II. Background

  1. Pregnancy Categories will be replaced on medication bottles with specific warnings and precautions by 2020 in U.S.
    1. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm425317.htm
    2. Although FDA Pregnancy Categories are no longer listed, they are included here
      1. As of 2018, succinct guidance (to replace ABCDX) on specific drugs in pregnancy is lacking

III. Approach: General Recommendations

  1. Avoid medications if possible in first trimester
  2. Limit use to safe, short-acting, non-combination drugs
  3. Some OTC Medications may be used safely in any trimester (but avoid overuse, esp. in first trimester)
    1. Acetaminophen
    2. Antihistamines
    3. H2 Blockers
    4. Proton Pump Inhibitors
    5. Servey (2014) Am Fam Physician 90(8): 548-55 [PubMed]
  4. Topical Medications are preferred over systemic agents
  5. Use the lowest effective dose of a medication
  6. Birth defects occur in 3% of pregnancies even without Teratogen Exposure
  7. Balance medication benefits versus risks in pregnancy
    1. Untreated serious conditions (e.g. Asthma, Seizure Disorder, Diabetes Mellitus) are associated with birth defects
    2. Uncontrolled Diabetes Mellitus with Hemoglobin A1C of 10% is associated with a birth defect risk up to 25%
  8. References
    1. (2018) Presc Lett 25(10): 56

IV. Preparations: Class A

  1. No risk in controlled human studies
  2. Examples
    1. Acetaminophen (Tylenol)
    2. Pyridoxine (Vitamin B6)

V. Preparations: Class B

  1. No risk in controlled animal studies
  2. Examples
    1. Amoxicillin
    2. Cephalosporin antibiotics

VI. Preparations: Class C

  1. Small risk in controlled animal studies
  2. Examples
    1. Codeine
    2. Dicloxacillin

VII. Preparations: Class D

  1. Strong evidence of risk to the human fetus
  2. Examples
    1. Coumadin
    2. Valium

VIII. Preparations: Class X (Never to be used in Pregnancy)

  1. Very high risk to the human fetus
  2. Examples
    1. Xanax
    2. Accutane

IX. Resources

  1. CDC Medications in Pregnancy
    1. http://www.cdc.gov/pregnancy/meds/index.html
  2. Vaccines and Medications in Pregnancy Surveillance System (VAMPSS)
    1. http://www.aaaai.org/about-the-aaaai/strategic-relationships/vampss/vampss-consumer.aspx
  3. MotherToBaby Fact Sheets (from Organization of Teratology Information Specialists or OTIS)
    1. http://www.mothertobaby.org/fact-sheets-s13037

X. References

  1. Briggs (1998) Drugs in Pregnancy and Lactation, 5th ed
  2. Larimore (2000) Prim Care 27(1):35-53 [PubMed]

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