when their benefit to the mother outweighs the risk of an adverse reaction to the fetus. As for category D, these drugs can be used in pregnant women only in conditions that threaten the mother's life. However, category X drugs are absolutely contraindicated in a pregnant patient or a woman trying to conceive.
Drugs are strictly forbidden in pregnant women and those trying to conceive
Group X drugs lead to significant damage to the embryo or fetus and miscarriage. This group includes, among others:
- statins, fibrates;
- estrogens, testosterone, antiandrogens;
- methotrexate;
- radioactive iodine;
- ribavirin;
- vitamin A derivatives;
- benzodiazepines;
- warfarin;
- misoprostol;
- ergotamine;
- leflunomide, raloxifene;
- MMR vaccinations: measles, rubella, mumps.
All of the above drugs can therefore lead to miscarriage and pregnancy loss and are forbidden. Regardless of whether you want to use them in the first trimester or later.
Pharmaceuticals can also change their category depending on the trimester of pregnancy. An example is non-steroidal anti-inflammatory drugs, which can be used as second-choice drugs in the second trimester of pregnancy, but are already contraindicated in the third trimester due to the risk of premature closure of the bubonic tube, necessary for the proper functioning of the fetal circulation.
Are medications prohibited during the first trimester of pregnancy?
Expert advises
The most critical time is the period of organogenesis, i.e. the formation of subsequent organs of the embryo, which takes place in the first trimester of pregnancy. During this time, many environmental and pharmacological factors can adversely affect development, causing miscarriage or birth defects to the fetus. So this is the period in which we avoid taking medications without consulting a doctor.
If necessary, drugs considered to be the safest for the embryo and thus the least interfering with its development are used. The knowledge about their safety was gained on the basis of the experience of clinicians and the knowledge of pharmacokinetics, which allows to determine whether a given substance crosses the placenta.
What medications are safe to use in pregnancy?
One of the most common situations that requires treatment is an upper respiratory tract infection, or the common cold. It is not always possible to contact your doctor immediately. It is therefore worth knowing what substances can be safely used at the beginning of a developing infection. Treatment should be based on natural ingredients. We know the beneficial effects of garlic, ginger and natural sources of vitamin C. Plant preparations dedicated to pregnant women to alleviate a sore throat are widely available. In case of fever or pain, paracetamol is considered the safest drug.
Recommended products
Head of the Department of Assessment and Development of Cooperation at the Institute of Mother and Child
Fungal infections in pregnancy
Another health problem that a pregnant woman may face is vaginal fungal infections. Topical medications based on clotrimazole will be the best choice, also because of their availability at the pharmacy.
Urinary tract infections
Urinary tract infections may occur more frequently during pregnancy. It is worth remembering that furaginium, commonly used in the population, cannot be given to pregnant women in the first and third trimesters. Therefore, while waiting for gynecological control, only preparations that acidify the urine, e.g. with cranberries, may be consumed.
What about nausea and vomiting?
Nausea and vomiting are a very characteristic symptom of pregnancy, especially in the first trimester. Routine use of antiemetics is not recommended during this time. The method of choice is to include ginger in your diet. Only in the case of a significant worsening of the problem, weight loss, risk of dehydration or serious electrolyte disturbances, pharmacotherapy is used under the supervision of the attending physician.
Flatulence and pregnancy
Due to the hormonal game, bloating is another common problem during pregnancy. Preparations that reduce surface tension such as simethicone only work in the intestine. So they can be safely used at any stage of pregnancy.
Vitamins
Objections may also apply to vitamin preparations, chosen independently by women planning the concept or already pregnant. In this case, multivitamin supplements are not the best choice. Rather, it is advisable to follow the rule: the fewer the better. In the first trimester, folic acid or its active form - metapholin, vitamin D3 and iodine - are most often sufficient. In subsequent trimesters, we add omega-3 acids and, depending on the indications, iron, B vitamins, magnesium or potassium.
Chronic diseases and treatment in pregnancy
Expert advises
In the case of chronic diseases, known and treated before pregnancy, the situation may be difficult. Each patient requires an individual approach and constant cooperation between the obstetrician and a specialist in a given field. Each pregnancy should be planned and discussed with the attending physician at the pre-contraceptive stage, as it may be necessary to change drugs and adjust the therapeutic process.
The most common chronic disease affecting women of childbearing age is hypothyroidism. In the treatment of the disease, levothyroxine is used, which is a thyroid hormone that can also be safely used in pregnancy. This hormone is even necessary for the proper course of pregnancy.
Drugs that can be used during pregnancy also include progesterone, acetylsalicylic acid, i.e. aspirin, and low molecular weight heparins as anticoagulants. These drugs, when properly indicated, are not only safe, but also often help to maintain pregnancy.
Consult your doctor about your treatment
The topic of drug safety in pregnancy is quite a difficult and extensive issue. The best solution is to discuss the pharmaceuticals you are taking with your doctor individually, before trying to become pregnant or during your first pregnancy visit. In the daily choices of supplementation and treatment methods, it is safest to stick to the principle that less is better, especially in the first trimester of pregnancy.
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