Taking medicine in pregnancy is a controversial topic. There’s no clear cut answer to “Is it safe to use medicine during pregnancy?” Healthcare providers typically don’t recommend that you use medicine unless the benefits of it outweigh the risk.
As a rule of thumb, however, it’s best that you avoid any medication (if possible) in the first trimester of pregnancy, since this is a vital time in fetal development, when the risk of birth defects is the highest. Try to avoid any medicine, whether over the counter or prescription, until the second trimester (after you are 14 weeks pregnant).
This is harder to do in some situations. For instance, if you’re having severe morning sickness, like my guest blogger Christina did in her pregnancies, you may need to take medicine to help you cope and feel better.
Benefits versus Risks of Medicine During Pregnancy
If you’re pregnant and must decide whether you should take a certain medication, you need to sit down and talk with your doctor about the benefits versus the risk of that medication.
What good will that medicine do (i.e. the benefits) versus what potential harm will the medicine cause on the growing baby (i.e. the risk)?
In some situations, you have a choice to make. Do you want to “live with” whatever ailment or pain you’re dealing with for the sake of your baby’s health? For example, if you have a cold or a stuffy nose, you may decide to forgo the medication due to the potential risk to your unborn baby.
Sometimes, you don’t have a choice of whether to take medicine in pregnancy. Without treatment, the risk of your ailment is too dangerous to your developing baby. For instance, you may have a health problem – like diabetes or asthma – that requires you to take medicine. Going without asthma medication, or your insulin, could put your baby’s life in danger. So, as a result, you must take your medicine. The benefits of the medicine far outweigh the potential risk to your baby.
The FDA’s Pregnancy Categories: A, B, C, D, X
The FDA has a classification system to help you distinguish what medications are safe in pregnant women, and which should be avoided. To help you understand the safety of medications in pregnancy, the FDA assigns a letter category to each. Similar to a grading system in school, it’s easy to understand the FDA pregnancy categories, which ranges from A (safest) to D, and X is the worst.
Here’s the breakdown of the pregnancy categories:
Category A Drugs — This is the safest classification for medications during pregnancy. All of the drugs in this category have been proven safe in controlled human studies. Very few medications on the market have a Pregnancy Category A. Examples of Category A medications include folic acid and levothyroxine, a drug used to treat hypothyroidism.
Category B Drugs — Not as safe as category A, but these drugs are still relatively safe. The drugs in pregnancy category B fall into two sub categories:
(1) There are no good human studies on the safety of the medicines in pregnancy, but in animal studies, these medications didn’t cause problems in the offspring of the animals tested.
(2) In human studies, when the medicine was tested, the babies didn’t have any problems. However, in animal studies, when pregnant animals were given the medication, some of their offspring did have problems.
Tylenol (acetaminophen) is classified as Category B, and for this reason, it’s the most recommended pain reliever in pregnancy. Other category B medicines used in pregnancy include certain antibiotics, like amoxicillin, and certain insulins to treat diabetes.
Category C Drugs — Medications in this category are not as safe, but they can be used in pregnancy if the benefit outweighs the harm. Category C medicines fall into two subcategories:
(1) There are no good controlled human studies. In animal studies, the offspring of the pregnant animals did have some problems.
(2) No animal studies using this medication have been performed, and there are no good human studies.
The antidepressants, Zoloft and Prozac, fall into Category C. Ventolin (albuterol) is also a Category C medicine. The over-the-counter expectorant guaifenesin, pepto bismol, Tums (calcium carbonate), and the antifungal lotrimin all fall into Category C.
Category D Drugs — Medications in this pregnancy category should not be used, unless the benefits far outweigh the risk. Human studies have indicated that babies are born with birth defects and other problems related to the medication. Paxil, lithium (a medication for bipolar disorder), dilantin (a medicine for epileptic seizures) and select chemotherapy drugs for cancer fall into category D.
Although aspirin has not been classified in any pregnancy category, it’s often thought to be a category D drug, due to its potential risk in the third trimester.
Category X Drugs — Medicine in this pregnancy category should never, ever be used. Both animal and human studies clearly indicate that these drugs will cause severe birth defects in the children. Examples of Category X medications include Accutane and Thalomid (a medication that treats skin disease).
Talk to Your Doctor Before Using Any Medication
Before you take any medications, whether this is over-the-counter or prescription, you need to discuss its safety with your healthcare provider. If you’re currently on prescription medication and you just became pregnant, contact your doctor right away and see whether it’s safe to continue taking your medicine.