Medication Safety During Pregnancy

Salvi Schostok & Pritchard estimate that there are over 1.5 million medical injuries in the US alone, and pregnant women are among those affected. As common as medical injuries are (to the mother and child, alike), many people seem to ignore their severity.

I have seen a few people with missing or malformed arms and often wondered what had gone wrong during development. Many of my questions were answered during the first trimester of my first pregnancy, when I became more aware of birth defects and medical conditions such as phocomelia and amelia.

Historically, these conditions became widely known due to the use of thalidomide, a medication once prescribed to pregnant women for morning sickness. Thalidomide exposure (men and women, alike) during pregnancy led to severe limb deformities in thousands of infants worldwide and remains a defining example of how medications that may seem safe can have devastating effects during pregnancy.

Research published in ResearchGate reports that approximately 3% of babies born in the US have a congenital defect, a leading cause of child mortality linked to medication exposure or medical management during pregnancy. Our community must also keep in mind that maternal mortality is 4 times higher among Black women when compared to white women, as reported by the National Institute of Health. As such, our community must approach medication use during pregnancy with heightened care and urgency.

For anyone who is pregnant or planning to become pregnant, it is essential to understand which medications are generally considered safe, which require caution, and why abrupt discontinuation can also cause harm. This information is crucial in protecting mothers and their innocent, vulnerable babies.

Prescription vs Over-the-Counter (OTC) Medications

I’ve always thought that over-the-counter medication is far safer than prescription medications. Still, in my research, I’ve come to discover that safety during pregnancy all depends on how a particular medicine works, when such a medicine is taken, and why the pregnant woman is taking it.

Prescription Medications: One special thing about prescription medications is that they are prescribed for special medical conditions like HIV, hypertension, depression, or epilepsy. Such medications are only to be specified for a pregnant woman if their benefits outweigh their risks. So, when a healthcare provider chooses such treatment for you, it is because they have a proven track record of safety

OTC Medications: These are medications that are readily available and generally pose no harm to the mother and fetus. Medications for pain relief, cold remedies, and herbal supplements fall in this category and, in many cases, are taken without any medical advice. Unfortunately, these medications may interfere with fetal development or pregnancy hormones. Because these are not prescribed, many users of these medications may not report the use to their healthcare practitioner and, by default, feel as if there will be zero side effects to the unborn child.

NEVER assume an easy-to-get medication is safe because you can just walk into a medical store and buy it without a prescription. For example:

Some painkillers such as non-steroidal anti-inflammatory drugs (NSAIDs) (including ibuprofen, naproxen, diclofenac, celecoxib, and indomethacin), aspirin, and opioids are known to cause complications later in pregnancy or even lead to miscarriage.

Simple cold and flu medicines that we commonly take occasionally often contain several active ingredients, making it difficult to determine their safety.

And when it comes to herbal remedies, the greatest challenge in using them is how poorly they are regulated and the little or no safety data that clear them to be used during pregnancy.

Special Considerations During Pregnancy

While several medications are unsafe during pregnancy, there are still some that are not optional because they are life-saving and necessary for long-term health. As a pregnant woman, stopping the use of these medication can be life-threatening for either you or your unborn child, or both of you. Instead, look for the safety position options when using such medications, and don’t take any medication without a doctor’s prescription.

Antiretroviral medications (ARVs)

If you are living with HIV and want to get pregnant, this medication should be one of your priorities. It not only reduces the risk of you transmitting HIV to your unborn child, but it also protects your immune system. Years of improvement have made ARVs safe during pregnancy, and stopping them at any time during pregnancy can cause viral rebound, serious health complications, and increase the rate of transmission.

Antidepressants

While physical health is essential, mental health is just as important, especially during pregnancy. When depression or anxiety are not treated during pregnancy, the end result could be preterm birth, substance use, poor nutrition, missed antenatal care, and postpartum complications.

Some antidepressants require careful monitoring, and have been associated with slightly increased risk of certain birth defects when taken early in pregnancy. However, when you and your healthcare practitioner consider the risk of severe and untreated depression, you will see that it often outweighs the potential medical risks.

Blood-pressure medications

According to the National Library of Medicine, high blood pressure (BP) is the cause of 10% of complications during pregnancy. A mother’s high BP may affect how well the placenta delivers oxygen and nutrients to the fetus, restrict growth, may require a preterm birth for safety, low birth way, and still birth. It can lead to stroke, kidney damage, preeclampsia, and poor fetal growth. Although not all blood pressure medications are okay during pregnancy, several BP medicines are known to be safe. When it comes to pregnancy, managing blood pressure is critical, as uncontrolled blood pressure has far worse consequences than appropriately choosing medication.

Why Stopping Medications Abruptly Can Be Dangerous

Naturally, our first instinct after discovering that we are pregnant is to stop all forms of medication, especially if they come without a prescription. However, not all medicines are harmful to the baby, and stopping your medications abruptly can be a very fatal mistake.

Abruptly stopping medication may:

Worsen chronic conditions like HIV, depression, and epilepsy
Lead to emergencies that are more costly and need more decisive intervention
Increased stress and strain on the body may affect the body negatively
Lead to a sudden spike in BP or seizure

As a mother of two, I understand how pregnancy can place an extra layer of demand on our bodies, both physically and mentally. Abruptly stopping medication without any backup safety plan can be devastating to both the mother and fetus. With research showing that Black women hardly get the same quality of care as their white counterparts, it’s about time we took precautions to ensure favorable health outcomes. Elevate Black Health recommends that any change in medication, whether it involves total stoppage, switching, or adjustment, must be done under the supervision of a qualified healthcare provider.

Patients should read the Medication Guides (or package inserts) of medicines which advise known pregnancy risks; consult the pharmacists and healthcare practitioner about OTC medications, and drug-drug interactions and side effects. Importantly, ask for them to explain it in plain language, not in high-science language.

Visit these sites to learn more:

Birth Injuries – Medication Errors. https://www.salvilaw.com/birth-injury-lawyers/medication-errors/

Environmental Factors and Birth Defects. https://www.elevateblackhealth.com/environmental-factors-and-birth-defects/

What Is Phocomelia? https://www.webmd.com/children/what-is-phocomelia

Amelia. https://archive.cdc.gov/www_cdc_gov/ncbddd/birthdefects/surveillancemanual/quick-reference-handbook/amelia.html

National estimates and race/ethnic-specific variation of selected birth defects in the United States, 1999–2001. https://www.researchgate.net/publication/6743336_National_estimates_and_raceethnic-specific_variation_of_selected_birth_defects_in_the_United_States_1999-2001

Disturbing Infant Mortality Rates in Black Community. https://www.elevateblackhealth.com/disturbing-infant-mortality-rates-in-black-community/

Listen to the Whispers before They Become Screams: Addressing Black Maternal Morbidity and Mortality in the United States. https://pmc.ncbi.nlm.nih.gov/articles/PMC9914526/