Analgesics

Acetaminophen

Safe at any stage of pregnancy

Human studies not done/animal studies negative; or human studies are negative, but animal studies are positive

Aspirin

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

Human studies not done/animal studies are positive; or there are no human or animal studies

Codeine (a)

First trimester use associated with inguinal hernias, cardiac and circulatory system defects, cleft lip and palate, and musculoskeletal defects

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

Meperidine

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

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

Anticoagulants

Warfarin

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

Human Studies are positive, but benefits outweigh the risks

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.

Phenytoin

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

Human studies are positive, benefits thought to outweigh risks

Carbamazepine

Similar to Pheytoin in effects, with increased risk of neural defects

Human studies not done/animal studies are positive, or there are no human or animal studies

(Manufacturer rated its product)

Phenobarbital

Similar to Phenytoin in effects with possible newborn/fetal addiction

Human studies are positive, benefits thought to outweigh risks

Valproic acid

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

Human studies are positive. Of four epilepsy drugs (including:phenytoin, carbamazepine and lamotrigine), valproate posed the highest risk to the fetus.

Antidepressants

Amitriptyline

Reported limb reduction anomalies reported, but studies of first trimester exposure do not confirm

Human studies are positive, but benefits outweigh risks

Nortriptyline

Weak association with limb reduction anomalies.

Reported urinary retention in newborn

Human studies are positive, but benefits outweigh risks

Clomipramine

No malformations reported

Possible neonatal convulsions, as well as newborn irregular respiration

Human studies are positive, but benefits outweigh risks

Desirpramine

No reported malformations, though some neonatal withdrawal symptoms reported

Human studies not done/animal studies are positive, or there are no human or animal studies

Imipramine

First trimester exposures caused anomalies including: cleft palate, defective abdominal muscles, adrenal hypoplasia

Neonatal withdrawal symptoms reported

Human studies are positive, but benefits outweigh risks

Antidiabetics - Not recommended for pregnant women because they provide inadequate glycemic control

Antihistamines - Use in last two weeks associated with retrolental fibroplasia in premature infants

Brompheniramine

First trimester exposure caused ten malformations

Human studies not done/animal studies are positive, or there are no human or animal studies (Manufacturer rated its product)

Clorphenimarine

Brompheniramine effects not produced

Human studies not done/animal studies are negative; or human studies are negative, but animal studies are positive

Diphenlydramine

Brompheniramine effects not produced

Human studies not done/animal studies are positive, or there are no human or animal studies

Tripolodine

Brompheniramine effects not produced

Human studies not done/animal studies are positive, or there are no human or animal studies (Manufacturer rated its product)

Antihypertensives NEWS: New studies suggest avoiding ACE inhibitor (angiotensin-converting enzyme) drugs during entire pregnancy.

Angiotensin converting enzyme (ACE)

In second and third trimester, related to fetal and neonatal injury, including hypotension, irreversible renal failure and death

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

Clonidine

No malformations reported, but little first trimester data reported

Human studies not done/animal studies are positive, or there are no human or animal studies

Hydralazine

No malformations reported with use of this drug, which is a common anithypertensive drug during pregnancy

Human studies not done/animal studies are positive, or there are no human or animal studies (Manufacturer rated its product)

Methyldopa

No abnormalities reported; drug commonly used during pregnancy

Human studies not done/animal studies are positive, or there are no human or animal studies

Reserpine

Reported anomalies include: microcephaly, hydronephrosis, hydroureter, and inguinal hernia.

Human studies are positive, but benefits outweigh risks

Anti-infectives

Cephalosporins

Limited data indicate they are safe

Human studies not done/animal studies are negative; or human studies are negative, but animal studies are positive

Chloramphenicol

Nontoxic to fetus, but newborns exposed to high doses may develop gray baby syndrome

Human studies not done/animal studies are positive, or there are no human or animal studies

Metronidazole

No evidence of animal or huuman teratogenicity, but it is contraindicated during first trimester again trichomoniasis

Human studies not done/animal studies are negative; or human studies are negative, but animal studies are positive (Manufacturer rated its product)

Pencillins

Data indicated safety

Human studies not done/animal studies are negative; or human studies are negative, but animal studies are positive

Quinolones

No congenital anomalies reported, but this drug class has caused lameness in immature dogs, so it is not advised for pregnant women

Human studies not done/animal studies are positive, or there are no human or animal studies (Manufacturer rated its product)

Ribavirin

Teratogenic in nearly all tested animal species

Human and/or animal studies are positive, and risks outweigh benefits. Contraindicated in pregnancy (Manufacturer rated its product)

Streptomycin

Low incidence of ototoxicity with low doses and potential for eight cranial nerve damage in high doses

Human studies are positive, but benefits outweigh risks

Sulfonamides

Teratogenic in some animal species, perhaps not with humans

Possible congential malformations: limb hypoplasia, foot defects, adrenal glad hypoplasia and benign tumors

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

Tetracyclines

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

Human studies are positive, but benefits outweigh risks

Antithyroid

Methimazole

Aplasia cutis (scalp defect) reported

Human studies are positive, but benefits outweigh risks

Propylthiouracil

No malformations reported, but when used towards term, goiter defects possible

Human studies are positive, but benefits outweigh risks

Sodium Iodide I 131

After 12 weeks gestation, causes partial or complete destruction of fetal thyroid gland

Human and/or animal studies are positive, and risks outweigh benefits. Contraindicated in pregnancy

Andregenics

Cocaine

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

Human and/or animal studies are positive, and risks outweigh benefits. Contraindicated in pregnancy

Pseudoephedrine

Past association between first trimester exposure and minor malformations such as inguinal hernia and clubfoot.

Human studies not done/animal studies are positive, or there are no human or animal studies

Terbutaline

No malformations reported

 

Beta Blockers

Acebutolol

No malformations reported

Human studies not done/animal studies are negative; or human studies are negative, but animal studies are positive (Manufacturer rated its product)

Atenolol

No malformations reported, possible problems may be related to maternal hypertension

Human studies not done/animal studies are positive, or there are no human or animal studies (Manufacturer rated its product)

Labetalol

No malformations reported

Human studies not done/animal studies are positive, or there are no human or animal studies (Manufacturer rated its product)

Nadolol

No malformations reported

Human studies not done/animal studies are positive, or there are no human or animal studies (Manufacturer rated its product)

Cardiac Drugs

Amiodarone

Serious implications for goiter

Human studies not done/animal studies are positive, or there are no human or animal studies

Diuretcs

Use for hypertension during pregnancy may prevent normal plasma volume expansion

Furosemide

No malformations reported

Human studies not done/animal studies are positive, or there are no human or animal studies (Manufacturer rated its product)

Hydrochlorothiazide

Near term use, possibly associated with fatal neonatal thrombocytopenia

No convincing evidence of malformations

Human studies are positive, but benefits outweigh risks

Nonsteroidal Anti-Inflammatory Drugs - Association with decreased amniotic fluid

Ibuprofen

No evidence of teratogenicity

Early closure of ductus arteriosus theoretically possible if drug taken 34-5 weeks after gestation

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

Naproxen

No evidence of teratogenicity

After 30 weeks, associated with persistent pulmonary hypertension

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

Sedatives/Hypnotics - All benzodiazepines (including diazepam) suspected of doing harm

Diazepam

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

Human studies are positive, but benefits outweigh risks

Tranquilizers

Chlorpromazine

Not teratogenic, though some evidence of extrapyramidal syndrome

Human studies not done/animal studies are positive, or there are no human or animal studies

Fluoxetine

No malformations reported

Human studies not done/animal studies are negative; or human studies are negative, but animal studies are positive (Manufacturer rated its product)

Lithium

Firs t trimester exposure: rare Epstein's anomaly and lythium toxicity with a range of symptoms

Human studies are positive, but benefits outweigh risks

Vitamins

Vitamin A

High doses associated with microtia, cranofacial and central nervous system anomalies

Human and/or animal studies are positive, and risks outweigh benefits. Contraindicated in pregnancy

Etretinate

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

Human and/or animal studies are positive, and risks outweigh benefits.

Contraindicated in pregnancy (Manufacturer rated its product)

Isotretinoin

After 7 weeks, malformations of central nervous system, cranium,. Face, cardiovascular system and thymus.

Human and/or animal studies are positive, and risks outweigh benefits. Contraindicated in pregnancy (Manufacturer rated its product)

Menadione
(vitamin k3)

Non-teratogenic, but marked hyperbilirubinemia and kernicterus of newborn may occur, particularly in newborns.

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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