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Massage Today
January, 2012, Vol. 12, Issue 01

The Potential Dangers of Taking Medications During Pregnancy

By Elaine Stillerman, LMT

We tend to think that if the Food and Drug Administration approves a medicine, it is safe for us to take. And we don't give a second thought to the potential side effects of over-the-counter (OTC) medicines since they don't require prescriptions.

But are these popular medications safe for pregnant women and their developing babies? Since very few drug trials involve pregnant women, how can anyone be sure that there are no harmful side effects or birth defects from these seemingly innocuous medicines?

Conception occurs about two weeks before the next menstrual cycle is due, and a positive confirmation of pregnancy may take another few weeks, so there is a window of extreme vulnerability for the growing baby if mom takes certain medicines (drinks or smokes) during this sensitive time. OTC drugs are used by many pregnant women and, as a rule, are generally safe. Some, however, have what are considered to be unproven safety and/or potentially harmful effects on the growing babies. Since an estimated 10% or more of birth defects are a result of maternal drug exposure, the FDA has assigned a risk category to each drug.

Category A No demonstrated risk to the fetus in the first or later trimesters.
Category B Animal studies didn’t demonstrate a fetal risk, but there are no controlled studies in pregnant women. Or animal studies showed an adverse effect that was not confirmed in controlled women during the first trimester or later trimesters.
Category C Animal studies showed harmful effects on the fetus or studies are not available. Drugs should only be given if the benefit outweighs the risk.
Category D There are confirmed fetal risks, but in the case of a life-threatening condition, the risks may be acceptable.
Category X The drug is not safe during pregnancy or for women who may become pregnant.

OTC medications that are considered relatively safe during pregnancy include most antacids, Acetaminophen, Chlorphenramine, Kaolin and Pectin preparations - although all expectant women should discuss the use of any and every medication (and herb) with their care providers. As an example, seemingly harmless Vitamin A (Retinol) used for skin conditions has shown to contain powerful teratogens which may cause serious birth defects. On the other end of the safety spectrum are drugs like H2 blockers, Pseudoephedrine, and Atropine/Diphenoxylate, to name a few, which are dangerous for developing fetuses.

medicine bottle - Copyright – Stock Photo / Register Mark During the 1940s – 1970s, DES (diethylstilbesterol) was often prescribed during pregnancy to prevent a miscarriage. That was until the daughters (and sons) of these DES mothers developed all sorts of reproductive anomalies and cancers during puberty. Then the use of this drug during pregnancy was immediately discontinued. But not until after the reproductive lives of thousands were adversely affected.

And for those of us old enough to remember the 1960's when thalidomide was prescribed to treat nausea during pregnancy, the images of those deformed babies was seared into our collective memories (remember the picture on the cover of Life Magazine?). Its use was quickly stopped after nearly 10,000 babies (mostly in Europe) were born with major physical disabilities – phocomelia, or seal-like flippers for arms and legs. Of course, the way these drugs received approval was very different 50 years ago than it is now.

The general rule is to avoid all drug exposure (including herbs and aromatherapy) during the first trimester when the fetal organs are developing (organogenesis) to prevent structural and functional abnormalities. Most drugs can cross the placental barrier (this includes pain medications and nerve blocks received during labor) and expose the developing embryo and fetus to harmful effects.

There are certain factors affecting placental drug transference and teratogenic effects:

  • The chemical properties of the drug.
  • The rate at which the drug crosses the placenta, how much reaches the fetus, and at what strength.
  • The length of time the fetus is exposed.
  • How the drug distributes to various fetal tissue.
  • The stage of fetal and placental development.
  • The effects of the combinations of the drugs mother takes.

Even one intrauterine exposure can have harmful effects. Thalidomide, for example, had catastrophic effects after brief exposure. When it comes to over-the-counter medications, some of them have unproven safety records or are known to affect the fetus. More than 80% of pregnant women take OTC or prescription drugs during pregnancy. Pain medications are widely consumed during pregnancy for relief of common aches and pains. A Danish study reported a direct link between the use of prescribed NSAIDS and miscarriages. Kaiser Permanente Medical also concluded the use of NSAIDS during pregnancy increased the risk of miscarriage by 80%, particularly when they were taken around the time of conception.

Categorized for risk during each trimester (1/2/3), this is a list of common analgesics used in pregnancy: Acetaminophen (B/B/B), Aspirin (D/D/D), Ibuprofen (B/B/D), Ketoprofen (B/B/D), and Naproxen (B/B/D). All of these drugs cross the placental barrier. Cold medicines, such as decongestants, expectorants, and antihistamines, may be unsafe during certain trimesters or their risk profile is unstudied.

Since most drugs taken while nursing are found in breast milk, all drugs and medications should be used carefully, conservatively and under medical supervision. The good news is that the concentration of the drugs in breast milk is low and the baby's exposure is less than what would be considered to be a therapeutic dose. If medication has to be taken while nursing, it is advisable to take the dose 30-60 minutes after nursing and 3-4 hours before the next feeding. This provides adequate time for the drugs to clear out of mother's blood, so the concentration in her breast milk will be minimal.

Pregnancy is a time of excitement and change. As the baby grows, mother's body adapts to the posture of pregnancy which can lead to aches and pains. Instead of reaching for that pill bottle, if she can, mom would be well-advised to pick up her phone and make an appointment with a qualified prenatal massage practitioner. So much safer and so much more pleasant.

Resources

  1. Barry WS, Meinzinger MM, Howse CR, "Ibuprofen overdose and exposure in utero :results from a postmarketing voluntary reporting system." Am J Med, 1984; 77:35-9.
  2. Das BP, Joshi M, Pan CR, "An overview of over the counter drugs in pregnancy and lactation", Kathmandu University Medical Journal, (2006), Vol. 4, No. 4, Issue 16, 545-554.
  3. Li DK, Odouli R, Wi S, et al. "A population-based prospective cohort study of personal exposure to magnetic fields during pregnancy and the risk of miscarriage." Epidemiology, 2002; 13:9-20.
  4. Macones GA, Marder SJ, Clothire B, Stamilio DY. "The controversy surrounding idomethacine for tocolysis. Am J Obstet Gyn, 2001; 184:264-72.

Click here for previous articles by Elaine Stillerman, LMT.

 

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