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When Lyle Kenny was pregnant with her second child, she suffered constant migraines. Her OB was sympathetic but said Kenny couldn't take the medication she usually took for relief. Visits to an acupuncturist, osteopath, and chiropractor made no difference. So she was sent to a neurologist who had no experience treating pregnant women. He said there was nothing he could do.
"I was incapacitated," says Kenny, 35, a mom of two boys in Brooklyn. "I couldn't take care of my son. I couldn't function, and I felt like nobody was dealing with it." After Kenny ended up in the ER three times, her OB finally let her take the painkiller Percocet, which brought a little relief. For the rest of her pregnancy Kenny reached for the bottle when she "absolutely had to," but was "really freaked out about what was going to happen to the baby."
She is far from alone.
"The decision of whether or not to use medications affects pretty much every pregnant patient, whether it's Tylenol for a headache or medication for a more serious condition such as a seizure disorder," says Chad Klauser, M.D., assistant clinical professor of obstetrics and gynecology at the Mt. Sinai School of Medicine in Manhattan.
According to the Centers for Disease Control and Prevention (CDC), 90 percent of women take medication at some point in their pregnancy and 70 percent take prescription medication. And yet women facing these decisions are often given conflicting information on medication safety from their primary care providers, their OBs, and the Internet.
That kind of ambiguity makes the decision to take medication in pregnancy very scary. I should know. I developed unexplained pain around my heart one week into my first pregnancy. For five months it was misdiagnosed as various things, including heartburn, and I took several medications to alleviate it, worrying what the effect on my child would be. Nothing worked. The pain became so bad that I ended up in the ER twice and was finally hospitalized. Along the way, I was subjected to X-rays, CT scans, and nuclear radiation -- all the things the books tell you to stay away from during pregnancy.
When the problem was finally diagnosed as benign inflammation in the sac around my heart, I had to manage it with ibuprofen and then steroids for the remainder of my pregnancy. I felt incredibly scared and guilty for doing so. I was worried that the radiation I had been exposed to had harmed my developing baby, and that the steroids I was taking would damage her immune system. I had to undergo monthly ultrasounds to make sure my daughter was growing properly and that my amniotic fluid levels were adequate (both of these can be affected by steroid use in pregnancy).
My daughter was born healthy, but the stress of worrying about her safety and my health hit me like a ton of bricks six months after delivery. I developed debilitating postpartum anxiety and eventually needed medication to control it.
Kenny, too, lived through her pregnancy in fear. Because of the medications she took and the inconsistent information she was given, Kenny says she was "scared to death there would be something wrong with the baby. It was bad," she says. "I don't think I will ever get pregnant again."
Why doctors can be confused
Medicating pregnant women can be more art than science. Drug companies rarely test pharmaceuticals on pregnant women in the controlled clinical trials that doctors depend upon when making treatment choices. To help physicians advise their patients on taking medications during pregnancy, the Food and Drug Administration (FDA) devised a rating system in the 1970s to indicate the likelihood of a medication causing harm to a developing baby. Drugs receive a rating of A, B, C, D, or X, depending on whether they have been studied in pregnancy and whether laboratory or animal studies indicate there could be a risk. An A rating is generally considered safest and X very dangerous. But the majority of medications are categorized as category C, which means there is a lack of adequate scientific data in humans to indicate whether they could cause harm.
"The category system looks very simple," says Sandra Kweder, M.D., deputy director of the office of new drugs at the FDA Center for Drug Evaluation and Research. "Unfortunately, the reality of prescribing in pregnancy doesn't come down to being quite so simple. As someone who has taken care of a lot of pregnant women, [I can say] it is not a smart thing to just rely on that," Dr. Kweder says. The FDA is in the process of changing drug pregnancy labeling, but the new system will take several more years to implement and women are looking for answers now.
Unfortunately, many of them turn to an unreliable source: the Internet. A recent CDC survey of 25 websites that offered lists of "safe medications in pregnancy" found significant inconsistencies between them. Twenty-two medications deemed safe by one site were considered unsafe by one or more of the others. Only three sites listed the references they used to make their determinations, and only half recommended making the decision with a health-care provider, which is what all experts in the field recommend women do before choosing to take any drug.