The Effects of Drugs on Pregnancy

The Effects of Drugs on Pregnancy

There was a question from one member of “milis dokter” group asking if amoxicillin is safe to be given to his pregnant wife. The answer was yes; so far amoxicillin is a safe drug that can be given to an expecting woman. The next problems then, how far is it safe? Are there absolutely no side effects both for the mother and the baby? In case of pregnancy, isn’t there any deviation of body’s response to drugs? Unfortunately, for all these questions, the answers are still unclear. Meanwhile, I read a related article in TIME magazines “Pregnancy and Pills” which spotlighted our very little known information about drugs in pregnancy. A good topic I would like to share with you.

I believe we must be familiar with all precautions written in the drugs label, warning us to avoid nearly every kind of medication from the moment of conception onward. However, many pregnant women have to battle against psychiatric illness, cancer, autoimmune disease, influenza and other conditions that require treatment. This condition is leaving many unanswered questions; will the benefits of the drugs outweigh the risk to the baby? what is the appropriate dosage for a mom-to-be? According to the article, an obstetrics researcher group in Seattle recently concluded there is no way to give a pregnant woman enough of the antibiotic to be effective. Kidney function is so revved up during pregnancy that even in high doses, amoxicillin is excreted before it can work its magic. Jason umans, an internist and maternal-fetal pharmacologist at Georgetown University said that in emergencies, you always hear, “Treat the pregnant women first!” but then the joke should be “Yeah, how?”

Chronic illness like depression, diabetes and hypertension do not magically disappear during pregnancy. And as women delay child-bearing, more pregnant women are facing cancer. They have to choose between decline medications whose effects on fetus may be largely unknown or take the treatment and worry about the consequences. If they choose the latter approach, they will be asked to sign a raft of release form so doctors will not be sued if problems arise. “It was very frustrating,” said Patty Sosnader who received a diagnosis of Hodgkin’s disease at the end of her first trimester. “Everyone had their own opinion about what I should do, but there were no facts to support any of it.”

So far, we are using FDA guideline on classifying drugs and their effects on pregnancy. However, there are some facts that we should be aware of. See the table below:

It is also written in the article that an elite group of some 30 doctors, ethicists, scientists and government officials gathered in Washington this spring to launch a movement they are calling the Second Wave of clinical research (The first happened in the early ‘90s, when studies began to include large numbers of women) to start formulating an answer for many questions above. They will seek for better information on how drugs affect pregnant women. The Second Wavers suggest a test which analyzes the amount of medication circulating in the bloodstream of pregnant women who are already taking prescriptions drugs out of necessity. Actually, this kind of study has already been doing by National Institute of Health (NIH), where they seed pregnant women taking prescriptions drugs who are willing to stay in a hospital for at least 12 hours hooked up to an IV, ideally once a trimester. You need to be an extremely generous person to volunteer for that and so far, only fewer than 500 women have taken part in that studies. Yes, this is not an easy job, since research on pregnant woman will raise ethical issue too; but I believe this is a good move to have a more reliable evidence-based data about drug’s effects on pregnant women.

“People are very uncomfortable with shades of gray, and pregnancy is all gray” said Karen Feibus who oversees the FDA’s maternal health team. It is true, but of course all of us are hoping that someday we can paint the grey area with a clear distinct colour. Well, research studies on pregnant woman are just beginning. Let’s wait and see.

Reference:

- Life: Pregnancy and Pills (TIME, June 8, 2009)