Pregnancy and Medicines

Recent comments from the Royal College of GP’s head of prescribing, state that drug companies are using too much caution when advising pregnant women against using medicines that could be useful to them. The industry has been reticent to advocate use of their products in such circumstances since the thalidomide tragedy of the late 1950’s and 1960’s. Thalidomide was a drug prescribed to combat morning sickness that resulted in the unforeseen serious birth defects of 12 to 15,000 children.

SAFETY OF MEDICINES IN PREGNANCY

The problem with determining the safety of medicines for use during pregnancy is that clinical drug trials are rarely carried out on pregnant women. Whilst evidence may come to light of drugs that do cause harm, most fall into the not proven category. This goes some way to explaining the policy of drug companies. Medicines can affect the unborn baby because they can enter the baby’s bloodstream, along with nutrients, via the placenta.

The trimesters of pregnancy are also factors in determining safety.

• In the first trimester, vital organs are just developing. Any medicines taken at this time could, therefore, cause birth defects or miscarriage.
• The second trimester is generally regarded as the safest in which medicines can be taken. They could, however, affect the baby’s growth and nervous system, leading to low birth weight.
• Medicines taken during the third trimester could stay in the baby’s system. This could cause such things as post birth breathing difficulties.
The properties of the womb environment could also be affected by some medicines. These changes could affect blood supply to the baby, or prolong or delay labour.
Without the aid of clinical trials to determine safety, the only other evidence that a medicine is not harmful comes from;
• it being in use over time with no recorded adverse effects,
• accidental exposure to it,
• any information that can be gathered from animal testing.

SPECIFIC CONDITIONS

Whilst taking any medicine for minor illnesses, especially during the first trimester, is probably best avoided, consulting your doctor or pharmacist will enable them to weigh up the pros and cons of the situation. It may be decided that treating the complaint is the safer option.

Some information on ailments and the safety, or problems with the common remedies (This information is intended as a guide only, and not a substitute for a proper medical consultation);

COUGHS
The safest cough medicines are cough linctuses or lozenges with honey or glycerol in them.

It is best to be aware of all active ingredients. Some cough and cold treatments use a combination of ingredients such as antihistamines, painkillers and decongestants.

Guaifenesin expectorant is probably safe to use in the second and third trimesters, though little different from drinking a lot of water or steam inhalation. Animal studies showed some harm to fetuses and, although no reliable studies have been done on humans, there are concerns about possible links to inguinal hernia (related to the groin area) if used in the first trimester.

Dextromethorphan is relatively safe for a short time in small doses after the first trimester.

Avoid cough medicines with codeine especially in the third trimester.
Some cough medicines contain iodine, which can affect the baby’s thyroid gland, and are best avoided. Whilst iodine deficiency is a recognized problem, there are concerns that too much iodine is also harmful, so levels must be kept in check.

COLDS AND FLU
As with cough medicines, cold and flu remedies may contain multiple active ingredients. The ones that just use paracetamol are safest. See your doctor, especially if the cold or flu symptoms persist for a long time, in case of secondary infection.

CONSTIPATION
Eat plenty of fibre and drink plenty of fluids. If you need to take laxatives, senna and cascara are generally regarded as safe. Bran, meythylcellulose,sterculia and ispaghula (Fybogel) are also regarded as safe.

DIARRHOEA
Dehydration can occur if diarrhoea lasts for more than a few days. Dioralyte or similar rehydration salts are said to be safe to use to combat dehydration. Stool bulk can be increased by using kaolin mixture. Prolonged use of kaolin could result in low birth weight, premature births so check with a doctor before taking it.
There is not enough information on whether Loperamide (Imodium, Arret etc) is safe or not, so this may be best avoided. There was no apparent harm to fetuses when tested on animals, but there are some concerns about possible cardiovascular problems if taken during the first trimester.

INSOMNIA
All sleeping tablets and herbal cures for insomnia are best avoided. Some herbal teas are made specifically for use during pregnancy, although caution should be used as herbs are also drugs, and the claims of safety may not be thoroughly researched. If in any doubt ask a health care professional.
Try drinking warm milk, or taking a warm bath before bed.

HAY FEVER/ALLERGIES
If limiting your exposure to the hay fever triggering allergens is not possible, sodium cromoglicate (Optrex allergy, Clarityn and Pollenase for instance) is deemed safe for use in all three trimesters.
Corticosteroid nasal sprays like beclometasone (e.g. Pollenase, Beconase) are relatively safe in the short term only. Discuss the use of this with your doctor.
If these measures are not effective, Chlorphenamine (e.g. Piriton, Pollenase) is regarded as relatively safe for all three trimesters. As always though, consult with your doctor.
Try steam inhalation rather than nasal decongestants (e.g. oxymetazoline, phenylephrine, pseudoephedrine, xylometazoline ), as there is not enough safety evidence about these.
There is not enough information about the safety of medications containing antihistamines (e.g. brompheniramine, cetirizine, cyclizine, diphenhydramine, doxylamine, loratadine and meclozine ), so these should be avoided. This includes any eye drops or nasal sprays that contain antihistamines.

PAIN (HEADACHE,BACKACHE ETC)
Paracetamol is regarded by experts as the safest treatment available for general pain treatment. It can be used as a short term measure in all three trimesters.
Aspirin and ibuprofen (and other Non Steroidal Anti-Inflammatory Drugs, NSAID’S, like Diclofenac) are advised against, as they can affect labour and cause other complications if taken during the third trimester. In the first trimester they could induce miscarriage or lead to serious birth defects. Aspirin could lead to bleeding in both mother and child if taken during the third trimester.
Codeine and dihydrocodeine can be used, if approved by a doctor, in the first and second trimesters of pregnancy. It is not recommended for use in the final stage of pregnancy, as it can cause, among other things, breathing difficulties for the child. Some non prescription, “over the counter” medicines contain codeine or dihydrocodeine.

VAGINAL THRUSH
It is important to consult with your doctor when considering treatment for vaginal thrush as not enough is known about the safety of such treatments as flucanazole (Diflucan One) and clotrimazole (Canesten). If these preparations are considered acceptable, care must be taken with the use of vaginal applicators if they can not be dispensed with altogether.

SKIN CONDITIONS, ECZEMA PSORIASIS ETC
Calamine lotion and other similar soothing products can be used safely, as can moisturisers.
Hydrocortisone and other steroid creams should be avoided unless a doctor recommends otherwise. If advised to use it, avoid applying it to large areas of skin, under airtight dressings or for long time periods. This should stop too much of it getting into the blood stream. Hydrocortisone may also appear in breast milk, but no conclusive research exists.
Psoriasis sufferers should also consult their doctor about their own individual needs. Methotrexate should not be taken by the pregnant, those planning on becoming pregnant or even their partners. As well as being a treatment for severe psoriasis, methotrexate is sometimes used for, among other things, terminating ectopic pregnancies. Calcipotriol (e.g. Dovonex) has not been properly tested on pregnant women. Animal testing has shown adverse affects on fetuses.

ACNE
Acne sufferers who use the drug isotretinoin (e.g.Roaccutane) should stop taking it immediately when even trying to conceive a child. It is known to cause birth defects ranging from heart problems and brain abnormalities, to facial disfigurements. Women who continue with this treatment into early pregnancy are more than a third more likely to have birth defects develop in their child. It could also result in miscarriage. Doctors advise caution with other vitamin A related drugs, (retinoids) such as tretinoin (Retin-A,Retin-A MICRO, Retisol-A and Renova) both oral and topical treatments. It is also wise to limit the use of vitamin A supplements, though naturally occurring vitamin A in fruits and vegetables need not be limited at all, as the body processes them in an entirely different way. See a doctor if you take any treatment for acne and are pregnant or planning to have a baby.

As well as doctors and pharmacists, it is wise to inform anyone else who is responsible for medical treatment that you are pregnant. Dentists need to be told so that they can appraise the situation with regard to any drugs, treatments or x-ray procedures they administer. As previously stated, care must be taken with herbal remedies and the like. Check with your doctor that they are safe to take.
Folic acid is one medicine that is generally considered important to take. It should be taken when trying to conceive, and in early pregnancy (the first twelve weeks). Folic acid helps with the baby’s nervous system, and spinal cord development. It also helps guard against spina bifida and birth defects like cleft palate. Doctors will be likely to recommend 400 Mg of folic acid per day in most circumstances.
With the area of medicines safety during pregnancy being such a grey one, and all parties concerned being so cautious in their advice, it is important to look after yourself, eat healthily and not overwork yourself while pregnant.