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Journalism of Courage
Doctors find it very difficult to prescribe drugs during pregnancy as most manufacturers put a very cryptic warning on all drugs which says “not to be used in pregnancy unless the benefits outweigh the risks”. The thalidomide disaster, where many pregnant women produced deformed children, has cast a long shadow over prescribing in pregnancy.
All drugs cannot be ethically tried in pregnancy if there is even the slightest doubt during animal trials. It would be better to avoid them totally. A lot of the evidence is therefore circumstantial and anecdotal. The major body structures are formed in the first three months of pregnancy. Interference here can cause teratogenesis (from the Greek word teratos meaning monster) or an abnormal baby. After the first three months it is unlikely that there will be a severe anatomical abnormality. So actually it not only depends on what drug is taken but when the drug is taken. Sometimes a drug may persist in the body even after the course is finished and in that case if conception occurs at that juncture then it may harm the foetus.
1There are certain drugs that harm the growth and development of the foetus. Drugs to lower blood pressure and ACE Inhibitors may cause growth retardation or kidney failure. Antithyroid drugs may cause hypothyroidism in the baby. Sedatives like Calmpose and Phenobarbitone may cause addiction in the baby. Tetracyclines (antibiotics) may inhibit bone growth and cause discolouration of the teeth. Even Aspirin, Brufen and other similar painkillers may cause heart and circulatory problems especially after the first three months. If aspirin is used in high doses before delivery it can cause bleeding in the newborn.
During breast-feeding even though most drugs go into the breast milk the quantity is rarely sufficient to cause harm to the newborn. Drugs that should be avoided are aspirin, sedatives, anti-thyroid drugs, combined oral contraceptives, drugs for cancer and immune diseases, ephedrine(commonly found in cough formulas).
Steroids have been shown to cause cleft palates in rats but have never been proven to harm humans babies. Warfarin is hardly secreted in breast milk and can be given to nursing mothers. Oral contraceptives are often taken inadvertently in the first three months and are fairly harmless. Even though antiepileptics are unsafe the safest is the drug which controls the seizures at the lowest dose. It is now obvious that no drug is absolutely safe in pregnancy but it would be foolish to assume that no pregnant mother must be given any drugs. The relatively safe drugs include paracetamol, penicillins and cephalosporins (both antibiotics), inhalers (both steroid and non-steroidal) and antacids (though aluminium containing antacids should be avoided on a long-term basis).
