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Analgesics
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Acetaminophen
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Safe at any stage of pregnancy
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Human studies not done/animal studies negative; or human studies are negative, but animal studies are positive
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Aspirin
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Full dose may cause premature closure of the ductus arteriosus in late pregnancy, as well as prolongation of gestation and labor.
May reduce platelet aggregation
May cause increased risk of intracranial hemorrhage in premature or low birth weight infants
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Human studies not done/animal studies are positive; or there are no human or animal studies
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Codeine (a)
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First trimester use associated with inguinal hernias, cardiac and circulatory system defects, cleft lip and palate, and musculoskeletal defects
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Human studies not done/animal studies are positive; or there are no human or animal studies
If use is prolonged or in high does at term: Human Studies are positive, but benefits outweigh the risks
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Meperidine
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No malformations reported
Neonatal addiction possible from abuse
If delivery happens an hour or more after injection, time and does respiration depression may occur, most likely due to unmetabolized meperidine
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Human studies not done/animal studies negative; or human studies are negative, but animal studies are positive
If is use is prolonged or in high does at term: Human Studies are positive, but benefits outweigh the risks
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Anticoagulants
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Warfarin
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First trimester use may result in fetal warfarin syndrome, which manifests as nasal hypoplasia.
Neonatal respiratory distress occurs frequently due to upper airway obstruction
Second and third trimester use may cause blindness, optic atrophy, and microphthalmia
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Human Studies are positive, but benefits outweigh the risks
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Anticonvulsants - An enzyme, epoxide hydrolase, may indicate which people are at risk of malformations resulting from congenital malformations. Combinations of anticonvulsants carry eight times the risk of a single agent.
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Phenytoin
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Fetal hydantoin syndrome features is well documented and includes a broad range of:
cranio facial malformations (broad nasal bridge, ocular hypertelorism, cleft lip/palate, abnormal ears)
limb malformations (dislocated hip, small or absent nails); and
congential heart defects, tumors and impaired physical and mental growth
Severe/fatal hemorrhagic disease of the newborn
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Human studies are positive, benefits thought to outweigh risks
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Carbamazepine
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Similar to Pheytoin in effects, with increased risk of neural defects
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Human studies not done/animal studies are positive, or there are no human or animal studies
(Manufacturer rated its product)
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Phenobarbital
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Similar to Phenytoin in effects with possible newborn/fetal addiction
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Human studies are positive, benefits thought to outweigh risks
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Valproic acid
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Taken between Day 17-30 after fertilization, 1-2% risk of neural defects.
Low birth weight and retarded psychomotor development possible. Over 20 percent of pregnancies exposed to valproate resulted in death or birth defects such as skull and limb deformities and brain, heart and lung problems.
Neurology, August 8, 2006
http://www.neurology.org
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Human studies are positive. Of four epilepsy drugs (including:phenytoin, carbamazepine and lamotrigine), valproate posed the highest risk to the fetus.
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Antidepressants
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Amitriptyline
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Reported limb reduction anomalies reported, but studies of first trimester exposure do not confirm
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Human studies are positive, but benefits outweigh risks
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Nortriptyline
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Weak association with limb reduction anomalies.
Reported urinary retention in newborn
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Human studies are positive, but benefits outweigh risks
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Clomipramine
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No malformations reported
Possible neonatal convulsions, as well as newborn irregular respiration
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Human studies are positive, but benefits outweigh risks
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Desirpramine
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No reported malformations, though some neonatal withdrawal symptoms reported
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Human studies not done/animal studies are positive, or there are no human or animal studies
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Imipramine
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First trimester exposures caused anomalies including: cleft palate, defective abdominal muscles, adrenal hypoplasia
Neonatal withdrawal symptoms reported
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Human studies are positive, but benefits outweigh risks
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Antidiabetics - Not recommended for pregnant women because they provide inadequate glycemic control
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Antihistamines - Use in last two weeks associated with retrolental fibroplasia in premature infants
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Brompheniramine
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First trimester exposure caused ten malformations
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Human studies not done/animal studies are positive, or there are no human or animal studies (Manufacturer rated its product)
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Clorphenimarine
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Brompheniramine effects not produced
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Human studies not done/animal studies are negative; or human studies are negative, but animal studies are positive
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Diphenlydramine
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Brompheniramine effects not produced
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Human studies not done/animal studies are positive, or there are no human or animal studies
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Tripolodine
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Brompheniramine effects not produced
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Human studies not done/animal studies are positive, or there are no human or animal studies (Manufacturer rated its product)
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Antihypertensives NEWS: New studies suggest avoiding ACE inhibitor (angiotensin-converting enzyme) drugs during entire pregnancy.
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Angiotensin converting enzyme (ACE)
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In second and third trimester, related to fetal and neonatal injury, including hypotension, irreversible renal failure and death
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First trimester: Human studies not done/animal studies are positive, or there are no human or animal studies
Second and third trimester: Human studies are positive, but benefits outweigh risks
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Clonidine
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No malformations reported, but little first trimester data reported
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Human studies not done/animal studies are positive, or there are no human or animal studies
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Hydralazine
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No malformations reported with use of this drug, which is a common anithypertensive drug during pregnancy
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Human studies not done/animal studies are positive, or there are no human or animal studies (Manufacturer rated its product)
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Methyldopa
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No abnormalities reported; drug commonly used during pregnancy
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Human studies not done/animal studies are positive, or there are no human or animal studies
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Reserpine
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Reported anomalies include: microcephaly, hydronephrosis, hydroureter, and inguinal hernia.
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Human studies are positive, but benefits outweigh risks
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Cephalosporins
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Limited data indicate they are safe
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Human studies not done/animal studies are negative; or human studies are negative, but animal studies are positive
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Chloramphenicol
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Nontoxic to fetus, but newborns exposed to high doses may develop gray baby syndrome
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Human studies not done/animal studies are positive, or there are no human or animal studies
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Metronidazole
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No evidence of animal or huuman teratogenicity, but it is contraindicated during first trimester again trichomoniasis
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Human studies not done/animal studies are negative; or human studies are negative, but animal studies are positive (Manufacturer rated its product)
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Pencillins
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Human studies not done/animal studies are negative; or human studies are negative, but animal studies are positive
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Quinolones
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No congenital anomalies reported, but this drug class has caused lameness in immature dogs, so it is not advised for pregnant women
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Human studies not done/animal studies are positive, or there are no human or animal studies (Manufacturer rated its product)
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Ribavirin
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Teratogenic in nearly all tested animal species
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Human and/or animal studies are positive, and risks outweigh benefits. Contraindicated in pregnancy (Manufacturer rated its product)
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Streptomycin
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Low incidence of ototoxicity with low doses and potential for eight cranial nerve damage in high doses
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Human studies are positive, but benefits outweigh risks
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Sulfonamides
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Teratogenic in some animal species, perhaps not with humans
Possible congential malformations: limb hypoplasia, foot defects, adrenal glad hypoplasia and benign tumors
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Human studies not done/animal studies are negative; or human studies are negative, but animal studies are positive
If near term: Human studies are positive, but benefits outweigh risks
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Tetracyclines
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May be incorporated into bone when ossification begins at 7 weeks
Exposure at give months may cause teeth discoloration
Some malformations: inguinal hernia, limb hypoplasia
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Human studies are positive, but benefits outweigh risks
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Methimazole
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Aplasia cutis (scalp defect) reported
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Human studies are positive, but benefits outweigh risks
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Propylthiouracil
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No malformations reported, but when used towards term, goiter defects possible
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Human studies are positive, but benefits outweigh risks
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Sodium Iodide I 131
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After 12 weeks gestation, causes partial or complete destruction of fetal thyroid gland
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Human and/or animal studies are positive, and risks outweigh benefits. Contraindicated in pregnancy
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Cocaine
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Maternal abuse associated with congenital defects of heart, limbs, genitourinary tract, face and increased morbidity and mortality, as well as with sudden infant death syndrome
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Human and/or animal studies are positive, and risks outweigh benefits. Contraindicated in pregnancy
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Pseudoephedrine
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Past association between first trimester exposure and minor malformations such as inguinal hernia and clubfoot.
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Human studies not done/animal studies are positive, or there are no human or animal studies
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Terbutaline
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No malformations reported
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Acebutolol
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No malformations reported
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Human studies not done/animal studies are negative; or human studies are negative, but animal studies are positive (Manufacturer rated its product)
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Atenolol
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No malformations reported, possible problems may be related to maternal hypertension
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Human studies not done/animal studies are positive, or there are no human or animal studies (Manufacturer rated its product)
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Labetalol
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No malformations reported
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Human studies not done/animal studies are positive, or there are no human or animal studies (Manufacturer rated its product)
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Nadolol
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No malformations reported
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Human studies not done/animal studies are positive, or there are no human or animal studies (Manufacturer rated its product)
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Amiodarone
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Serious implications for goiter
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Human studies not done/animal studies are positive, or there are no human or animal studies
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Diuretcs
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Use for hypertension during pregnancy may prevent normal plasma volume expansion
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Furosemide
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No malformations reported
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Human studies not done/animal studies are positive, or there are no human or animal studies (Manufacturer rated its product)
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Hydrochlorothiazide
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Near term use, possibly associated with fatal neonatal thrombocytopenia
No convincing evidence of malformations
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Human studies are positive, but benefits outweigh risks
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Nonsteroidal Anti-Inflammatory Drugs - Association with decreased amniotic fluid
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Ibuprofen
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No evidence of teratogenicity
Early closure of ductus arteriosus theoretically possible if drug taken 34-5 weeks after gestation
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Human studies not done/animal studies are negative; or human studies are negative, but animal studies are positive
In third trimester: Human studies are positive, but benefits outweigh risks
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Naproxen
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No evidence of teratogenicity
After 30 weeks, associated with persistent pulmonary hypertension
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Human studies not done/animal studies are negative; or human studies are negative, but animal studies are positive (Manufacturer rated its product)
If near delivery: Human studies are positive, but benefits outweigh risks
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Sedatives/Hypnotics - All benzodiazepines (including diazepam) suspected of doing harm
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Diazepam
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First and second trimester use: risk of cleft lip or palate
Firs trimester use: risk of inguinal hernia, cardiac defects and pyloric stenosis
Second trimester use: cardiac and circulatory defects
High doses: severe neonatal depression
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Human studies are positive, but benefits outweigh risks
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Chlorpromazine
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Not teratogenic, though some evidence of extrapyramidal syndrome
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Human studies not done/animal studies are positive, or there are no human or animal studies
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Fluoxetine
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No malformations reported
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Human studies not done/animal studies are negative; or human studies are negative, but animal studies are positive (Manufacturer rated its product)
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Lithium
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Firs t trimester exposure: rare Epstein's anomaly and lythium toxicity with a range of symptoms
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Human studies are positive, but benefits outweigh risks
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Vitamin A
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High doses associated with microtia, cranofacial and central nervous system anomalies
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Human and/or animal studies are positive, and risks outweigh benefits. Contraindicated in pregnancy
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Etretinate
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Drug is stored in subcutaneous fat and evidence shows it remains for years.
Malformations include: decrease cranial volume, facial dysmorphia, absence of terminal phalanges and a range of other malformations
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Human and/or animal studies are positive, and risks outweigh benefits.
Contraindicated in pregnancy (Manufacturer rated its product)
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Isotretinoin
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After 7 weeks, malformations of central nervous system, cranium,. Face, cardiovascular system and thymus.
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Human and/or animal studies are positive, and risks outweigh benefits. Contraindicated in pregnancy (Manufacturer rated its product)
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Menadione
(vitamin k3)
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Non-teratogenic, but marked hyperbilirubinemia and kernicterus of newborn may occur, particularly in newborns.
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Human studies not done/animal studies are positive, or there are no human or animal studies (Manufacturer rated its product)
In third trimester and on: Human and/or animal studies are positive, and risks outweigh benefits. Contraindicated in pregnancy
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