Friday, January 21, 2011

Pregnant Humans Who Actually Take Drugs

Part 1 (FDA Categories)

Part 2 (So What Do I Do, Then? Eh?? EH?)

So 2/3 of drugs are Category C and, according to the FDA, the average woman of childbearing age is taking 3 medications.

Say you're pregnant, or about to get pregnant. You go to your doctor to talk about meds. Chances are, your doctor will say, "Oh, well... just to be SAFE, you shouldn't take that! After all, you wouldn't want to hurt your baby!"

This frequently happens over antidepressants- most of which are very safe in pregnancy. Also, I am too lazy to find the articles, but 1) 80% of unmedicated women with a major depressive episode will have postpartum depression and 2) a recent, quite good, study shows that tapering off SSRIs a week or two before the due date does not, in fact, prevent infant respiratory distress. (A month or two is required, which is plenty of time to feel really, really nuts.) Therefore, "stop your meds" is stupid, dangerous, bad advice. For the mother.

This rant is, in fact, relevant. Liability has a lot to do with OB care. If you can convince your medical-professional-of-choice that you are making an informed decision, it reduces their fear that you will sue them.* Plus, they can write it down in your chart and all.

So how do you and your doctor know if something is safe? In order of ease-of-use:

1) Motherisk (pregnancy and breastfeeding): They run trials and write reviews. They also have a hotline. They have good, sensible information on drugs in pregnancy and breastfeeding. Unfortunately, they think one glass of wine MAY HURT YOUR BABY OMG. You can ignore that part if you want.

2) Dr. Jack Newman's book or website (breastfeeding:) Note: I recommend reading through this web page for a truly excellent general summary of when drugs are safe. Example: if they give it to newborns, it's probably safe in breastfeeding and maybe in pregnancy.

3) Common sense. I knew someone whose husband was worried about her taking Tums. They are made of calcium. Like in vitamins. Tylenol? Probably harmless. One glass of wine? Europe's rate of birth defects is no higher than it is here even though about 50% of women report drinking a little while pregnant.** Also, alcohol is proportionally present in breastmilk; if your BAC is 0.02, then 0.02% of your breastmilk is alcohol. If your kid drinks 100 mL of milk right after you drink, they'll get about 0.02 mL of alcohol, which is 0.4 mL of beer, or 8 drops. One cup of coffee in the morning while pregnant? Even March of Dimes, crazy fearmongers though they tend to be, thinks that's safe. Most drugs, about 1% ends up in breastmilk. Think before panicking, that's my motto!

4) The NHS publishes a clinical knowledge summary which is like the Cliff's Notes version of PubMed. (Registration required.) It tends to be conservative, but accurate.

5) There's always PubMed for the hard-core article-readers, (it's an index of all biology and medicine articles published). How do you tell if something's a good study? Well.... that's harder. Is it published in NEJM or Proceedings of the Royal Swedish Academy of Neurotoxicity in Cats? Do the error bars overlap, yet they claim P < 0.05?*** Is it the only article ever claiming that result? Is it a meta-analysis of twenty articles with widely differing methods, controls, and data? If you know a scientist or medical professional... ask them to read up on it for you. We're well practiced in spotting crappy data. Also we have academic-library access to all the darn articles. (Rot in hell, Else.vier.)

* One day, I should perhaps relate my not-very-amusing, three-days-before-Bug's-birth story of double vision, the ER, the MRI, the very cranky neurologist, the ex-military ex-OB specialty ophthalmologist, the lumbar puncture and C-section I didn't get, three most excellent midwives, and a partridge in a fricking pear tree, i.e., how to very firmly refuse treatment even while pregnant. It was, of course, idiopathic.

**Roughly four times the reported alcohol-in-pregnancy rate here, and yet the birth defect rate is no higher. Therefore, if there is an effect, it is lost in the noise. As another side note, one of the most-cited papers on drinking in pregnancy is a CDC study where they defined "moderate drinking" as 3 drinks. A DAY.

*** Mathematically, virtually impossible. I calculated it out once.


  1. Anonymous4:34 PM

    love the comment about Else.vier :)

    sounds like some good sound advice & great resources for the pregnant and pregnant to be, thanks!

  2. Thanks for the advice and links! I agree about convincing doctors that you're making an informed decision, works well with mine (regarding infertility, not drugs in pregnancy, but I hope we'll get there eventually).

  3. This post is sooo old, but this irritated me in my last pregnancy. My OB finally convinced me to go on an anti-depressant, and she suggested Wellbutrin. I agreed, asked about safety with breastfeeding and everything, and went on it. I decided to read up on whatever studies I could find so I was informed, and what I kept seeing everywhere was that Wellbutrin was either not indicated during pregnancy and breastfeeding or was at least way far down on lists of recommended anti-depressants. When I did a little more digging to find out what the studies had to say, I found that there weren't any studies, at least not that I could find, and that everything saying that data showed a possible increase in likelihood of seizures was based on--get this, no exaggeration--one internet-based survey in which one mother was on a cocktail of depression and anxiety meds, of which Wellbutrin was one, and her baby had a single incident of something that looked kind of like a seizure but the doctors never settled on a diagnosis. That is it. It makes me want to take my Wellbutrin pill to the offices of some of the people putting out these lists and stare them down while I chew it like a SweeTart.


Comments are moderated, so it may take a day or two to show up. Anonymous comments will be deleted.