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DRUG USE DURING PREGNANCY
Deciding About Drugs
Drugs pose dangers to the embryo or fetus throughout pregnancy, but they are especially of concern during the first trimester, when the vital organs and systems are developing, and the last trimester, when excessive bleeding can occur during labor. It is estimated that 10% to 45% of pregnant women in the first trimester, unaware of their condition, reach for the most common over-the-counter drug: aspirin. Aspirin and other drugs containing salicylate are not recommended throughout pregnancy, especially during the last 3 months, except under a doctor's supervision. Acetylsalicylate, a common ingredient in many over-the-counter painkillers, may prolong pregnancy and cause excessive bleeding before and after delivery.
Many over the counter drugs can be used during pregnancy with the supervision of a physician. Although scientists do not know the effects on the fetus of all over-the-counter and prescription drugs, some are known to cause birth defects and should be avoided.
Since 1984, all over-the-counter drug products have carried the following warning: "As with any other drug, if you are pregnant or nursing, seek the advice of a health professional before using this product." In July 1990, FDA issued a regulation requiring all oral and rectal nonprescription aspirin and drugs containing aspirin to include the additional warning: "It is especially important not to use aspirin during the last 3 months of pregnancy unless specifically directed to do so by a doctor because it may cause problems in the unborn child or complications during delivery."
One drug that can cause severe birth defects is Accutane, or isotretinoin. Accutane, a derivative of vitamin A, is a powerful prescription drug that can clear severe cystic acne, but can cause birth defects (such as heart defects, small jaw, cleft palate, and skull and facial disfigurements) in about 1 out of every 4 exposed fetuses. Accutane can also cause miscarriages.
Since its approval, Accutane has been labeled as being in pregnancy category X, meaning it should not be used during pregnancy. However, due to persistent reports of birth defects associated with the use of the drug in 1988, the manufacturer, Hoffman-La Roche, began including additional patient information in the packaging, including a drawing of a baby with birth defects associated with the drug. Before being permitted to take Accutane, a woman of childbearing age must sign a consent form stating that she has been fully informed of the drug's side effects.
Another derivative of vitamin A, etretinate (or Tegison), was approved in the mid-1980s to treat psoriasis. This drug is also forbidden for use by women who are pregnant or who are likely to become pregnant either while taking it or for a certain period after they have stopped taking it.
What About Alcohol?
While pregnancy is a time for celebration, toasting with champagne, a few beers, or any alcoholic beverage is not healthy for the fetus or the mother-to-be. Alcohol can cross the placenta and, in the case of heavy drinking (at least four standard drinks per day), can cause a condition known as "fetal alcohol syndrome," or FAS. Babies with FAS are frequently shorter and lighter in weight. They have the following characteristics:
- Smaller heads
- Abnormal features of the face, head, joints and limbs
- Heart defects
- Poor control of movements
- Mental retardation is common, as is hyperactivity, extreme nervousness, and poor attention span
According to a report, "Alcohol and Health," released by the Department of Health and Human Services in January 1990, some studies suggest that the more alcohol a mother drinks during pregnancy, the greater the danger to the fetus, especially in the first trimester. Because it is difficult to determine how much alcohol puts a fetus at risk and at what stages of pregnancy the fetus is affected, it is not known whether drinking any amount of alcohol is safe. The safest course at present, therefore, is for pregnant women to abstain from drinking alcoholic beverages.
Thomas G. Stovall, M.D.
Dr. Stovall is a Clinical Professor of Obstetrics and Gynecology at the University of Tennessee Health Science Center in Memphis, Tennessee and Partner of Women's Health Specialists, Inc.
Date Published: 2000-09-21
7800 Wolf Trail Cove, Germantown, TN 38138
Phone: (901) 682-9222; Fax: (901) 682-9505