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Patient is Not (PIC)turing Pregnancy - Medication Use

Background

  • Scope: 10-15 percent of congenital anomalies can be attributed to prescription medication use by the mother. CDC reports that from 1976 – 2008, about 90 percent of women take at least one medication during pregnancy and 70 % take at least one prescription medication.

    More than 60 percent of women use prescription medication during their first trimester of pregnancy.

It is estimated that about 18-52 percent of the U.S. population, use dietary supplements which includes vitamins, herbs, weight loss aids and sport enhancement substances.

Note that there is not enough data to fully understand all fetal risks of every medication and those commonly used in pregnancy. Though medications have an FDA pregnancy category, it is very limited and can be difficult to gage clear and accurate information about the potential risks of the medication for clinicians. 

Dietary supplements and herbal remedies are not regulated as the prescription medications are and therefore has even less information of the safety and effects if taken during pregnancy. 

Organization of Teratology Information Specialists (OTIS)

http://www.mothertobaby.org/otis-fact-sheets-s13037

  • Preconception Significance:  Congenital anomalies caused by teratogenic exposures in medication, are considered preventable because they can be altered during the period of organogenesis in pregnancy. This is especially important in preconception because organogenesis begins 3 days after the first missed menstrual period, therefore woman must try to reduce avoidable exposures must be initiated before the woman becomes pregnant.

  • Risk Identification Strategies: Identify risks of teratogenic medications by assessing for exposure/use of:

  • Prescription medications

  • Over-the-counter medications
  • Dietary supplements

  • Folk and herbal remedies

Assess the likelihood a woman is or will become pregnant while taking any of these drugs, supplements and remedies to be prepared for preconception counseling and helping woman to avoid early exposure of fetus to harmful medications.

Clinician Guide

Identify for exposure/use of:

  • Prescription or Over-the-counter medications

  • Dietary supplements and minerals

  • Folk and herbal remedies

    Completely accept and acknowledge that she does not desire pregnancy at this time but encourage her to reach out to your office if she changes her mind before her next visit.

    If condition being managed by another provider, acknowledge and discuss with her that you must work with her other providers before stopping contraception if she desires pregnancy later in order to minimize exposure of fetus to teratogenic medication.

    Encourage strategies about medication risk reduction for future pregnancies by:

  • Planning pregnancies through the reproductive life plan

  • Advise woman to avoid non-essential medications (over-the-counter, herbal, etc.)

  • Switch to safe alternative medications with provider guidance

  • Caution to reduce risks for becoming pregnant (inconsistent/no contraception use) when using prescribed medication.

    Educate the woman that she should NOT stop medication for chronic diseases without clinical guidance (even if pregnant).

    Emphasize that one multivitamin (especially for the dose of 400 mcg of folic acid) daily is highly recommended for her own health and the healthy development of future pregnancies if she desires, but that any more supplements are unnecessary and may pose risks.

Page Updated: 8/14/2017