Drugs and Pregnancy

When we talk about drugs, it is important to include medicines prescribed by a doctor, medications purchased at the pharmacy, such as pain killers, cough and cold medicines, laxatives, and also herbal medicines, vitamins, alcohol, cigarettes and illegal drugs.

During pregnancy, drugs taken by the mother can be passed on to her unborn child through the umbilical cord or placenta.

During the first three months, the baby’s organs, which are just developing, could be affected. After these first three months, the risk is not so great, but drugs should still only be taken when really necessary, and only on the advice of someone who knows something about the safety of particular drugs in pregnancy. Drugs should be avoided by pregnant women as they get close to delivery this is because, when babies are born, they have immature organs, and it is much more difficult for them to get rid of unwanted chemicals in their bodies which are present at birth. It would be wonderful if all of us could totally avoid all drugs while pregnant. However, some women have conditions such as asthma, epilepsy and high blood pressure which will need continuing treatment during pregnancy, and some women may develop conditions in pregnancy such as infections, severe morning sickness or high blood pressure which will need to be treated with drugs.

When you visit the doctor to see how your baby is doing, it is important to remember to discuss with the doctor any medicines taken by you for conditions that are not related to your pregnancy, so that the doctor is fully acquainted with you and the medications you take.

Your doctor, local pharmacist and places such as the Royal Women’s Hospital Drug Information Centre, are all available to help you make decisions regarding the safety of taking medications in pregnancy.

Prescribed Medicines

Sedatives, Tranquillisers and Hypnotic Drugs e.g.,
Diazepam (Valium), Oxazepam (Screpax),
Nitrazepam (Mogadon), Flunitrazepam
(Rohypnol) and Temazepam (Normison, Temaze):
These drugs are used to treat anxiety, to aid sleep and
to help treat depression.

When these agents are taken strictly as prescribed, they are not likely to cause abnormalities in the unborn baby. However, if they are taken regularly in high doses in later pregnancy, they can affect the newborn baby’s muscles and nerves. If you need these types of drugs while you are pregnant, make sure that both your obstetrician and psychiatrist know that you are taking them, and what you are taking them for.

Antibiotics and Anti-infective Drugs:

Commonly prescribed antibiotics such as the penicillin's eg, Amoxycillin (Amoxil, Cilamox, Moxacin), Erythromycin (Eryc, EES, Erythrocin), and Cephalosporins (Cephalexin - Keflex) may be taken safely during pregnancy.

If you are than three months pregnant, it is recommended that the Tetracycline group eg, Doxycycline (Doryx, Vibramycin, Vibra-tabs) of antibiotics be avoided as they may interfere with normal bone and tooth development and may result in baby having stained teeth.

If you are at the late stages of pregnancy, you need to avoid the sulphonamide antibiotics eg, Bactrim and Septrin. These drugs pass across the placenta, and remain in the infant for some time after birth, as the baby’s immature liver and kidneys cannot efficiently break them down.

Right throughout pregnancy, the antibiotics Norfioxacin (Noroxin), and Ciprofloxacin (Ciproxin), should be avoided unless they are the only antibiotics which will clear up your infection.

It is safe to use all the anti-thrush creams available eg, Nilstat, Canesten, even if they need to he inserted into the vagina.

Drugs used to treat morning sickness:

Uncontrolled nausea and vomiting can be potentially hazardous and debilitating for both the mother and the unborn baby, so that a doctor will often prescribe one or more of a number of preparations to control this condition.

The most common drugs prescribed are Pyridoxine (Vitamin B6), Metoclopramide (Maxolon, Pramin) and the antihistamines eg, Promethazine (Phenergen, Avomine).

Despite media publicity questioning their safety for the unborn child, antihistamines have been used throughout the world to treat morning sickness during pregnancy, without reports of adverse effects on the baby.

Antihistamines are also used to treat allergic conditions such as hay fever and asthma. It is obviously important not to “double up” on the use of antihistamines for treating allergies, where these drugs may also be used for treating morning sickness.

Isotretinoin and Tretinoin:

These drugs are Vitamin A derivatives prescribed for treating severe acne. When these drugs have been inadvertently used during pregnancy, they have been associated with birth defects. They should never be given during pregnancy.

Methadone:

If drug dependent during pregnancy, Methadone maintenance therapy often gives the best chance of a normal pregnancy and a healthy baby and because you take a daily dose, there are no unexpected periods of withdrawal for yourself and the baby. In fact, pregnant women usually require higher methadone doses than usual, not decreased doses - pregnancy is not the time to be coming off a methadone program.

Non-Prescribed Medicines

Pain-relieving Drugs:

Paracetamol (Panadol, Dymadon, Tylenol) and Paracetamol with Codeine (Panadeine, Dymadon Co) may be used safely during pregnancy to treat headache, toothache, influenza, muscular pains etc.

Many pain-relief products contain the ingredient Aspirin. Aspirin may be harmful to infants if taken during pregnancy, in large amounts, without medical supervision. If taken late in pregnancy, especially during the last week before delivery, it may affect the infant’s blood clotting ability and there are some suggestions that it may delay the onset of labour and increase the likelihood of jaundice in the baby.

Laxatives:

Laxatives that soften or add bulk to the bowel contents are safe to use in pregnancy. It is always better to try things like adding more fibre to the diet, but if you do require a laxative, your doctor or pharmacist will advise you on the most suitable preparation to use.

Laxatives which are absorbed or have a direct stimulant effect on the bowel eg Senna, Epsom Salts and some liquid Paraffin emulsions, should be avoided during pregnancy.

Cough and Cold Medications:

It is wise to treat a cold symptom by symptom, rather than take a multi-ingredient product during pregnancy. Use Paracetamol (Panadol, Dymadon) for aches and pains, a simple cough suppressant for a dry, unproductive cough, or an expectorant if the cough is chesty or “mucousy”. You could also occasionally use a nasal spray eg, Sinex nasal spray to dry up a runny nose. This is thought to be safer than taking Sudafed (Pseudoephedrine).

Diet Preparations:

These should not be used, unless suggested by your doctor.

Vitamins, Minerals and Herbal Preparations:

Before pregnancy, and for the first 12 weeks of a pregnancy, it is recommended that all women take a folic acid supplement (0.5 mg daily) to help decrease the occurrence of certain birth defects. These tablets are available from your local pharmacy, and are quite inexpensive.

Usually, a well balanced diet containing adequate fruit and vegetables will provide sufficient minerals for both mother and infant, however some women become anaemic during pregnancy and their doctor may prescribe iron with or without folic acid, to help restore an adequate supply of healthy red blood cells.

Many women become quite tired during pregnancy. In these cases, most women will require a vitamin supplement containing the B-group vitamins and a little vitamin C 2.J.y. Multi-vitamin preparations should be avoided especially those containing vitamin A, and Iodine (or kelp or seaweed), as these ingredients can harm the unborn baby if taken in high doses.

Pluravit Profiles Prenatal capsules (available at your local pharmacy) is recommended by dietitians at the Royal Women’s Hospital as being one of the best prenatal vitamin supplements.

High doses of Vitamin C (more than 1000mg daily) can lead to a type of Vitamin C deficiency in the newborn infant, when Vitamin C levels (received via placenta) are ceased.

Because there is a lack of safety data available, it is always best to check with a doctor or pharmacist before taking a herbal preparation during pregnancy. A great number of medicinal plants are highly toxic, and their improper use may cause severe poisoning. Some herbs to be avoided in pregnancy include Mugwort, Nutmeg, Mistletoe, Origanum Oil, Kelp, Juniper, Irish Moss, Feverfew, Pennyroyal, Tansy, Savine and Roe.

Socially Used “Drugs”:

eg tobacco, alcohol, coffee, tea, cola and chocolate -based drinks

Tobacco - regular nicotine intake restricts the oxygen supply to the developing infant. Babies born to mothers who smoke heavily are often smaller, less well developed and have poorer health than babies born to non-smokers. You should try to give up smoking completely when you are pregnant.

Alcohol - it is well established that regular use of large quantities of alcohol may lead to physical and mental abnormalities and growth retardation in a baby. Therefore you should limit your intake of alcoholic beverages in pregnancy. Authorities have not established a safe lower limit of alcohol consumption in pregnancy.

Caffeine - in tea, coffee, cola etc. A moderate intake of caffeine is considered safe in pregnancy. This translates to about 2 cups of coffee per day, 4 cups of tea or less than 1 litre of cola drinks per day.

Illegal Drugs:

eg Marjuana, heroin, methadone, amphetamines
You should avoid the use of these drugs during pregnancy especially heroin, non-prescribed methadone, and related drugs which result in complications at delivery and cause the newborn infant to be smaller and less healthy than normal. Babies can also suffer from a withdrawal reaction to the drug used by the mother arid require treatment in a special-care nursery.