Special Considerations with Pregnant Women

With mental health, every risk should be considered especially for pregnant women. All medications cause some kind of effect and sometimes, providers simply don’t know the long-term ramifications.

Here’s a history of medications that have fetal adverse events, avoided, or should be assessed in child-bearing women:

Substance	Manifestations
Alcohol	Growth restriction, mental retardation, midfacial hypoplasia, renal/cardiac defects
ACE Inhibitors	Pulmonary hypoplasia, hypocalvaria, oligohydramnios, fetal kidney anuria, neonatal renal failure
Anti-thyroid Drugs	fetal/neonatal goiter with iodine use, small risk of aplasia cutis with methimazole
B-Blockers	IUGR and decrease in placental weight
Carbamazepine	Neural tube defects, minor craniofacial defects, fingernail hypoplasia
Cigarettes	IUGR, functional and behavioral deficits
Cocaine	Bowel atresias. heart/limbs/face/genitourinary tract malformations, microcephely, cerebral infarcts, restricted growth
Corticosteroids (systemic)	oral cleft lip and palates if used during organogenesis
Cyclophosphamide	Craniofacial, eye, and limb defects, IUGR, neurobehavioral deficits
Diethylstilbestrol	vaginal carcinoma, genitourinary defects
Lamotrigine	Oral cleft lip and palate
Lithium	Ebstein anomaly
Methotrexate	CNS and limb malformations
Misoprostol	Spontaneous abortions
NSAIDS	Constriction of the ductus arteriosus, oral clefts, cardiac defects, possibly spontaneous abortions
Paraxetine	Heart defects
Phenytoin	Fetal hydantoin syndrome, growth retardation, CNS defects
Streptomycin and kanamycin	Hearing loss, eighth cranial nerve damage
Systemic retinoids (isotretinoin and etretinate)	CNS/craniofacial/heart defects
Tetracycline	Permanent teeth discoloration
Thalidone	Limb, heart, and skeletal shortening defects
Topiramate	Neural tube defects and heart defects
Trimethoprim	Neural tube defects and heart defects
Valproic Acid	Neural tube defects, developmental delay and deficits
Vitamin A	Microtia, anotia, thymic aplasia, heart defects with high doses
Warfarin	Fetal warfarin syndrome with nasal hypoplasia, skeletal and CNS defects

Postpartum Symptoms:

Key Considerations 

• Always assess the risks versus benefits and consider nonpharmacological treatments; ECT is becoming safer for treating certain forms of depression. No mood stabilizer is F.D.A. approved or safe.
• Pregnant categories are helpful but are not considered safe practice anymore, labels are being used; must consider medications during lactation, the stages of pregnancy (some stages are higher risk than others), and childbearing ages may have to consider birth control or be tapered off medications to reduce risks.
• SSRI’s are considered the safest (except PAROXETINE). Bupropion is used more frequently.
• Encourage pregnancy registration and telephone hotlines, which is located in the insert and helps track the effects of medications and give valuable insight into the use of medications.
• Be aware of the lawsuits concerning common OB/women medications: Zofran, Essure, Abilify, & other meds…

Additional Resources & Information

• Advocates for Pregnant Women
• FDA Approves of New Treatment for PPD
• List of Pregnancy Exposure Registries & Pregnancy Topics by FDA. Enrolling your patients in a pregnancy exposure registry can help improve safety information for medicines used during pregnancy and can be used to update drug labeling.
• Medicine Assistance Tool: a free-to-use search engine that focuses its searches on patient assistance resources available to eligible patients.
• Mother To Baby: a service of the non-profit Organization of Teratology Information Specialists, is dedicated to providing evidence-based information to mothers, health care professionals, and the general public about medications and other exposures during pregnancy and while breastfeeding.
• Prescription medicine during pregnancy by March of Dimes  
• Women’s Health & Postpartum Depression