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Moms-to-be, though, are not necessarily getting this weigh-the-risks message. One source of misinformation is the Internet, where women tend to turn for health information. According to a new study conducted by Broussard, many websites, including the sites of doctors themselves, have lists of “safe” medications for pregnant women, despite the fact that most of the meds on these lists have limited to no studies on their effect on the fetus. While some websites offer caveats like “Generally, you should not take any over-the-counter medication while pregnant unless it is necessary,” others wrongly state: “Many over-the-counter medications are safe during pregnancy.”
The study found that only 7 out of 103 ingredients on these “safe” lists had good to excellent evidence of their safety. A whopping 43 ingredients had an “undetermined risk” because they had not been adequately evaluated for their effects during pregnancy. And even among those rated as having no to minimal risk, these ratings were based on a very small number of studies and should be interpreted cautiously, Broussard says.
Why is there such a paltry amount of information on the effects of medications on the developing fetus? Because drug studies usually exclude pregnant women from tests on drug safety and efficacy, so data has to come from “post-market” research, essentially reports of adverse effects after the drugs are available and used by pregnant women.
Determining what meds are acceptable for expectant moms may take some digging. “We need more research, more surveillance and more data to give women enough evidence to make better decisions,” says Dolan. “While women would love to have a blanket reassurance that a drug is safe for them, we can’t do that,” she says. Even the Food and Drug Administration’s (FDA) current pregnancy labeling requirements, which use five categories—A, B, C, D and X—is hard to interpret. The FDA is in the process of replacing these categories with research summaries to provide more helpful information to women and their physicians.
For now, women can look for reliable sources such as mothertobaby.org, a service of the Organization of Teratology Information Specialists (OTIS). The website provides easy-to-digest summaries of research and potential risks of specific medications and herbal products. Be sure to discuss any medications you are taking or plan to take with your health care provider. “Women need to ask what’s the safest medication they can take to keep the condition under control and make sure it’s safe for the pregnancy,” Dolan says. The goal is not to deem a drug good or bad, but to weigh its potential risks and benefits.
Laurie Tarkan is the co-author of Perfect Hormone Balance for Pregnancy (Clarkson Potter).