Ask About These Common Medications during Pregnancy

By Joanne Stone, Keith Eddleman, Mary Duenwald

A few medications can cause problems for the baby’s development. So let your doctor know about all the medications you take. If one of them is problematic, you can probably switch to something safer. Keep in mind that adjusting dosages and checking for side effects may take time.

The following are some of the common medications that women should ask about before they get pregnant:

  • Birth control pills: Women sometimes get pregnant while they’re on the Pill (because they missed or were late taking a couple of pills during the month) and then worry that their babies will have birth defects. But oral contraceptives haven’t been shown to have any ill effects on a baby. Two to three percent of all babies are born with birth defects, and babies born to women on oral contraceptives are at no higher risk.

  • Ibuprofen (Motrin, Advil): Occasional use of these and other nonsteroidal anti-inflammatory agents during pregnancy (for pain or inflammation) is okay and hasn’t been associated with problems in infants.

    However, avoid chronic or persistent use of these medications during pregnancy (especially during the last trimester) because they have the potential to affect platelet function and blood vessels in the baby’s circulatory system, and because your baby’s kidneys process them just like your own kidneys do.

  • Vitamin A: This vitamin and some of its derivatives can cause miscarriage or serious birth defects if too much is present in your bloodstream when you get pregnant. The situation is complicated by the fact that vitamin A can remain in your body for several months after you consume it.

    Discontinuing any drugs that contain vitamin A derivatives — the most common is the anti-acne drug Accutane — at least one month before trying to conceive is important.

  • Blood thinners: Women who are prone to developing blood clots or who have artificial heart valves need to take blood-thinning agents every day. One type of blood thinner, Coumadin, or its derivatives can trigger miscarriage, impair the baby’s growth, or cause the baby to develop bleeding problems or structural abnormalities if taken during pregnancy.

    Women who take this medicine and are thinking of getting pregnant should switch to a different blood thinner. Ask your practitioner for more information.

  • Drugs for high blood pressure: Many of these medications are considered safe to take during pregnancy. However, because a few can be problematic, you should discuss any medications to treat high blood pressure with your doctor.

  • Antiseizure drugs: Some of the medicines used to prevent epileptic seizures are safer than others for use during pregnancy. If you’re taking any of these drugs, discuss them with your doctor. Don’t simply stop taking any antiseizure medicine, because seizures may be worse for you — and the baby — than the medications themselves.

  • Tetracycline: If you take this antibiotic during the last several months of pregnancy, it may, much later on, cause your baby’s teeth to be yellow.

  • Antidepressants: Many antidepressants (like Prozac and Zoloft) have been studied extensively and are considered safe during pregnancy. Recent studies on selective serotonin reuptake inhibitors (SSRIs) showed a small increase in certain birth defects, particularly with paroxetine, while other studies showed no increased risk.

    Some of the newer antidepressants like Cymbalta, Celexa, Lexapro, and Effexor appear to be safe in pregnancy, but because they are new, data is limited. If you need to start an antidepressant during pregnancy, many doctors feel that sertraline (Zoloft) is the best first-line drug. But if you’re already taking an antidepressant, ask your doctor whether you’ll be able to keep taking the medication while you’re pregnant or need to switch to something safer.

    Aside from birth defects, there’s also been concern that SSRIs were associated with an increased risk for autism. More recent studies, however, did not find a significant increase in the risk of this disorder in women taking SSRIs during pregnancy.

  • Bupropion: Bupropion is an antidepressant, but it’s also prescribed to help people stop smoking (for example, Wellbutrin or Zyban). Very little info exists on its use during pregnancy, but the available data doesn’t suggest any significant problems with fetal development. Although you shouldn’t use it as a first line for depression, its use for smoking cessation may be beneficial.

  • Fluconazole: Fluconazole is an oral medication used to treat yeast or other fungal infections. A recent study showed that oral fluconazole used during the first trimester was not associated with an increased risk of birth defects overall, but that it may be associated with an increased risk of a specific heart defect known as Tetralogy of Fallot.

  • Decongestants: A mounting body of recent evidence suggests that decongestants like phenylephrine and phenylpropanolamine, when used during the first trimester, may be associated with an increased risk of birth defects. If possible, you should avoid taking these medications until you have completed your first trimester, but if you inadvertently took some before you found out that you were pregnant, the likelihood of a birth defect resulting from it is still very low.

  • Lithium: Lithium is a medication that is used occasionally to treat bipolar disorder. It is thought that this medication places women who take it during pregnancy at an increased risk for having a child with a specific cardiac abnormality known as Ebstein’s anomaly.

    If possible, an alternative medication should be chosen for the first trimester, but if lithium is inadvertently taken during the first trimester, the risk is still quite low. Women taking lithium during early pregnancy should have a fetal echocardiogram around 20 weeks. This is a special type of ultrasound done to diagnose cardiac abnormalities, including Ebstein’s anomaly.