Medications in Pregnancy

 Historical view

Most doctors used to firmly believe that the placenta protect the fetus from the outside world and that the uterus provided a safe environment for the developing embryo. This conviction was questioned in 1941 by Australian doctor Dr. N.M. Gregg, who noted a high frequency of birth abnormalities in women in the first three months after having German measles (rubella) of a woman’s pregnancy. The growing fetus’s vulnerability to drugs grew tragically obvious when babies born to mothers who took thalidomide during the first trimester of their pregnancy had abnormalities in the limbs. throughout the 1950s, the sedative Thalidomide was prescribed and sold throughout Europe and Canada help alleviate morning sickness in expectant mothers. Fortunately, the United States did not introduce it.

Due to the FDA’s (Food and Drug Administration) lack of conviction on its safety. Later on discovered that thalidomide resulted in babies being born with short, flipper-like limbs or missing limbs, and the drug was later outlawed globally. The FDA’s circumspect stance most likely saved hundreds of such birth abnormalities inside this nation.

Summary

Numerous drugs and substances may pass through the placenta and, depending on their characteristics, may even differ in degrees in the fetus and embryo. If the fetus comes into contact with certain drugs and substances, or these agents, which include viruses like rubella, may lead to aberrant cell development and proliferation. Something that produces teratogenicity, which is defined as causing cellular harm or aberrant cell development in the fetus.

Teratogenesis is the process that results in congenital abnormalities such as cleft lip and aberrant limbs, as a result of teratogen exposure in pregnancy.
Since clinical trials on medications in expectant mothers are lacking, a large portion of our knowledge on the dangers of drugs during pregnancy is derived from data collecting, empirical analysis, and animal research from instances that have been reported. While research on animals is valuable and offers some understanding of the potential negative effects in people, they do not imply that a medication that has been shown safe in animals would likewise be secure for people.

The FDA has mandated since 1975 that pharmaceutical firms provide a section on the drug’s potential to result in birth abnormalities as well as other pregnancy-related side effects. Additionally, all drugs have to be categorized into one of the five risk factors that the FDA has designated.

pregnancy and medicines

Risk groups for prescription drugs used during pregnancy
Description of the Category, Studies under control indicate no danger to people. 

• Controlled studies show no risk to humans.
• B, Studies on animals have not shown any indication of fetal damage, although there are no sufficient and well monitored research on expectant mothers. 
• C, Research on animals has shown a negative impact, but there isn’t enough reliable research involving expectant mothers. Thus, it is impossible to completely rule out the danger to people. 
• D, Research findings or firsthand accounts have provided conclusive proof of fetal danger. The advantages of treatment could be greater than the possible hazards. 
• X, Research findings or observations revealed conclusive proof of prenatal defects, and the application is not recommended for pregnant or potentially pregnant women. 

Psychiatric Drugs During Pregnancy

To differing degrees, all psychotropic drugs pass the placenta. When taken when pregnant, Certain drugs provide a risk of teratogenesis, especially in the first trimester. 

Lithium-based medicine has been linked to heart abnormalities, and the medication Depakote (divalproex sodium), which is used to treat bipolar disorder.

A 1%–2% chance of spina bifida, or inadequate spinal cord development, is associated with bipolar illness; these drugs are categorized as high-risk under Category D. The benzodiazepines used for sleep disorders illnesses, such as (flurazepam), Halcion (triazolam), and (temazepam).

Estazolam belongs to Category X and shouldn’t be used while pregnant. The majority of psychiatric drugs are categorized as Category C, while they haven’t been shown to cause birth abnormalities; still, there are hazards in humans that are still a possibility.

Psychotropic drugs may potentially have an impact on childbirth. The unfavorable consequences of this Medication side effects or pregnancy complications are possible. For instance, children born to moms withdrawal symptoms from benzodiazepines (e.g., Valium) may occur soon after delivery. After birth, babies are often seen to be floppy and sluggish to react. If at all possible, avoid taking medications while pregnant. But when drugs are stopped, symptoms often return, exacerbating pre-existing mental health issues. The doctor and patients often have to decide whether to resume taking their drug or look for a safer, but maybe less viable substitute therapy for pregnant women. Not seeking treatment for the mental illness while expecting carries substantial dangers for both the expectant mother and the child.

Considerations for Treatment

Pregnancy-related pharmaceutical decisions must be supported by the informed consent of the tolerant. The doctor needs to advise the patient about the possible side effects of the drug and suggest alternatives to medicine, which may not be one of them. In the end, the advantages of treatment must be greater than any possible dangers.