No medication does not mean no risk
In the face of such uncertainty it might seem safest to avoid medication altogether. But that can bring its own set of (sometimes greater) risks.
"There is this thought that because you are going to get pregnant, you have to stop every medication," says Siobhan Dolan, M.D., professor of obstetrics and gynecology and women's health at the Albert Einstein College of Medicine in New York City and author of Healthy Mom, Healthy Baby.
"Take depression. The old notion was that medication posed risks, and taking no medication did not pose risks. But that's not true. A depressed mother poses risks to the fetus, not to mention that the mothers' well-being needs to be considered in the equation." Mental health professionals in reproductive medicine agree that there are several antidepressants that carry only a small risk of harm to developing fetus and that, in women for whom depression is a serious medical concern, not treating it carries a higher risk than the medication.
Ultimately, when women need medication for significant health issues (mental or otherwise) during pregnancy, "it's all about weighing the risks and benefits for moms and babies and getting to the safest medication," says Dr. Dolan.
Even though the research is limited, doctors are able to make informed choices about medications based upon the results of laboratory and animal studies as well as the accumulated experiences of women who have taken medication in pregnancy.
"There are very few instances where we have to recommend medications that have a largely unknown or a known adverse effect on pregnancies," says Dr. Klauser, who treats women with complex medical conditions at his maternal fetal medicine practice in New York City.
When Dr. Klauser talks with a patient about taking a medication, he says he tries to help her understand the risks that come with medicating balanced against the potential effects on her and her baby if she leaves an acute condition untreated. Dr. Dolan agrees: "We don't want women to have to feel so afraid. We're trying to move away from 'this is so scary and bad' to weighing the risks and benefits and making a good decision."
That will be a welcome shift for women who need medication to take care of their health during pregnancy. I understand the fear Kenny feels about getting pregnant again. That's exactly how I felt after my first difficult pregnancy. But after seeing that my daughter was growing up happy and healthy, I changed my mind.
Before we started trying for number two, my husband and I sat down with each of my doctors (including my psychiatrist) to talk through the medications I might have to take (including the possibility of Zoloft for anxiety) and how we would use them safely.
As luck would have it, I remained healthy throughout my second pregnancy. But I was reassured to know that I had made a plan with doctors I trusted about how I could take care of myself if and when I needed to.
10 Tips for Making Good Medication Choices in Pregnancy
Plan ahead when possible. If you're on medication for a chronic condition (mental or physical), meet with your OB or specialist before trying to conceive to discuss what is known about the medication you are taking and whether there are safer choices you can switch to.
Don't decide on your own. If you discover you are pregnant while taking a medication critical to your health (mental or physical), speak to your provider before deciding to stop it.
Talk with your doctor. Even if you're not on medication, ask your provider what drugs (such as pain relievers and cold medicines) she is comfortable with your taking. "Most OBs can provide you a list of safe medications that their practice came up with through the use of guidelines," says Dr. Klauser. Of course, if you don't have a true medical need for a medication, it's best to avoid exposing your developing baby to it.
Find good medical care. If you have a chronic condition (such as asthma, epilepsy, high blood pressure, depression, or diabetes) ask your specialist or OB if he has experience treating pregnant women, and, if not, if he can recommend a colleague who does. Look for a provider who works in consultation with other specialists such as a maternal-fetal medicine expert.
Limit your sources of information. If you want to do additional research, ask your provider what websites she recommends. Dr. Dolan likes MothertoBaby, a website and hotline (866-626-6847) with up-to-date information on many medications. She says genetic counselors can be another good resource. They have access to detailed databases with the latest information on medication effectiveness and safety.
Choose fewer medications when possible. "We always attempt to use the [lowest] number of medications possible," says Dr. Klauser. Let every physician you encounter know the medications you are taking. The more you use, the greater the likelihood for an interaction that might be harmful to you or your developing baby.
But don't assume less is better. One mistake even doctors make, says Dr. Kweder, is to lower the medication dose to reduce any potential risk. "They think they are doing the right thing, but if it doesn't work because you gave too little, you're getting the risk for no benefit." In fact, says Kweder, many medications require a higher dosage in pregnancy, because they are metabolized or cleared more rapidly by the liver or the kidney, which may function differently during pregnancy. The new FDA rating system will address dosing as well as safety.
Count over-the-counter meds. OTC medications can present the same risks as prescription medication. And because many of them combine several ingredients, they have the potential to present a greater risk. Before taking any medication, talk with your provider.
Don't equate natural with safe. "Some herbal combinations and supplements have components that can stimulate uterine activity and can be potentially quite dangerous for a pregnancy," says Dr. Klauser.
Ask out about extra testing. If a medication is known to increase the risk of a problem in pregnancy, your doctor can do extra ultrasounds or other tests to look for early signs that you should discontinue it. Ask your provider if she recommends additional monitoring.
Kate Rope is the coauthor of The Complete Guide to Medications During Pregnancy and Breastfeeding.
Copyright © 2013 Meredith Corporation.
All content on this Web site, including medical opinion and any other health-related information, is for informational purposes only and should not be considered to be a specific diagnosis or treatment plan for any individual situation. Use of this site and the information contained herein does not create a doctor-patient relationship. Always seek the direct advice of your own doctor in connection with any questions or issues you may have regarding your own health or the health of others.