Drugs and supplements during pregnancy and lactation

Which preparations can be safely used in pregnant and lactating women?

How is it known that the drug taken by the mother will not hurt the child?

Each medicine sold has one of the safety categories for use during pregnancy, given to it by the American Food and Drug Administration (FDA). This category allows to determine the degree of risk of taking a given preparation and its possible harmful effect on a child. Information on the category can be found on the medicines leaflets.

Based on data from the Drug Information Center.

Category A

These are medicines that have been tested in pregnant women and have not shown any harmful effects on the fetus.

•           Herbal preparations: Urosept , Neospasmina , Pyrosal , Fitolizine , Alitol , Hedelix , Marshmallow syrup

•           Vitamin preparations (some B vitamins, folic acid) and Magnesium-calcium preparations (eg Asmag)

•           Calcium-magnesium neutralizing preparations (e.g. Rennie)

•           homeopathic medicines

B category

Drugs with which animal experiments have been carried out did not show harmful effects on the fetus, however, no controls were performed in pregnant women,

or

Drugs whose harmful effects on the fetus have been found on animals, but have not been confirmed in pregnant women.

•           analgesics eg ibuprofen (Nurofen, Advil), ketoprofen (Profenid , Ketonal );

•           antibiotics, e.g. amoxicillin (Amotaks, Duomox, Ospamox) •      drugs used in respiratory diseases: ambroxol (Mucosolvan, Deflegmin ), bromhexine ( Flegamine ), acetylcysteine ( ACC , Fluimucil );

•           anti-allergic drugs: clemastine, loratadine (Claritine),

•           drugs in hypertension, e.g. methyldopa (Dopegyt)

•           medicines in diseases of the gastrointestinal tract: cimetidine (Altramet), sucralfate (Ulgastran , Venter ), loperamide ( Laremid )

Category C

Animal studies have shown adverse effects of fetal medications, but there are no adequate and controlled studies in pregnant women

or

Drugs that have not been adequately controlled on animals and the lack of adequate and controlled tests in pregnant women.

These medicines can only be used in cases where the benefit of using them in the mothers outweighs the risk of unwanted effects in the fetus.

•             painkillers: acetylsalicylic acid (Aspirin, Polopiryna , Upsarin ) - I and II trimester , tramadol ( Tramal ), Pyralgina

•             antivirals: aciclovir (Zovirax , Antivir , Heviran ). Antifungal agents: ketoconazole ( Nizoral ) and antibacterial (Klacid, Fromilid , Biseptol, Bactrim, Cipronex, Nolicin)

•             drugs used in respiratory diseases: dextromethorphan ( Acodin ), guajafenesine ( Guajazyl , Robitussin ), phenylephrine ( Coldrex , Rhinopront), theophylline ( Euphyllin , Theospirex ), naphazoline ( Rhinazin , Sulfarinol ), oxymetazoline ( Acatar , Nasivin , Oxalin , Resoxym ) , tetryzolina (Tyzine, Visine )

•             antiallergics : antazoline (Phenazolinum), astemizole, chlorfeniramina ( Tabcin )

•             drugs in hypertension, e.g. amlodipine ( Amlopin , Amlozek , Norvasc )

•             medicines in diseases of the gastrointestinal tract: omeprazole ( Losec , Polprazol , Gasec )

•             vitamins A, D, B12, iron

Category D

Adequate and controlled studies or observations have shown that these medicines during pregnancy are a threat to the fetus.

Drugs in this category can be used in pregnant women in conditions threatening the life of the mother and only in cases when medicaments of categories A, B, C cannot be used or are ineffective.

• antibacterial agent’s chloramphenicol (Detreromycin), doxycycline

•           sedatives and sleeping pills: lorazepam (Lorafen), clonazepam, diazepam (Relanium), haloperidol

•           drugs in diseases of the circulatory system: acenocoumarol, enalapril ( Enarenal , Mapryl , Enap ), amiodarone, azathioprine

•           antiepileptic drugs: phenytoin, valproic acid (Convulex , Depakine )

•           anticancer drugs: cyclophosphamide, fluorouracil

Category X

Drugs with proven harmful effects on the fetus.

The use of these drugs is absolutely contraindicated in pregnant women or women who can and want to get pregnant.

• sedatives and sleeping pills: estazolam, temazepam (Signopam)
• anticancer drugs: methotrexate
• antithyroid drugs: methylthiouracil
• vitamin A derivative

Is the use of a drug in a category other than A contraindicated during pregnancy?

There are chronic diseases (such as epilepsy, hypertension, asthma) in which prescribed drugs have a category other than A. However, discontinuation of medications for this type of disease may prove to be more dangerous for the life of the unborn child than the preparation itself. Therefore, for women with chronic diseases, the decision about pregnancy should be a conscious decision, which will be preceded by a discussion with the doctor about the risks and possible problems during pregnancy. In the case of some diseases (eg epilepsy, diabetes type II) newer generations are forbidden in favor of the elderly (eg epilepsy is usually prescribed for a well-known carbamazepine) or replaced with alternative therapy (eg for diabetes, antidiabetic drugs are withdrawn) and gives insulin).

What determines the safety of the drug during pregnancy and lactation?

The safety of a drug during pregnancy and lactation is determined by the degree to which it passes through the placenta or the degree to which it passes into breast milk, where medicines that are potentially safe during pregnancy may have side effects during feeding.

The ease of penetration into the blood of the fetus or breast milk depends on many factors determining the properties of the drug (e.g. compounds with very good solubility in fats penetrate the placenta more easily than those soluble in water, and compounds with high molecular weight - insulin and heparin - not they are able to penetrate the blood of the fetus). In addition, the placenta can break down some medicines so that they will not be present in the baby's blood (e.g. prednisolone)

Are drugs and dietary supplements safe for pregnant women and nursing mothers?

It is widely believed that women during pregnancy and lactation should reduce the intake of non-prescription drugs and supplements to a minimum. Some formulas are recommended for future mothers (e.g. folic acid supplementation to prevent developmental defects in a child, or supplementation with preparations containing probiotic bacteria Lactobacillus rhamnosus GG (Dicoflor) during the last trimester of pregnancy to reduce the risk of allergies in a child).

When choosing a preparation written by the attending physician it is worth paying attention to whether the drug has the status of a drug or a dietary supplement (e.g. folic acid at a dose of 0.4 mg occurs in preparations with the status of the drug Folik and dietary supplement Puritan's Pride). Dietary supplements as food products are not subjected to such detailed research before being marketed as medicines.

And what about the problems that arise during pregnancy?

Pregnancy is a real challenge for women. During these nine months there may be numerous ailments with which we had no problem before. In some women, there are problems resulting from changes in hormone levels (estrogen and progesterone) and gradual child growth:

• nausea, vomiting, heartburn, constipation, appetite disorders
• frequent urination, bacterial infections
• fatigue, irritability, excitability, insomnia
• pain of the mammary glands
• bleeding and gingivitis, caries
• back pain, leg edema, varicose veins
• hemorrhoids
• pregnancy discolorations on the skin (most often on the face)
• dermatoses, tightening of cellulite
• fainting
• headaches, sometimes exacerbation of migraines
• weakness and hair loss

How to deal with problems of pregnancy and breastfeeding?

Although there are drugs and preparations specifically designed for pregnant women and nursing mothers (e.g. Prenalen syrup for a cold, Mustela cosmetics series, Elasti-Q), most of the drugs available in the pharmacy are not recommended for this group of patients.

Herb preparations seem the safest, although there are absolutely contraindicated plants in pregnancy (e.g. laxative Xenna, Radirex, Figure 1, which can cause miscarriage!).

If you are already deciding to take herbs, it is best to use these in the form of teas.

Also safe are drugs that work in the gastrointestinal tract, which are virtually non-absorbed into the bloodstream (antacids, e.g. Rennie, drugs p / flatulence, eg Espumisan , Esputicon , drugs used in food poisoning, e.g., Medicinal Coal , Smecta ).

For more serious ailments, it is always better to choose topical preparations (ointments, sprays), avoiding taking drugs that work in general (tablets).

If you want to use pharmacy preparations during pregnancy, please consult your doctor or pharmacist. Thanks to this, our doubts about the safety of a given product will be dispelled.