Drugs in pregnancy
Tobacco, alcohol, marijuana, and illicit drug use while pregnant may be dangerous for the unborn baby and may lead to severe health problems and/or birth defects.
[4] In addition to medications and substances, some dietary supplements are important for a healthy pregnancy, however, others may cause harm to the unborn child.
[5] The Food and Drug Administration (FDA) in the United States reports that there are six million pregnancies with at least 50% of the women taking at least one medication.
[12] There is potential for fetal liver toxicity in cases of maternal overdose, where the mother consumes more than the recommended daily dose.
When ibuprofen and naproxen are used within the third trimester, there is a significant increase in the risk of premature closure of the ductus arteriosus with primary pulmonary hypertension in the newborn.
[18] Evidence is conflicting for carbamazepine regarding any increased risk of congenital physical anomalies or neurodevelopmental disorders by intrauterine exposure.
If heartburn appears after 20 weeks of gestational age or is severe and persistent, this can indicate other conditions including HELLP syndrome and preeclampsia.
Histamine H2 blockers and proton pump inhibitors, such as famotidine (Pepcid) and omeprazole (Prilosec), respectively, can also be used to help relieve heartburn, with no known teratogenic effects or congenital malformations.
[12] Aluminum hydroxide/magnesium hydroxide and calcium carbonate, when consumed, do not cross the placenta and are regarded as safe pharmacological options to treat heartburn, since there are no significant association with maldevelopment or injury to fetus.
[14] Ginger and acupressure are common non-pharmacological options used to treat nausea and vomiting as alternatives to antacids, histamine H2 blockers, and proton pump inhibitors.
[23][24] Personal hygiene and a healthy lifestyle also help, however dietary restriction and abrasive agents found in facial cleaning products are not beneficial.
[25] As there are limited options to safely treat acne in pregnancy, shared decision-making between the health care provider and client is recommended.
Enoxaparin is listed as Pregnancy Category B, meaning animal studies have failed to show harmful effects to the fetus and therefore are safe to use in pregnant women.
[56] It is suggested that women speak to their healthcare professionals before taking any over-the-counter or prescription medication while pregnant to ensure that there are no adverse health outcomes.
[58] Signs and symptoms of ACEi and ARB use during pregnancy include kidney damage or failure, oligohydramnios, anuria, joint contractures, and hypoplasia of the skull.
[58] Common, alternative agents for high blood pressure in pregnant women include anti-adrenergic and beta-blocking medications, such as methyldopa or metoprolol, respectively.
[14] Pseudoephedrine is an alpha-adrenergic receptor agonist that enacts a vasoconstrictive effect to reduce airflow resistance in the nasal cavity and allow easier breathing by relieving a stuffy or congested nose.
[11] Since pseudoephedrine activates alpha adrenergic receptors, it has the ability to elevate blood pressure and cause vasoconstriction within the uterine arteries.
[59][60] Many countries such as the USA, Canada, Chile, and Costa Rica have fortified foods with folic acid and have seen a reduced incidence of neural tube defect (NTD).
[61] The Center for Disease Control and Prevention (CDC) recommends that all women of child-barring age receive 400 μg of folic acid supplement (even if they are not planning on getting pregnant).
[66] Additionally, it raises the likelihood of various pregnancy complications, including spontaneous miscarriage, preterm birth, and puts the mother at an increased risk of medical issues such as postpartum bleeding and placental abruption.
Since the fetus is smaller and does not have a fully developed liver, the concentration of alcohol in its bloodstream lasts longer, increasing the chances of detrimental side effects.
FAS is characterized by slower physical growth, distinct facial abnormalities including smooth philtrum, thin vermilion, and short palpebral fissures, neurological deficits, or smaller head circumference.
According to the American College of Obstetricians and Gynecologists, an acceptable intake of caffeine for pregnant women is less than or equal to 200 mg per day.
[78] Other comprehensive reviews reported that caffeine intake of more than 300 mg per day have been associated with spontaneous abortions and low birth weight, but further research is needed to establish this causal relationship.
[80] Tetrahydrocannabinol (THC), an active ingredient in cannabis, can both cross the placenta and accumulates in high concentrations in breast milk.
[89] Methamphetamine use in pregnancy may lead to babies born with an earlier gestational age at delivery (pre-term), lower birth weight, and smaller head circumference.
[89] Methamphetamine use during pregnancy also negatively impacts brain development and behavioral functioning and increases the risk of the baby having ADHD and lower mental processing speed.
Typical symptoms may include tremors, convulsions, twitching, excessive crying, poor feeding or sucking, slow weight gain, breathing problems, fever, diarrhea, and vomiting.
[95] Until 2014, the U.S. Code of Federal Regulations required that certain drugs and biological products be labelled specifically with respect to their effects on pregnant populations, including a definition of a "pregnancy category".
