Pregnancy is a delicate time for mothers and babies.
The health and wellness of the mother are inextricably linked to the health of the baby.
Many prescription drugs are not safe to use during pregnancy.
If you are pregnant or trying to become pregnant, consult your doctor regarding which medications are safe to continue in pregnancy.
During pregnancy, the fetus is attached to the mother through the placenta in the uterus, which is the source of all nutrition to the fetus. Most things the mother consumes can be transferred to the baby through the placenta.
Because of this biological link between pregnant mothers and babies, mothers need to pay special attention to the medications and other substances they are consuming to ensure the health of their baby throughout their pregnancy. The U.S. Food and Drug Administration reports that 50 percent of pregnant women say they take at least one medication.
Sometimes, you can continue to take prescription drugs normally throughout pregnancy. However, many medications can be dangerous, especially if they are misused or abused.
Some classes of prescription drugs should be carefully monitored or avoided during pregnancy.
Discussing all prescription drugs with your doctor is an important part of prenatal care.
The risks of specific medications vary widely in terms of their risks during pregnancy. Classes of drugs that are of particular concern include:
These medications are commonly prescribed for pain. Some women may already be taking opioids prior to their pregnancy to treat various conditions, and they may have a level of physical dependence. The withdrawal process from opioids can be complicated and poses risks to the mother and fetus that need to be evaluated.
These medications may be prescribed for sleep disorders and ADHD, and they can speed up heart rate and affect appetite and nutritional intake. More research is needed into how stimulants affect pregnancy, and the recommendations for pregnant women vary.
Many medications that are prescribed to treat anxiety and sleep disorders function by depressing heart rate and the respiratory system, but this can pose risks during pregnancy. Too much sedation could adversely affect both mother and fetus. The risks of CNS distress are amplified during pregnancy.
Women who are taking medication for their mental health when they become pregnant may be concerned about whether they can continue to take their prescriptions during pregnancy. The risks of exacerbated mental health problems can pose additional risks during the pregnancy.
Women need to discuss their individual risk factors with their doctor and consider their own mental health needs before making decisions about medication changes. Studies have documented the risks associated with untreated mental illness during pregnancy as well as the risk to the fetus with psychiatric medications. It’s a decision that is made on a case-by-case basis.
This does not mean that pregnant women can never take these medications. They have implications for pregnancy and should be used only under the prescribed conditions and dosages.
There are many reasons why different prescription drugs may be necessary even though they may pose some risk during pregnancy. All health conditions have to be treated with attention to balance the risks and benefits of any treatment plan. This is why having a discussion with your prenatal care providers is so important when making medication decisions during your pregnancy.
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There is a distinct difference between recreational use of prescription drugs and cases of medical necessity.
When people are using prescription drugs recreationally, they are looking for the pleasure reward they receive from taking the drug, and they may be more likely to take more than the prescribed dose. Taking more than the prescribed dose of any medication increases the risk of adverse outcomes and negative side effects.
Second, when you are taking a prescribed medication during pregnancy under the supervision of a doctor, you will be taking it within the confines of the recommended dose and with the guidance of a medical professional who knows how the medication can affect both mother and baby. Following this guidance will lower the risks associated with prescription drug use during pregnancy.
There are safe ways to take prescription drugs during pregnancy, most importantly by following the recommendations of your neonatal care providers.
The CDC has guidelines for how to treat many different medical conditions during pregnancy and provides detailed summaries of the research and precautions that providers can use for guidance.
Another consideration of the effect of prescription drugs during pregnancy is the impact of potency on the fetus. The amount of medication that an adult woman takes of any medication based on the symptoms being treated will be amplified in the body of the fetus because the fetus is so much smaller.
This is another reason that all prescribed medications should be taken only under the supervision of your obstetrician or in conjunction with your primary physician.
If you have been taking any prescription medications that you want to stop due to pregnancy, have a conversation with your doctor about the risks and benefits of getting off these drugs.
With antidepressants or other mental health medications, it is especially important that you consider the potential risks to you as the mother. Your mental health is part of your overall health. The hormonal changes that pregnant mothers go through can have an added effect on your mental health and wellness.
A study from the journal Psychiatry Qfound that in a group of pregnant women with prior depression, 35 percent were not receiving treatment and 42 percent had no opportunity to continue with their medication. This highlights the need for increased access to mental health care for pregnant women.
If you decide that the best course of action is to come off a prescription medication during pregnancy, discuss a tapering method with your doctor. Many times, medications need to be gradually reduced rather than stopped all at once.
Using a slow tapering method can reduce the impact of negative side effects or withdrawal symptoms that affect both the mother and fetus.
Medical detox can be another way to slowly taper the dose of medication while also treating the symptoms of withdrawal and monitoring the health and safety of the mother and fetus throughout the process.
Treatment plans for medical detox will be highly individualized based on a number of factors, such as the medication the mother has been taking, the dosage she is accustomed to, and the individual health considerations of the mother and fetus.
In many cases, a replacement medication may be used during medical detox to ease withdrawal symptoms. Due to the more complex situation, inpatient medical detox is usually recommended for pregnant women.
The risks of substance withdrawal can endanger both the mother and the fetus. Sometimes, the safer route is not to detox from medication but to remain under a doctor’s care and address withdrawal for both mother and baby after delivery.
The FDA has reported that babies can experience withdrawal symptoms from psychiatric medications taken by their mothers during pregnancy. The medications often improve the daily lives and functioning of pregnant women with mental health conditions, so specialized care needs to be given to both mother and baby following birth.
If the mother and fetus do begin to experience withdrawal symptoms, they can sometimes be treated with safer alternatives. However, this is another situation where a doctor should develop an appropriate treatment plan that considers the risks and benefits of all factors involved.
Treating withdrawal syndrome can be complicated even in healthy adults. The additional risk factors and considerations with a pregnant mother further complicate treatment.
Pregnant women who have a dependency on a prescription drug, whether they are using the drug as prescribed or misusing it, need specialized treatment to ensure a healthy pregnancy.
Find an obstetrician or addiction specialist with experience treating pregnant women with substance dependency. This will help to ensure the health and safety of the pregnant mother and her baby.
(September 2012). An Investigation into the Use of Stimulant Therapy during Pregnancy. Sleep Disorders. from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3581134/
(February 2011). Antipsychotic drug labels updated on use during pregnancy and risk of abnormal muscle movements and withdrawal symptoms in newborns. U.S. Food and Drug Administration. from https://www.fda.gov/Drugs/DrugSafety/ucm243903.htm
Benefits and risks of Psychiatric Medications During Pregnancy. American Family Physician. from https://www.aafp.org/afp/2002/0815/p629.html
Guidelines and Recommendations for Treating and Managing Health Conditions during Pregnancy. Centers for Disease Control and Prevention. from https://www.cdc.gov/pregnancy/meds/treatingfortwo/treatment-guidelines.html
(December 2018). Medicine and Pregnancy. U.S. Food and Drug Administration from https://www.fda.gov/ForConsumers/ByAudience/ForWomen/ucm118567.htm
Pregnancy and Opioid Pain Medications. Centers for Disease Control and Prevention. from https://www.cdc.gov/drugoverdose/pdf/pregnancy_opioid_pain_factsheet-a.pdf
(September 2014). What Happens to Mental Health Treatment During Pregnancy? Women’s Experience with Prescribing Providers. Psychiatry Q. from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4399820/