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Pregnancy and the Drug Dilemma

What medicines are safe for mom-to-be and her fetus

SUNDAY, Oct. 20, 2002 (HealthDayNews) -- You're pregnant, and suddenly laid low by a cold or strep throat. Should you take medicine?

What about regular asthma medication?

In fact, what drugs are safe for pregnant women and their babies?

Questions like these pop up all the time when expectant mothers talk with their obstetricians. The answers, doctors say, depend on the situation.

"For the nine-month period of pregnancy, my first choice would be to take nothing," says Dr. Shari Brasner, an obstetrician and gynecologist at Mount Sinai Hospital in New York City and author of Advice from a Pregnant Obstetrician.

Her reasoning: Women tend to irrationally blame themselves if something happens in the pregnancy or later in a baby's life.

"The feeling of guilt is a real phenomenon, and they will go back and point to medicine they took, from a Tylenol to a tranquilizer, if they have an adverse outcome with their baby," Brasner says. "But, having said that, there are clear indications for the use of medication during pregnancy."

Women on long-term medication to treat a chronic condition, such as asthma, seizure disorders or depression, need guidance about the risks of their drugs on the fetus. Brasner recommends those women have pre-conception counseling to discuss their options, which can include stopping the drug for the duration of the pregnancy, continuing it as before, or, in some cases, switching to drugs with less risk to the fetus.

Dr. John Larsen, an obstetrician at George Washington University Hospital in Washington, D.C., treats many women with high-risk pregnancies and says about one-third of his patients are on some kind of long-term medication for conditions ranging from depression to high blood pressure.

"You have to do a risk/benefit analysis with these women because you have two patients -- them and their babies," he says.

Sometimes medication can be safely stopped, say, when a women who has been taking it for a long time gets a new health assessment and finds she no longer needs the drug. In other cases, you can substitute a new drug with less risk for a fetus, Larsen says.

He points to some medications for lowering blood pressure as an example. One class of drugs, called ACE inhibitors, can cause birth defects, Larsen says.

So doctors can switch a woman to another drug -- such as methyldopa, which belongs a class of medicines called antihypertensives, Brasner says.

The U.S. Food and Drug Administration (FDA) has a rating system for drugs' effects on a fetus, and doctors and pharmacists can quickly consult it to see how harmful a drug is known to be for unborn babies.

Sometimes, however, a woman needs to continue taking a drug, and doctors must assess the risk to the fetus as best they can during the course of the pregnancy.

A woman who takes an antidepressant such as Zoloft or Prozac for mild mood swings, for instance, might be able to stop the drug for the duration of her pregnancy. However, a severely depressed woman who takes lithium should most likely continue with the drug, Larsen says.

Since lithium is not recommended for use during pregnancy, especially during the first three months, according to the FDA, Larsen says you must be diligent about monitoring the fetus.

"Lithium is teratogenic (harmful to the fetus), so it is really important to test the fetus during the pregnancy" for potential heart problems, he says.

Happily, most women are generally healthy when they become pregnant, and for those women the questions of medication are less pressing.

Brasner recommends that her patients try to avoid all medication for the first trimester of a pregnancy, when the baby's organs are developing. By the second trimester, it's all right to take over-the-counter cough and cold remedies, for instance, she says.

"When they call about it, though, I explain that the medicines will only give them symptom-relief until the cold abates. And they will often say, 'Oh, I can wait it out,' and not take anything," Brasner says.

There are exceptions, however.

When pregnant patients get a bacterial infection, Brasner urges them to take antibiotics as soon as possible. For instance, upper respiratory tract and urinary tract infections need immediate care, and there are many antibiotics, such as penicillin and cephalosporins, that are safe for pregnant women and their fetus, Brasner says.

"There's a lot of resistance to taking medicine. They're very health-conscious and worried about the baby," she says of her patients. However, she tells them that if they're sick, it's not helping the fetus in the least.

Adds Larsen: "If you have a fever, or diarrhea that won't stop, you're over the line in terms of sacrificing for your baby."

What To Do

For more on pregnancy and the "drug dilemma," visit the U.S. Food and Drug Administration. To see how illicit drugs -- and even legal ones such as alcohol -- can harm a fetus, check with the National Library of Medicine.

SOURCES: Shari Brasner, M.D., obstetrician and gynecologist, Mount Sinai Hospital, New York City, and author Advice from a Pregnant Obstetrician; John Larsen, M.D., professor, obstetrics and gynecology, George Washington University Hospital, Washington, D.C.
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