Drugs And Substances To Avoid In Pregnancy

Most women know that some drugs and food are dangerous during pregnancy. These can affect either the mother, baby or both. To be on the safer side, they seek advice from pharmacists or other healthcare persons including Google. They may also look up to their parents or other mother's. The amount of information that keeps coming sometimes overwhelms them into more confusion. They end up in more serious doubts.

The amount of information available for pregnant women is high. But most are limited to theory. Very few are from reputable research work. This is because of the complications of carrying out research on pregnant women. The few available are mostly from a few groups of pregnant women or random personal experience during practice.

Unsafe medications and substances in pregnancy

Drugs To Avoid In Pregnancy

I have come to realise that most drugs claimed to be contraindicated in pregnancy are not really dangerous at therapeutic doses. Others are safe over a short duration. But the red flag placed on them by manufacturers and regulatory bodies makes people scared of using them. Let us look at them.

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Misoprostol

This drug is used to prevent stomach ulcer while on non steroidal antiinflammatory drugs (NSAIDS). It does this by lowering the amount of acid that comes in contact with the stomach. It therefore prevents stomach bleeding. However, it is teratogenic. Congenital defects following prenatal exposure in early pregnancy include skull defects, bladder exstrophy, arthrogryposis, cranial nerve palsies, facial malformations, terminal transverse, limb defects and Möbius sequence. It is thought to be due to vascular disruption secondary to uterine contraction.

Isotretinoin And Co-cyprindiol

It is used in treating chronic acne and psoriasis. It is contraindicated in pregnancy because it may cause malformations while the baby's organs are forming. Topics are safer.

Ergotamine And Methysergide

This drug is used to treat serious headaches such as migraine. They cause miscarriage and still birth.

Tetracycline

Another antibiotics that is contraindicated in pregnancy. It's use in pregnancy can harm the unborn and cause permanent tooth discoloration later in the baby's life. It affects tooth and bone development especially in the last half of pregnancy.

Atorvastatin

It is a lipid lowering drug. It is contraindicated in pregnancy because cholesterol and product synthesized by cholesterol are important during fetal development. But because the need for the baby during the first trimester is not much, no much risk is recorded when atorvastatin is used. There have been rare reports of congenital anomalies following intrauterine exposure to statins. But other statins did not exceed the rate expected in general population of congenital anomalies, spontaneous abortion and fetal still birth. In general, there is no benefit of statins in pregnancy.

Warfarin

Warfarin is used to thin blood and treatment or prophylaxis is deep vein thrombosis. It is contraindicated in pregnancy in the first trimester because of its teratogenic risk. It's use in pregnancy 2-4 weeks before delivery can lead to hemorrhagic complications. The inhibition of a clotting factor can lead to internal bleeding of the fetus while the inhibition of osteocalcin causes lower bone growth and it can also induce spontaneous abortion or stillbirth.

Non Steroidal Antiinflammatory Agent (NSAIDs)

NSAIDs like ibuprofen are used for management of pain and inflammation. But they cause problems with the baby 's heart and lungs, interfere with labour or reduce amniotic fluid around the baby. Ibuprofen given in the first 30 weeks of pregnancy can lead to miscarriage. However, a small dose of aspirin is safe.

Chloramphenicol

This is an antibiotic used in treating many types of infection. This drug is class C in the FDA. This means that animal reproduction studies have shown adverse effects to the fetus but no controls trials in humans which could possibly have high risk.

But there are some works to show that it is safe in pregnancy. But it should be avoided in the circulatory system at the time of delivery. So if the clearance of the drug from the body is 10 days, the last dose should be before 10days to the expected day of delivery.

Sodium Valproate

Is a drug used in the management of epilepsy. However, it has been shown to affect baby spine, heart and face as well as brain development. The only situation it is given to pregnant women is when it is followed with folic acid 5mg daily to the end of the third trimester.

Thalidomide

Thalidomide is a popular drug among pharmacists because of its rich history. Many people may not have heard of it. This drug was used in the 1950s to 1960s to manage nausea and vomiting in pregnant women. It leads to severe birth defects in thousands of children. It was later banned. This led the federal drug agency (FDA) to tighten its regulations and regulations on drugs and food products. Thalidomide is currently used in the treatment of leprosy and multiple myeloma.

Drugs With Caution In Pregnancy

Quinine

Quinine is always added to the list of drugs contraindicated in pregnancy. However, it is surprising to note that quinine and especially it's sister, chloroquine is the recommended drug of choice in treating malaria in the first trimester of pregnancy. Here is the reason for the controversy. Quinine and chloroquine are safe in pregnancy at therapeutic level. At high doses, it damages the fetal optic and auditory nerves.

Vitamin A

All nutrients are good in pregnancy. But some can cause havoc when consumed in excess or overdose. A good example is vitamin A. Vitamin A (retinol) is a fat soluble that is stored in the body. It is good for the immune system, vision and beauty but can harm the unborn. The right amount of vitamin A is good for fetal growth.

Excess of it is teratogenic in the first 60 days following conception. Women in  countries with recorded cases of vitamin A deficiency should start taking vitamin A supplement from the second trimester.

Excess of it harms the skeleton, morphological and functional development including ocular integrity. It affects the central nervous and cardiovascular system and also cause spontaneous abortion.

Avoid taking vitamin A supplements without proper advice from a medical personnel. So many processed foods contain vitamin A which may be sufficient enough to provide the dietary need for pregnant women. A good source of vitamin A is the liver.

Ciprofloxacin

Ciprofloxacin is an antibiotic that is used to treat several infections. The drug has some side effects when used for a long time lik three months. An example is arthropathy. However, it's use in pregnancy has met stiff opposition from members of the health sector. They fear its side effects even for a short duration. The data in ciprofloxacin during pregnancy is limited. However, the little available data show that it is unlikely to cause any substantial teratogenic risk when used in short duration. Long term therapy has not been evaluated like in anthrax. Even the risk of arthropathy is limited.

Codeine And Dihydrocodeine

They are use in pain management. They are class as control drugs (CD). This is because they are addictive. It is contraindicated in long term use. It's use in pregnancy is limited to short term especially. During the third trimester, they may cause withdrawal syndrome or breathing problems in babies.

Substances To Avoid In Pregnancy

There are so many substances around the world. This post focuses on substances readily available in Nigeria.

Alcohol

There is no safe level as long as pregnancy is concerned. And there is no safe period from day one of conception until delivery. Using alcohol during pregnancy can lead to fetal alcohol spectrum disorders (FASD). FASD can lead to premature birth, miscarriage, stillbirth and a range of lifelong physical, behavioural and intellectual abilities. Drinking in the first semester can cause the baby to have abnormal facial features, growth and central nervous system problems (e.g low birth weight, behavioural problems).

Tobacco

Tobacco smoking is bad for everyone. The problems increase in pregnancy. It increases the risk of other substances and drugs. It is also attributed to preterm birth, low birth weight and other birth defects of the mouth and lips. It also increases sudden infant death syndrome (SIDS).

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Raw Food

Fruits, meat, eggs, and other uncooked foods should be consumed with extreme caution. This is because they may contain organisms that can cause disease to both mother and unborn child. However, with improved hygienic preparation especially raw egg, contamination is reduced and not as risky as some years ago.

Caffeine

Caffeine has some acclaimed benefits like a fat burning effect. However, in pregnancy, the story may be different. There is a safe level of caffeine in pregnant women. Above 200mg daily, the baby may be born with low weight and miscarriage can occur. And just two mugs if coffee is more than enough to provide that level.