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Medications in Pregnancy
Aka: Medications in Pregnancy, FDA Pregnancy Categories
- See Also
- Over-The-Counter Medications in Pregnancy
- Analgesic Medications in Pregnancy
- Antibiotics in Pregnancy
- Cardiovascular Medications in Pregnancy
- Cold Preparations in Pregnancy
- Endocrine Medications in Pregnancy
- Fetal Hydantoin Syndrome
- Gastrointestinal Medications in Pregnancy
- Hematology Medications in Pregnancy
- Lactation Safe Medications
- Neuro-Psychiatric Medications in Pregnancy
- Respiratory Medications in Pregnancy
- Teratogen Exposure
- Background
- Pregnancy Categories will be replaced on medication bottles with specific warnings and precautions by 2020 in U.S.
- http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm425317.htm
- Although FDA Pregnancy Categories are no longer listed, they are included here
- As of 2018, succinct guidance (to replace ABCDX) on specific drugs in pregnancy is lacking
- Approach: General Recommendations
- Avoid medications if possible in first trimester
- Limit use to safe, short-acting, non-combination drugs
- Some OTC medications may be used safely in any trimester (but avoid overuse, esp. in first trimester)
- Acetaminophen
- Antihistamines
- H2 Blockers
- Proton Pump Inhibitors
- Servey (2014) Am Fam Physician 90(8): 548-55 [PubMed]
- Topical Medications are preferred over systemic agents
- Use the lowest effective dose of a medication
- Birth defects occur in 3% of pregnancies even without Teratogen Exposure
- Balance medication benefits versus risks in pregnancy
- Untreated serious conditions (e.g. Asthma, Seizure Disorder, Diabetes Mellitus) are associated with birth defects
- Uncontrolled Diabetes Mellitus with Hemoglobin A1C of 10% is associated with a birth defect risk up to 25%
- References
- (2018) Presc Lett 25(10): 56
- Preparations: Class A
- No risk in controlled human studies
- Examples
- Acetaminophen (Tylenol)
- Pyridoxine (Vitamin B6)
- Preparations: Class B
- No risk in controlled animal studies
- Examples
- Amoxicillin
- Cephalosporin antibiotics
- Preparations: Class C
- Small risk in controlled animal studies
- Examples
- Codeine
- Dicloxacillin
- Preparations: Class D
- Strong evidence of risk to the human fetus
- Examples
- Coumadin
- Valium
- Preparations: Class X (Never to be used in Pregnancy)
- Very high risk to the human fetus
- Examples
- Xanax
- Accutane
- Resources
- CDC Medications in Pregnancy
- http://www.cdc.gov/pregnancy/meds/index.html
- Vaccines and Medications in Pregnancy Surveillance System (VAMPSS)
- http://www.aaaai.org/about-the-aaaai/strategic-relationships/vampss/vampss-consumer.aspx
- MotherToBaby Fact Sheets (from Organization of Teratology Information Specialists or OTIS)
- http://www.mothertobaby.org/fact-sheets-s13037
- References
- Briggs (1998) Drugs in Pregnancy and Lactation, 5th ed
- Larimore (2000) Prim Care 27(1):35-53 [PubMed]