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| |    Medications in Pregnancy: General Principles by Marjorie Greenfield, M.D. reviewed by Marjorie Greenfield, M.D. In this day and age, people take a lot of medications. There are lifesaving drugs that were not available years ago, as well as numerous medications that improve the quality of our lives. In addition, there are substances that we often don't consider medications, (like caffeine, herbal teas, and vitamins) that can have medicinal effects and should be considered in the same light. When you're pregnant, the medications you take usually pass through the placenta to some degree and get into the bloodstream of your growing baby. Many medications cannot be processed by the fetus because of his immature organs; instead, they are passed back through the placenta, and your system either breaks them down or passes them out in your urine. How safety is determined I often am asked which medications are safe to take in pregnancy, a question that is actually quite difficult to answer. In the U.S., medicines are tested for safety first on animals, and then on adult volunteers who take either the medicine or a placebo so that the effectiveness and side effects can be scientifically compared. Since pregnant women usually aren't included in such tests and problems in their offspring can take years to show up, we don't have this kind of scientific data for pregnancy. Instead, we rely on the results of animal tests, as well as individual (or anecdotal) reports of effects on human mothers and fetuses. Of course, a woman is exposed to many different substances in a pregnancy, so it is difficult to know if a particular medicine she took was responsible for a particular negative effect. Medicines that are safe There are a few medications that have been tested in pregnant human subjects and have been shown to be safe. Examples include folic acid and vitamin B6 (both in the B vitamin family) and levothyroxine (Synthroid), which replaces thyroid hormone in people whose glands aren't functioning. These are known as Category A medications. Categories of medications based on safety and risk Most medications, though, have not been studied or shown to be safe to this extent. For these, we are left with this guideline: Medications that are considered safe in pregnancy are those that have been used extensively in humans and don't appear to cause any major birth defects or other problems (they also have been shown not to cause birth defects in animals). The FDA classifies these drugs as Category B. Treatment with Category B medications is considered "probably safe." This group includes ampicillin, acetaminophen (Tylenol is a common brand), ibuprofen (such as Motrin) before third trimester, aspartame, caffeine in moderation, hydrochlorothiazide (HCTZ), metoclopramide (Reglan), famotidine (Pepcid), loperamide (Imodium), and insulin. Category C medications are somewhat more likely to have some complications for mother or fetus, or there isn't enough research to draw conclusions about their safety. These medications come with the warning that they should be used only if the potential benefits outweigh the possible risks. These include prochlorperazine (Compazine), Sudafed, fluconazole (Diflucan), and ciprofloxacin (Cipro). Most prescription medications are classified in Category C. Category D medications are those that clearly have some health risks for the fetus, including ethanol (alcohol), lithium, phenytoin (Dilantin), and most chemotherapy agents, which still may be used under certain circumstances. Category X drugs have been shown to cause birth defects and are not to be used in pregnancy under any circumstances. This category includes isotretinoin (Accutane), thalidomide, ribavirin (a treatment for hepatitis C) and diethylstilbestrol (DES). For a list of treatments that are considered safe in pregnancy, go to our article about the specific condition or symptom in which you're interested, or see the article on antibiotics in pregnancy.
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