An increasing number of pregnant women are taking over-the-counter and prescription drugs. Learn what's safe and what's not.
The majority of moms-to-be—about 90 percent—take at least one medication during their pregnancies. Additionally, more than two-thirds of pregnant women take a prescription medication during the first trimester, a crucial period of fetal development when medications are more likely to affect your baby.
Why the increase in use? It's partly due to medical advances. We now have more effective medications to treat such conditions as depression, chronic pain, diabetes and high blood pressure. Add to that the fact that women are having babies later in life, when they may be more likely to suffer from illnesses that require medication. Additionally, with the thalidomide disaster of the 1960s a distant memory (reminder: the anti-nausea drug caused deformities in thousands of babies), women may be lulled into thinking that many medications, especially over-the-counter drugs and herbal treatments, are safe to take while pregnant.
The Truth About Meds and Moms-To-Be
Among medications approved in the U.S. between 2000 and 2010, more than 79 percent had no published data on their risk to the developing fetus, and 98 percent had some data but not enough to pass judgment on their safety. "The reality is that for a lot of medicines, there is limited data to assess the risk of birth defects," says Cheryl Broussard, Ph.D., an epidemiologist with the National Center on Birth Defects and Developmental Disabilities at the Centers for Disease Control and Prevention (CDC).
That doesn't mean all drugs are unsafe to take during pregnancy. "What does lack of data mean? It simply means a lack of data," says Siobhan Dolan, M.D., associate professor of obstetrics at Albert Einstein College of Medicine in New York City and an adviser to the March of Dimes. Experts say you shouldn't necessarily stop taking medications if you're pregnant or trying to conceive. Some drugs are important to your health or mental health and despite their risks are safer for you to take than not take. "If you consider a condition such as depression, there are risks to being depressed while pregnant, so it's about weighing the risks and benefits of the medication," says Dolan.
Check Your Sources
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.
How to Know What's Safe
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).