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Feature Article

Drugs in pregnancy

Debra Kennedy

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Abstract

GPs are likely to be the first point of contact for advice about safety or otherwise of drugs during pregnancy. Some medications appear to be safer for use in pregnancy than others but this aspect has to be considered alongside their relative effectiveness.

Key Points

  • Contrary to popular belief, there are relatively few proven human teratogens. Increasing numbers of prescribed medications are being shown to be safe for use during pregnancy.
  • The risk of adverse pregnancy outcomes related to an exposure to drugs, chemicals and other environmental agents during pregnancy must always be given in the context of the background risk of major malformations (3% of live births) and the risk of spontaneous miscarriage (15% of recognised pregnancies).
  • The Australian Drug Evaluation Committee’s categorisation of risk of drug use in pregnancy is useful as a guide for doctors but should not be regarded as definitive. In some situations the risks and benefits to both mother and fetus of using a particular drug in pregnancy must be weighed up and appropriate counselling given.
  • There are some drugs that appear to be safer than others for use in pregnancy. In general, the lowest effective dose of a single agent should be used, and older ‘tried and true’ rather than newer drugs should be used if clinically appropriate.
  • Ideally, women should be counselled about chronic medication use prior to pregnancy and drug regimens optimised at this time. Other important issues such as folic acid supplementation and rubella immune status, as well as general health and lifestyle modifications, should also be discussed and implemented before conception.

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