Healthy Pregnancy: Medications, Avoid Infections

by Food and Drug Administration (FDA)

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Avoid Infections

Many infections during pregnancy can be dangerous to an unborn child. Urinary tract infections and any sexually transmitted diseases need to be treated immediately.

Cat litter and raw meat may contain the parasite Toxoplasma gondii, which can cause toxoplasmosis infection. It's rare for a pregnant woman to get the infection, but if she does, her baby could be at risk for serious illness or death. Get someone else to change the kitty litter if possible, or wear a face mask and rubber gloves for protection.

Problems also may arise when a pregnant woman eats undercooked or raw foods, or cooked foods that have been cross-contaminated with bacteria from raw food nearby. Food poisoning can cause meningitis, pneumonia, or even death to an unborn child, plus the vomiting and diarrhea involved leave the mother exhausted and dehydrated.

The 'Naughty' Stuff

Nearly everyone knows pregnant women shouldn't take illicit drugs, but it's the legal ones — alcohol and tobacco — that are more commonly the source of pregnancy problems.

"I think if women truly understood the adverse impact smoking and drinking have on their babies, they would quit," says Jeffrey King, M.D., the director of the division of maternal and fetal medicine at Wright State University School of Medicine, and the author of a recent study on substance abuse in pregnancy.

Smokers put their babies at a significantly higher risk of preterm birth, low birth weight, and stillbirth compared with nonsmokers. After birth, the babies of mothers who smoked during pregnancy are more likely to have poor lung development, asthma and respiratory infections, and to die of sudden infant death syndrome (SIDS).

If a woman quits smoking early in pregnancy, however, she can still improve her chances of having a healthy baby. Expectant fathers or other members of the family should quit, too, because studies suggest breathing second-hand smoke may be dangerous as well.

Alcohol, too, can damage a developing fetus. Alcohol travels rapidly to the bloodstream, so when an expectant mother drinks, her baby drinks also.

Alcohol is known to cause mental retardation and facial abnormalities in babies, a condition called fetal alcohol syndrome. The Institute of Medicine estimates some 12,000 children with fetal alcohol syndrome are born in the United States each year. No one knows what amount of alcohol is safe during pregnancy; therefore, the U.S. Surgeon General recommends pregnant women avoid alcohol altogether.

A few other activities are known to be dangerous during pregnancy. X-rays can expose the fetus to radiation and potentially cause birth defects. Hot tubs and saunas can raise the core temperature of a pregnant woman's body and could potentially harm the fetus. Warm baths, however, are fine if the water is kept at body temperature.

Medications

Many drugs are appropriate for use in pregnancy, if really needed. But a pregnant woman shouldn't take any medication, even an over-the-counter one, unless she checks with her doctor first. If possible, she should avoid taking drugs in the first trimester or taking more than one medication at a time. She can also ask for the lowest dose possible to treat her condition.

Some medications have a long history of being used in pregnancy without problems. A pregnant woman shouldn't be deprived of drug therapy she really needs, says Sandra Kweder, M.D., the co-chair of FDA's task force on pregnancy labeling. She adds that women with pre-existing medical conditions such as epilepsy, lupus, asthma, or high blood pressure shouldn't quit their drugs because of pregnancy. Safer drugs can be used if necessary, but those medical conditions still need to be treated.

Kweder explains, "A common thing with patients is that they'll say, 'I know I'm supposed to take medication, but I'm worried about my baby, so I'll take less of it instead.' They'll take it every other day, or half as much. That's not wise."

The risks of a drug have to be weighed against its benefits. For example, some epilepsy drugs are known to cause birth defects, but an epileptic seizure can cause brain damage to the fetus. Most experts agree that the benefits of medication in such cases outweigh the risks.

Other drugs, however, are not so clear-cut. "It's really hard because there aren't easy answers," says Kweder. "For a baby to be healthy, it needs a mother who's healthy." However, most drugs have not been tested scientifically in pregnant women. Reliable scientific information about medication use in pregnancy is often incomplete or nonexistent. FDA is trying to change that.

The agency has begun a comprehensive review about how it regulates drugs for pregnant women and how safety information is communicated on the label. The present system is not as helpful as the agency would like. "The system has been criticized, and rightly so," says Kweder. "It is complicated to interpret data for medications used in pregnancy. We're making progress, but it's slow."

A new system is needed, she says, but it will be difficult to create. Drugs can't be tested in pregnant women the same as in other groups of people. Animal studies, while helpful, don't necessarily show what a drug will do to a woman and developing fetus.

In the meantime, a woman who has taken a drug and discovers she is pregnant should consult her doctor and avoid making decisions about her pregnancy in panic. While about 80 percent of approved drugs lack adequate scientific evidence about use in pregnancy, that doesn't necessarily mean they can harm the fetus or are harmful in the doses prescribed.

Only a very few drugs definitely known to be extremely bad for a human fetus are clearly labeled or, in one case, have special requirements attached to their approval. The drug thalidomide, which was recently approved by FDA to treat leprosy and is being explored for other uses, is devastating to developing fetuses and causes severe deformities of the arms and legs. FDA is requiring that patients who take the drug enroll in a national registry that will track their progress monthly and record the occurrence of any pregnancy. The hope is that this process will discourage physicians from prescribing the drug to women who might become pregnant and keep patients from "sharing" the drug with a woman of childbearing age.

About the Author

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FDA is A United States government body that oversees medical devices, including contact lenses, intraocular lenses, excimer lasers and eyedrops. In the US, these products must be approved by the FDA before they can be marketed.