Centers for Disease Control and Prevention
As additional research is published, it is increasingly important that women talk with their doctor about the risks and benefits of taking prescription and over-the-counter drugs, vitamins, and dietary or herbal supplements before getting pregnant, during pregnancy, and while breastfeeding.
Many pregnant or breastfeeding women worry about whether to take medications, including prescription and over-the-counter drugs, vitamins, and dietary or herbal supplements. They are afraid these could harm their child. However, sometimes taking medication can’t be avoided. Women who are pregnant or breastfeeding can have short-term or long-term health problems. In addition, women sometimes take medication before they realize they are pregnant. A survey in the U.S. in 1998–99 found that 46% of women in their childbearing years took a prescription medicine during the previous week. So, it is important that we know more about which medications may be harmful during pregnancy and breastfeeding and which are not.
Safety of Medication Use during Pregnancy and Breastfeeding
We know that taking certain medications – such as thalidomide, isotretinoin or Accutane© – during pregnancy may cause serious birth defects in the baby. These medications should be avoided by all pregnant women. However, we do not have enough information about the safety of many other medications when they are taken by pregnant women. A study1 in 2001 found there was not enough information about the risk or safety of more than 90% of medications approved by the US Food and Drug Administration (FDA) between 1980 and 2000 when taken during pregnancy. This makes it difficult for women and health care providers to decide whether to use medication during pregnancy or while breastfeeding. Clearly, more and better information is needed.
The National Center on Birth Defects and Developmental Disabilities at CDC is committed to working with its partners and the public to build a comprehensive approach to address these issues. Our goals for this approach are to generate and interpret information about the effects of medications during pregnancy and lactation; to make that information available to women and health care providers; and to translate it into safe and effective health care for pregnant and breastfeeding women.
New Information about Antidepressant Medications
A recent article2 was published in the New England Journal of Medicine about the use of selective serotonin reuptake inhibitors or SSRIs during pregnancy. SSRIs are the most frequently used class of antidepressant medications in general and during pregnancy in the United States, but information on the safety of SSRI medications in pregnancy was limited. The study, “Use of Selective Serotonin-Reuptake Inhibitors in Pregnancy and the Risk of Birth Defects,” found no significant increase in the risks for the majority of birth defects assessed when all SSRIs were studied together. Researchers did, however, find associations between SSRI use and three specific birth defects: a defect of the brain, one type of abnormal skull development and a gastrointestinal abnormality.
The study examined four SSRIs used to treat depression–fluoxetine, sertraline, paroxetine, and citalopram–and 18 birth defect categories, including defects of the brain, spine, heart and mouth. The women in the study took these SSRIs the month before they became pregnant or in the first three months of pregnancy.
“Overall, our results are generally reassuring with respect to the use of antidepressants during pregnancy,” said Jennita Reefhuis, a CDC epidemiologist and one of the authors of the study. “We know that both the mother and baby benefit when a pregnant woman with a serious depressive illness is able to stay on some sort of treatment. The risks may vary for different SSRIs and groups of women. It’s important that women talk with their doctor about the risks and benefits of taking SSRIs during pregnancy.”
Information for Pregnant and Breastfeeding Women
• If you have taken a medication, or need to take a medication, the first thing to do is talk with your doctor. Some medications are harmful when taken during pregnancy, but others are not. The effects depend on many factors such as: How much was taken, and when during the pregnancy? Do you have other health conditions? For more information, your doctor may contact the Organization of Teratology Information Specialists (OTIS).
• Some pregnant or breastfeeding women must take medications to treat health conditions like asthma, epilepsy (seizures), high blood pressure, depression, and others. If these conditions are not treated, the mother or the child could be harmed. It is important when treating these conditions to know which medications are safest for pregnant women.
• Herbals and other dietary supplements are made from natural ingredients, and many people think they are safer than other medications. However, herbals and other dietary supplements are not regulated by the FDA. Some could have side effects or other problems. You should talk with your doctor before taking any medications – including herbals and other dietary supplements – if you are pregnant, could become pregnant or are breastfeeding.
• Some vitamins are important to a healthy pregnancy. Folic acid is a B vitamin and is used by the body to make new cells. If a woman has enough folic acid in her body before she is pregnant, some major birth defects of her baby’s brain and spine – called neural tube defects (NTDs) – can be prevented. Women need to take folic acid every day starting before they are pregnant to help prevent NTDs. The CDC and the U.S. Public Health Service urge every woman who could become pregnant to get 400 micrograms (400 mcg) of synthetic folic acid every day. Most multivitamin preparations contain this amount of folic acid.
• Some vitamins, such as vitamin A, are important to a healthy pregnancy, but can be harmful if taken in high doses. Taking more vitamin A than the recommended amount could be harmful to an unborn child. It is important to talk with your doctor before taking any extra vitamins if you are pregnant or might become pregnant.
• Breast milk is the healthiest food for babies. It is important that women do not stop breastfeeding unnecessarily, even though many prescription and over-the-counter drugs, herbals, and dietary supplements can reach a nursing baby through breast milk. Fortunately, most medications enter breast milk in small amounts that won’t affect a nursing baby very much. However, we need more information about the actual effects of most medications on nursing babies to be certain they are safe to use while breastfeeding.