Treating for Two: Medicine in Pregnancy
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It is recommended to avoid using medicines during pregnancy because most medicines taken during pregnancy cross the placenta and reach the baby. But sometimes you have to take medicine to treat a health problem, such as high blood pressure or asthma.
So if you are pregnant, before taking any medicine including painkillers, you should check with your pharmacist, midwife, or physician that it’s suitable. They will check if the risk of taking a medicine is higher than the risk of not treating your illness? If you or your baby would face worse problems without treatment, then your doctor or midwife will prescribe medicine or recommend an over-the-counter one. He or she will also look at which medicine to give you. For example, some antibiotics are safe for pregnant women. And some are not.
What We Know About Medicine Use in Pregnancy
- 9 in 10 women report taking some type of medicine during pregnancy, and 7 in 10 report taking at least one prescription medicine. Over the last 30 years, women’s use of prescription medicines during the first trimester (first 3 months) of pregnancy increased by more than 60%;
- Many women need to take medicines during pregnancy to control their health conditions. In some cases, avoiding or stopping a medicine during pregnancy may be more harmful than taking that medicine;
- At the same time, we know that taking certain medicines during pregnancy can increase the risk for birth defects, pregnancy loss, prematurity, infant death, or developmental disabilities; and
- The effects of medicine on you and your baby may depend on many factors, such as
- How much medicine you take (sometimes called the dose),
- When during the pregnancy you take the medicine,
- Other health conditions you have, and
- Other medicines you take.
Which medicines are safe?
First of all, if a medicine is prescribed to you for any pre-existing medical conditions (such as asthma, epilepsy or diabetes) you should not stop taking it unless you have side effects. And if you have any side effects and stop taking a medicine that’s prescribed to you, you should consult your pharmacist or physician. Stopping taking a prescribed medicine could be harmful to both you and your baby.
When you are pregnant (or trying for a baby)
- Make sure your physician, dentist or another healthcare professional knows that you are pregnant before they prescribe any medicine or give you a treatment.
- Talk to your physician if you take regular medicine. Ideally, you should talk to your physician as soon as you find out you’re pregnant.
- Always check with your physician, midwife or pharmacist before taking any prescribed medicines or OTC medicines. Do not hesitate to ask your physician, midwife, or pharmacist questions regarding medicines or your requirements but avoid using any kind of medicines without the approval of your physician, midwife, or pharmacist.
Effects of medication, drugs or substances during pregnancy
Generally a drug, substance or medication can cause harm by:
- interfering with normal fetal development
- damaging the baby’s organs
- damaging the placenta and putting the baby’s life at risk
- increasing the risk of miscarriage
- bringing on premature labour.
The potential for harm to the pregnancy and unborn baby depends on a range of factors including:
- the type of drug or medication taken
- how the drug or medication is taken
- the size of the dose
- how often it is taken
- whether the drug or medication is used alone or in combination with other drugs or medications
- the individual response of the baby to the drug or medication
- the gestational age of the baby
- other factors, such as maternal health and diet.
Harmful drugs, substances and medications
Some drugs, substances or medications may be harmful during pregnancy, depending on the amount and frequency of use. These include:
- medicines – including some prescription drugs, over-the-counter medicines and complementary medicines, such as herbal remedies or nutrition supplements
- illicitly used prescription drugs – such as benzodiazepines or morphine
- caffeine – for example, tea, coffee and cola drinks
- illegal drugs – such as cannabis, heroin, cocaine or amphetamines
- substances used as drugs – such as inhalants (glues or aerosols).
Drugs such as heroin and amphetamines are often mixed or ‘cut’ with unknown substances. These unknown substances can also be harmful to the pregnancy or fetus.
Illegal drugs and pregnancy
Since illegal drug use is a secretive activity, our knowledge of the effects of these drugs during pregnancy is limited. Substances with some known effects include:
- amphetamines – increased risk of low birth weight, birth defects, premature birth
- cannabis – increased risk of growth retardation, sleep problems, behavioural problems
- cocaine – increased risk of miscarriage, pre-term birth, growth retardation, stillbirth and birth defects (of the brain, heart, genitals and urinary system)
- heroin – increased risk of low birth weight, prematurity, fetal distress, stillbirth, blood-borne viral disease such as hepatitis, infant withdrawal after birth
- inhalants – increased risk of miscarriage, low birth weight, birth defects, SUDI.
The use of such illegal products, which have extremely negative effects on the health of even a healthy adult, should be especially avoided during pregnancy.
Recommendations for use of medication, drugs and substances during pregnancy
Be guided by your doctor, but general recommendations include:
- Limit yourself to less than 200 mg of caffeine per day (which roughly equates to one espresso-style coffee or two cups of instant coffee per day, or four cups of medium strength tea or hot chocolate per day, or six cups of cola per day).
- Avoid energy drinks.
- Don’t smoke.
- Avoid illegal drugs.
- See your doctor or seek drug counselling if you need help to quit smoking, alcohol or other drugs.
- Don’t assume that non-prescription medications are safe because you can buy them over the counter without a prescription. Be advised by your doctor or pharmacist.
Can I use herbal and homeopathic remedies and aromatherapy in pregnancy?
Not all-natural remedies or complementary therapies are safe in pregnancy. There might be substances that could be harmful to you or your baby and if you are using or plan to use herbal, homoeopathic or aromatherapy, tell your physician, midwife or pharmacist before using. You should mention that you are pregnant (or trying for a baby) while talking with your physician, midwife, or pharmacist.
Please note that complementary remedies or therapies cannot replace conventional antenatal care. It is important to go to all your regular antenatal checkups throughout your pregnancy.
Can I take paracetamol when I'm pregnant or while breastfeeding?
Paracetamol is the first choice of painkiller if you’re pregnant or breastfeeding. And if you are not allergic to paracetamol, it is safe to take in pregnancy and while breastfeeding, at recommended doses.
If you take paracetamol in pregnancy or while breastfeeding, take the lowest dose of paracetamol that works for you for the shortest possible time.
Can I take ibuprofen when I'm pregnant or while breastfeeding?
It is not recommended to take ibuprofen in pregnancy, especially if you’re 30 or more weeks unless it’s prescribed by a physician.
There might be a link between taking ibuprofen in pregnancy and some birth defects, in particular damage to the baby’s heart and blood vessels. There may also be a link between taking ibuprofen in early pregnancy and miscarriage.
Paracetamol is the best painkiller to take during pregnancy.
Ibuprofen is safe to take by mouth or use on your skin if you are breastfeeding.
You should get the most accurate guidance about the use of ibuprofen from your doctor.
Should I trust online information about medicine safety in pregnancy?
Use caution when consulting online sources about medicine safety in pregnancy– instead, use this information to start a conversation with a healthcare professional. Many websites post lists of medicines that are “safe” to take during pregnancy. However, for many medicines listed, there is not enough scientific evidence of their safety during pregnancy.
Regardless of whether you are pregnant or not, you should not take any medication or stop using the medications you are using without consulting your doctor.
- NHS : https://www.nhs.uk
- Michigan Medicine, Michigan State University, Medicines During Pregnancy: https://www.uofmhealth.org/
- CDC: https://www.cdc.gov/pregnancy/meds/treatingfortwo/facts.html
- National clinical guidelines for the management of drug use during pregnancy, birth and the early development years of the newborn, 2006, NSW Department of Health, for Australian Government.
- Medicines in pregnancy, 2012, The Royal Women’s Hospital, Melbourne.
- Bánhidy F, Lowry RB, Czeizel AE, 2005, ‘Risk and benefit of drug use during pregnancy’, International Journal of Medical Sciences, vol. 2, no. 3, pp. 100–106.
- Browne ML, Bell EM, Druschel CM, et al, 2007, ‘Maternal caffeine consumption and risk of cardiovascular malformations’, Birth Defects Research. Part A: Clinical and Molecular Teratology, vol. 79, no. 7, pp. 533–43.
- Browne ML, Hoyt AT, Feldkamp ML, et al, 2011, ‘Maternal caffeine intake and risk of selected birth defects in the National Birth Defects Prevention Study’, Birth Defects Research. Part A: Clinical and Molecular Teratology, vol. 91, no. 2, pp. 93–101.
- Signorello LB, McLaughlin JK, 2004, ‘Maternal caffeine consumption and spontaneous abortion: a review of the epidemiologic evidence’, Epidemiology. Vol. 15, no. 2, pp. 229–39.
- Gouin K, Murphy K, Shah PS, Knowledge Synthesis group on Determinants of Low Birth Weight and Preterm Births, 2011, ‘Effects of cocaine use during pregnancy on low birthweight and preterm birth: systematic review and meta analyses’. American Journal of Obstetrics and Gynecology, vol. 204, no. 4, pp. 340.e1-340.e12.
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