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RX and Pregnancy - What Medications are Safe?

Prescription Drugs During Pregnancy: Safe or Not?
Prescription Drugs During Pregnancy: Safe or Not?
medication

Blaine Moats

Every medication -- whether it's over-the-counter or available by prescription -- is categorized as safe (or unsafe) for use in pregnancy. You name the drug and it has a listing of A, B, C, D or X attached to it.

"The only 'A' drugs are prenatal vitamins and thyroid medication," says Daniel Roshan, M.D., assistant professor of ob-gyn at NYU School of Medicine in New York City. "Nothing else is 100 percent safe. Even Tylenol is considered a 'B.' " Here's more on these designations:

A: Considered very safe.

B: Considered safe in animal studies but there are no human studies.

C: Adverse effects in animal studies but there are no human studies.

D: Can cause birth defects.

X: Should never be used.

CATEGORY C: Adverse effects in animal studies but there are no human studies.

A: Not unless it's absolutely necessary. Here's why: When used during pregnancy, Topamax (generic name: topiramate), an oral medication used alone or in combination with other medications to treat seizures (it's also used for bipolar disorders and migraines), can lead to an increased risk of miscarriage as well as facial anomalies and abnormalities in the baby's brain and genitalia. "It's not recommended to take Topamax during pregnancy unless your neurologist says you must," says Dr. Roshan.

If your neurologist wants you to stay on the drug while you're pregnant, there's a registry you can call (888-233-2334) that will follow your health (and your baby's) throughout your pregnancy. Deciding whether (or not) to take this drug comes down to weighing the benefit of the drug (controlling seizures) against the risks to your baby. "If at all possible, Topamax should be avoided during the first 14 weeks of pregnancy," adds Michele Hakakha, M.D., co-author of Expecting 411. "And, if a woman must be on Topamax during pregnancy because nothing else is controlling her seizures, it's strongly recommended that she take additional folic acid (four milligrams a day instead of the standard 400 micrograms) daily." A consultation with the obstetrician, neurologist and a high-risk OB specialist is key to help you come up with the best plan for you.

CATEGORY D: Can cause birth defects.

A: No. Valium, which acts as a central nervous system depressant and belongs to a class of drugs called benzodiazepines (sedatives used to treat anxiety or panic disorder), isn't safe to take during pregnancy because its effects on the development of the fetus haven't been clearly defined. "This class of drugs cross the placenta, causing exposure to the fetus," says Millie A. Behera, M.D., an assistant adjunct professor in the department of ob-gyn at Duke University School of Medicine in Durham, North Carolina. "Like other drugs, if it's absolutely crucial for you to remain on it, you'll want to speak with your doctor so you're aware of the risks involved with taking this medication. Ideally, you should review your medications and potential risks on the fetus before you conceive. This way, you and your doctor can develop a plan together to modify or wean off medications as needed."

CATEGORY C: Adverse effects in animal studies but there are no human studies.

A: Only if you have to. This anti-anxiety medication (sertraline hydrochloride) is known as a selective serotonin reuptake inhibitor (SSRI) and is used to help control depression, as well as obsessive-compulsive and panic disorders. Because it crosses the placenta, it puts your baby at risk. Be sure to consult with your psychiatrist and ob-gyn to come up with a plan as quickly as possible since Zoloft, when taken during the last half of pregnancy, can be associated with a rare newborn lung problem known as persistent pulmonary hypertension of the newborn (PPHN).

In fact, women who take Zoloft during the latter part of their pregnancy are six times more likely to deliver a child with PPHN. "You'll also want to avoid taking Zoloft in the third trimester because you're setting up your baby for withdrawal symptoms when she's born," says Dr. Roshan, "She may even have seizures after birth due to withdrawal."

CATEGORY B: Considered safe in animal studies but there are no human studies.

A: Yes. However, while this popular antihistamine is considered safe, it should be taken only if necessary. "If your nose is running all the time and you're sneezing non-stop, you can consider taking it if your doctor gives you the OK," says Dr. Roshan. But always use caution when driving, since this medication can cause drowsiness. "Even though Zyrtec is considered a 'non-sedating' antihistamine, it should be used with caution until you know how it affects you," adds Dr. Hakakha.

Also, if you're taking other medications, research whether these drugs may also prompt drowsiness. "Talk to your doctors," says Dr. Hakakha. "During pregnancy, you want all of the physicians treating you to talk with one another and make sure you're being treated in the most optimal way. In addition, remember to always consult with your ob-gyn or pediatrician if you're planning to breastfeed, as some medications are okay during pregnancy but not if you're breastfeeding, and vice versa."

Copyright © 2011 Meredith Corporation.

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