The care of pregnant women presents one of the paradoxes of modern medicine. About 80 percent of pregnant women use prescribed or over-the counter (OTC) drugs. At least 10 percent of birth defects are thought to result from maternal drug exposures. Although most OTC drugs have a good safety profile, some are known to adversely affect the fetus or may have unproven safety.
The safety and efficacy profile of some medications may change according to different reproductive stages during the course of a pregnancy; therefore limiting the exercise of caution to the first 3 months of pregnancy is both shortsighted and effectively impossible. In 1979, the US-FDA introduced a classification of fetal risks due to medications. However, many drugs have not been evaluated in controlled trials because of ethical consideration.
Of the commonly used analgesic OTC medications, acetaminophen has shown a good safety record. However, the use of other non-steroidal anti-inflammatory drugs during pregnancy may result in oligohydramnios; and they are classified as “category D” in the third trimester due to the risk of premature closure of the fetal ductus arteriosus, prolonged gestation and labor, and possibly birth defects.
Moreover, chlorpheniramine, diphenhydramine, and pseudoephedrine are the most recommended OTC antihistamines and decongestants to be used in pregnancy. Histamine H1-receptor blockers, diphenhydramine, is also indicated for treating nausea and vomiting.
Kaolin and pectin preparations are the antidiarrheal of choice, and loperamide is considered an alternative. On the other hand, laxatives should only be used in pregnancy when dietary and physical measures have been unsuccessful. In this case, stool-bulking agents are the drugs of choice.
Most antacids are regarded as safe in pregnancy. Histamine H2-receptor blockers, mainly the most studied medications; ranitidine is recommended in pregnant women whose symptoms cannot be adequately controlled with lifestyle modification and antacids.
Regarding the topically used preparations, benzoyl peroxide in therapeutic concentrations may be used topically on a limited area (i.e. the face) to treat acne. In addition, the usual hemorrhoid medications (contain local anesthetics, astringents, and disinfectants) have proved to be safe during pregnancy.
If use of smoking cessation products is desired, the intermediate-release preparations minimize the amount of nicotine while maintaining efficacy.
With all OTC medications used during pregnancy, the benefit of the medication should outweigh the risk to the fetus. Healthcare professionals and pregnant women need to develop a more critical attitude to the use of drugs during pregnancy. These drugs should only be used when essential, thereby avoiding many unnecessary and unknown risks.