[INFO] Drug Use During Pregnancy

[Forte]

Sekedar share, kemarin sempat diskusi dengan nobby. Kami berdiskusi mengenai penggunaan obat2 selama kehamilan. Dan kesulitan yang ditemui adalah cenderung paradigma orang awam berpikiran bahwa berobat ke dokter harus diberikan resep obat, tanpa resep obat kalau misal hanya meresepkan vitamin saja kurang sreg.

Untuk kali ini, coba dibahas mengapa pada masa kehamilan, kebanyakan dokter hanya akan meresepkan vitamin atau suplemen saja. Hal ini disebabkan karena obat2 yang digunakan pada dasarnya dapat membahayakan bagi janin apalagi pada saat kehamilan trimester pertama. Jadi bagi para member DC di sini, sekedar share, jika akan hamil, atau tengah hamil, perhatikanlah agar tidak mengkonsumsi obat secara sembarangan. Diskusikan dengan dokter kandungan / apoteker Anda.

Ada beberapa kategori obat ditinjau dari aman tidaknya digunakan pada saat kehamilan.

Pregnancy Category A    Adequate and well-controlled studies have failed to demonstrate a risk to the fetus in the first trimester of pregnancy (and there is no evidence of risk in later trimesters).

Pregnancy Category B    Animal reproduction studies have failed to demonstrate a risk to the fetus and there are no adequate and well-controlled studies in pregnant women OR Animal studies have shown an adverse effect, but adequate and well-controlled studies in pregnant women have failed to demonstrate a risk to the fetus in any trimester.

Pregnancy Category C    Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.

Pregnancy Category D    There is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience or studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.

Pregnancy Category X    Studies in animals or humans have demonstrated fetal abnormalities and/or there is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience, and the risks involved in use of the drug in pregnant women clearly outweigh potential benefits.

Contoh kasus obat yang berbahaya yang pernah terjadi pada zaman dulu adalah kasus Thalidomide yang biasanya digunakan sebagai sedatif hipnotik. Di mana thalidomide ini bersifat teratogenik (arti : menyebabkan berbentuk seperti monster) akan menyebabkan anak yang lahir akan cacat. Dan thalidomide termasuk dalam kategori X.

Intinya jagalah segala hal yang masuk dalam mulut Anda ketika lagi hamil, karena apa yang Anda makan juga akan didistribusikan ke janin Anda. Sakit2 sedikit, misal pusing sedikit bisa menggunakan balsem, tingkatkan gizi selama masa kehamilan untuk menjaga badan tetap fit dan tidak gampang sakit. Dan juga tidak ada salahnya menjadi lebih giat dan cerewet bertanya mengenai obat yang diberikan pada masa kehamilan. Anda memiliki hak u/ bertanya pada dokter kandungan / apoteker Anda. 

Semoga bermanfaat

Forte / nobby_ta

Sedikit bacaan :

Selengkapnya dapat di baca di :
http://www.merck.com/mmhe/print/sec22/ch259/ch259a.html

More than 90% of pregnant women take prescription or nonprescription (over-the-counter) drugs or use social drugs (such as tobacco and alcohol) or illicit drugs at some time during pregnancy. In general, drugs, unless absolutely necessary, should not be used during pregnancy because many can harm the fetus. About 2 to 3% of all birth defects result from the use of drugs other than alcohol.

Sometimes drugs are essential for the health of the pregnant woman and the fetus. In such cases, a woman should talk with her doctor or other health care practitioner about the risks and benefits of taking the drugs. Before taking any drug (including over-the-counter drugs) or dietary supplement (including medicinal herbs), a pregnant woman should consult her health care practitioner. A health care practitioner may recommend that a woman take certain vitamins and minerals during pregnancy.

Drugs taken by a pregnant woman reach the fetus primarily by crossing the placenta, the same route taken by oxygen and nutrients, which are needed for the fetus's growth and development. Drugs that a pregnant woman takes during pregnancy can affect the fetus in several ways:

    * They can act directly on the fetus, causing damage, abnormal development (leading to birth defects), or death.
    * They can alter the function of the placenta, usually by causing blood vessels to narrow (constrict) and thus reducing the supply of oxygen and nutrients to the fetus from the mother. Sometimes the result is a baby that is underweight and underdeveloped.
    * They can cause the muscles of the uterus to contract forcefully, indirectly injuring the fetus by reducing its blood supply or triggering preterm labor and delivery.

Some of the fetus's blood vessels are contained in tiny hairlike projections (villi) of the placenta that extend into the wall of the uterus. The mother's blood passes through the space surrounding the villi (intervillous space). Only a thin membrane (placental membrane) separates the mother's blood in the intervillous space from the fetus's blood in the villi. Drugs in the mother's blood can cross this membrane into blood vessels in the villi and pass through the umbilical cord to the fetus.

How a drug affects a fetus depends on the fetus's stage of development and the strength and dose of the drug. Certain drugs taken early in pregnancy (within 20 days after fertilization) may act in an all-or-nothing fashion, killing the fetus or not affecting it at all. During this early stage, the fetus is highly resistant to birth defects. However, the fetus is particularly vulnerable to birth defects between the 3rd and the 8th week after fertilization, when its organs are developing. Drugs reaching the fetus during this stage may have no effect, or they may cause a miscarriage, an obvious birth defect, or a permanent but subtle defect that is noticed later in life. Drugs taken after organ development is complete are unlikely to cause obvious birth defects, but they may alter the growth and function of normally formed organs and tissues.

The Food and Drug Administration (FDA) classifies drugs according to the degree of risk they pose for the fetus if they are used during pregnancy. Some drugs are highly toxic and should never be used by pregnant women because they cause severe birth defects. One example is thalidomide. Several decades ago, this drug caused extreme underdevelopment of arms and legs and defects of the intestine, heart, and blood vessels in the babies of women who took the drug during pregnancy. Some drugs cause birth defects in animals, but the same effects have not been seen in people. One example is meclizine, frequently taken for motion sickness, nausea, and vomiting.

[Forte]

Drug Monograph based on Pregnancy Category Risk

Alphabet A: ShowHide

Acebutolol
Category B. May cause bradycardia and
hypotension in infant exposed near term.
Carefully monitor blood pressure and heart
rate.

Acetaminophen
Category B. Safe for short-term use in
therapeutic doses. If medication is required to
treat fever or pain, use acetaminophen rather
than aspirin.

Acetazolamide
Category C. Not associated with major or
minor malformations.

Acetohexamide
Category D. Pregnant diabetics should be
managed with insulin, not oral
hypoglycemics. Causes symptomatic
hypoglycemia resulting from
hyperinsulinemia in newborn. Monitor
infant's serum glucose for 5 days after birth.

Acetophenazine
Category C. No reports of fetal risk available.

Acetylcholine
Category C. No reports of fetal risk available.
Significant transplacental passage not
expected.

Acyclovir
Category C. Report of 2 infants exposed in
utero who exhibited no toxicity. Fetal risk
minimal, but insufficient data exist to
establish safety.

Adenosine
Category C. No adverse effects in fetus and
newborn reported. High intravenous doses
could potentially produce fetal toxicity.

Albumin
Category C. No known problems associated
with use in pregnancy.

Albuterol Category C. Used to prevent premature labor,
as is terbutaline and ritodrine. May cause fetal
tachycardia (>160 beats/min) and
hypoglycemia in newborn. Decreases
incidence of neonatal respiratory distress
syndrome.

Alcohol Category D or X if used excessively. Causes
multiple congenital anomalies. Causes fetal
alcohol syndrome (prenatal and postnatal
growth deficiency, facial dysmorphogenesis,
CNS abnormalities, and impairment in mental
and motor function), spontaneous abortion,
renal anomalies, alcohol withdrawal
syndrome, and other abnormalities.

Alfentanil Category C. No adverse effects reported.
Could cause respiratory depression, reversible
with naloxone.

Allopurinol Category C. No adverse reports in humans.

Alprazolam Category D. Freely crosses placenta.
Neonatal withdrawal may occur.

Alteplase (t-PA) Category C. May be used if mother's
condition warrants.

Amantadine Category C. Teratogenic in animals in high
doses. In 1 reported case, exposure in first
trimester may have caused a single ventricle
with pulmonary atresia.

Ambenonium Category C. No reports of fetal risk available.
Intravenous anticholinesterases could
potentially induce premature labor.

Amikacin Category C. No reports of adverse effects on
fetus. Testing for ototoxicity recommended
because other aminoglycosides (eg,
kanamycin and streptomycin) have been
associated with eighth cranial nerve damage.

Amiloride Category B. Hypospadias reported in 1 infant.

Aminocaproic acid Category C. No fetal toxicity occurred in 1
patient given aminocaproic acid in second
trimester.

Aminoglutethimide Category D. Possible virilization when given
throughout pregnancy.

Aminophylline Category C. At birth, transient tachycardia,
irritability, and vomiting may occur,
especially if mother's serum concentrations
above therapeutic range. No congenital
defects reported.

Aminopterin Category X. Several reports have described
fetal malformations when used unsuccessfully
to induce abortion in first trimester.
p-Aminosalicylic Category C. In 1 study, congenital defects
were found in 5 infants; other studies
acid (PAS) have reported no fetal risk.

Amiodarone Category D. Transient bradycardia and IUGR
may occur. Also, because this drug contains
iodine, there is potential concern regarding
fetal thyroid gland. Test thyroid function of
newborn. Use with caution, if at all, during
pregnancy.

Amitriptyline Category C. Malformations, neonatal
withdrawal, and urinary retention in neonate
are potential problems. Most evidence
indicates amitriptyline is relatively safe in
pregnancy and may be preferred over other
antidepressants during gestation.

Ammonium chloride Category B. Three possible malformations
(inguinal hernia if taken during first trimester,
cataracts, and benign tumors) reported.
Acidoses may occur in mother and fetus
when taken near term.

Amobarbital Category D. Increased incidence of
congenital defects reported. May cause
withdrawal syndrome.

Amoxapine Category C. Three major birth defects (type
unknown) reported from first-trimester
exposure.

Amoxicillin Category B. No evidence of fetal or neonatal
risk.

Amphetamines Category C. With amphetamine abuse,
increased incidence of preterm labor,
placental abruption, fetal distress, postpartum
hemorrhage, IUGR, feeding difficulty,
drowsiness, and lassitude that may last
several months.

Amphotericin B Category B. No adverse effects on fetus
reported.

Ampicillin Category B. Probably not teratogenic.

Amyl nitrite Category C. Insufficient data to draw
conclusions regarding safety during
pregnancy.

Anileridine Category B. Potential risk of withdrawal
syndrome and respiratory depression from
maternal use of this narcotic analgesic.

Antacids Category C. No teratogenic effects reported.
Avoid chronic use of high doses.

Aspartame Category B. Not a risk to fetus.

Aspirin Category C. May cause increased risk of
hemorrhage, closure of ductus arteriosus, and
prolonged labor. First-trimester use does not
increase risk of congenital heart defects. Risk
is greatest in last 3 months of pregnancy.
High doses may cause increased perinatal
mortality and IUGR. If medication required
to treat fever or pain, use acetaminophen
rather than aspirin.

Atenolol Category D. May cause bradycardia and
hypotension in infant exposed near term.
Carefully monitor blood pressure and heart
rate. May cause IUGR.

Atracurium Category C. No adverse effects reported.

Atropine Category C. No association with
malformations reported in 1 large survey. In
another survey, possible association with limb
reduction in 2 infants.

Aurothioglucose Category C. No reports of fetal risk available;
however, experience with use during
pregnancy limited.

Azatadine Category B. Not associated with birth defects.

Azathioprine Category D. Most investigators have found
azathioprine to be relatively safe. In a few
cases, however, abnormalities reported,
including leukopenia and thrombocytopenia,
immunosuppression, transient chromosomal
aberrations, and congenital defects. Interferes
with effectiveness of intrauterine
contraceptive device.

Azithromycin Category B. Macrolide antibiotics are not
considered major human teratogens. More
study needed.

Aztreonam Category B. No reports of adverse effects
located.

Alphabet B: ShowHide

Bacampicillin Category B. No reports of fetal risk available.

Bacitracin Category C. Not associated with birth defects.

Baclofen Category C. No reports of adverse effects
located. Limited data.

BCG (bacille Calmette- Category C. Animal studies not done. If
possible, avoid use in pregnancy. Live, at-
Guerin) vaccine tenuated vaccine.

Belladonna Category C. Associated with fetal
malformations of varying severity in general
and with minor malformations when used in
first trimester.

Benazepril Category D (Category C in first trimester).
Discontinue as soon as pregnancy detected.
ACE inhibitors have caused fetal death and
malformations.

Benzocaine Category C. No adverse effects reported.

Benzoyl peroxide Category C. No adverse effects reported.

Benzthiazide Category D. Thiazide-related diuretics may
cause increased risk of congenital defects if
taken during first trimester. May also cause
hypoglycemia, thrombocytopenia,
hyponatremia, hypokalemia, and death. May
inhibit labor. Use during pregnancy only if
required for patients with heart disease.
Carefully monitor infant's electrolytes,
platelet count, and serum glucose after birth.

Benztropine Category C. May cause decreased intestinal
motility in infant.

Beta-carotene Category C. No reports of fetal risk available.

Betamethasone Category C. Stimulates fetal lung maturation,
thus reducing incidence and severity of
respiratory distress syndrome. No reports of
congenital defects associated with human use
of corticosteroids in pregnancy.

Bethanechol Category C. No reports of fetal risk available,
but data limited.

Biperiden Category C. No reports of fetal risk available.

Bisacodyl Category C. Bulk-forming (methylcellulose)
or surfactant (docusate) laxatives preferred
for use in pregnancy over this stimulant
laxative.

Bismuth subsalicylate Category C. Contains salicylates. See Aspirin.
(Pepto-Bismol)

Bleomycin Category D. If possible, avoid during
pregnancy. Two normal infants born to
mothers receiving bleomycin and other
antineoplastic agents in second and third
trimesters.

Bretylium Category C. No reports of fetal risk available;
however, may cause maternal hypotension,
with potential risk to fetus from reduced
uterine blood flow and hypoxia.

Bromides Category D. Possible association with
polydactyly, GI malformations, clubfoot, and
congenital dislocation of hip. May cause
neonatal bromism (poor sucking, diminished
Moro's reflex, and hypotonia). Monitor serum
bromide concentrations in newborn.

Bromocriptine Category C. Does not pose significant risk to
fetus.

Brompheniramine Category C. Increased risk of fetal
malformations if taken during first trimester.
Increased risk of retrolental fibroplasia in
premature infant exposed to antihistamines
during last 2 weeks in utero.

Buclizine Category C. Possible increased risk of fetal
malformations. Increased risk of retrolental
fibroplasia in premature infant exposed to
antihistamines during last 2 weeks in utero.

Budesonide Category C. Not a major teratogenic risk.

Busulfan Category D. Use during pregnancy associated
with fetal malformations and low birth weight.

Butalbital Category C. No association with fetal
malformations reported. However,
withdrawal syndrome may occur; observe
infant for 48 h after birth.

Butorphanol Category B. No association with fetal
malformations reported; however, respiratory
depression and withdrawal syndrome may
occur.

[Forte]

Alphabet C: ShowHide

Caffeine Category B. Moderate consumption of
caffeine probably does not pose risk to fetus;
even so, prudent to avoid or limit
consumption. Consumption of 6-8 cups of
coffee/day may be associated with decreased
fertility, spontaneous abortion, and low birth
weight.

Calcifediol Category A for RDA amounts; category D for
therapeutic and higher doses. Vitamin D
analog. High doses of vitamin D teratogenic
in animals but not in humans. Because
vitamin D raises calcium levels, it may be
associated with supravalvular aortic stenosis
syndrome, which is often associated with
hypercalcemia of infancy.

Calcitonin Category B. No reports of fetal risk available.

Calcitriol Category C; category D for doses higher than
RDA. High doses of vitamin D teratogenic in
animals but not in humans. Because vitamin
D raises calcium levels, may be associated
with supravalvular aortic stenosis syndrome,
which is often associated with hypercalcemia
of infancy.

Camphor Category C. No reports of fetal risk with
topical application available. May cause fetal
death and respiratory failure with maternal
ingestion.

Captopril Category D; category C in first trimester.
Discontinue as soon as pregnancy detected.
ACE inhibitors have caused malformations
and fetal death.

Carbachol Category C. No reports of fetal risk available.

Carbamazepine Category D. May cause craniofacial defects,
fingernail hypoplasia, and developmental
delay (similar to fetal hydantoin syndrome).
May cause spina bifida.

Carbarsone Category D. Contains arsenic, which has been
associated with CNS lesions. If possible,
avoid during pregnancy.

Carbenicillin Category B. Has been used in a large number
of pregnancies; no malformations associated
with use.

Carbimazole Category D. May cause aplasia cutis (scalp
defects). For treatment of hyperthyroidism
during pregnancy, use propylthiouracil rather
than carbimazole or methimazole.

Carbinoxamine Category C. No reports of fetal risk available,
but data limited.

Carphenazine Category C. No reports of fetal risk available,
but data limited.

Casanthranol Category C. No reports of fetal anomalies
reported in 109 infants exposed to this drug
during pregnancy.

Cascara sagrada Category C. Higher than expected risk for
benign tumors in 1 study, but confirmation
needed.

Castor oil Category C. May cause premature labor.

Cefaclor Category B. Increased risk of congenital
defects, but other factors may be involved.

Cefadroxil Category B. No association with congenital
defects.

Cefamandole Category B. Data limited, but no
abnormalities noted in 1 infant exposed in
first trimester.

Cefazolin Category B. No reports of fetal risk available.

Cefonicid Category B. No reports of fetal risk available.

Cefoperazone Category B. No adverse newborn effects
noted.

Ceforanide Category B. No reports of fetal risk available.

Cefotaxime Category B. No reports of fetal risk available.

Cefotetan Category B. Not teratogenic or fetotoxic in
animals. Cephalosporins are usually
considered safe during pregnancy.

Cefoxitin Category B. No adverse newborn effects
noted when administered to mother at term.

Ceftazidime Category B. Not teratogenic in animals. No
data on human pregnancy outcome available.

Ceftizoxime Category B. No adverse newborn effects
noted when administered to mother at term.

Ceftriaxone Category B. No adverse newborn effects
noted when administered to mother at term.

Cefuroxime Category B. No adverse newborn effects
noted.

Cephalexin Category B. Increased risk of congenital
defects, but other factors may be involved.

Cephalothin Category B. No adverse newborn effects
noted.

Cephapirin Category B. No data available.

Cephradine Category B. Increased risk of congenital
defects, but other factors may be involved.

Chloral hydrate Category C. No adverse effects reported.

Chlorambucil Category D. Reports of unilateral agenesis of
kidney and ureter and cardiovascular
anomalies. May cause low birth weight.

Chloramphenicol Category C. No congenital defects reported.
Avoid at term because of risk for gray
syndrome (cardiovascular collapse).

Chlordiazepoxide Category D. Some studies found increased
risk of fetal malformations; however, others
have not confirmed this. When given at term,
neonatal depression with hypotonia persisting
for up to 1 week reported. Neonatal
withdrawal syndrome may occur.

Chlorhexidine Category B. No reports of adverse effects in
the newborn have been reported.

Chloroquine Category C. Generally considered safe, but
there may be a small increased risk of birth
defects.

Chlorothiazide Category D. Thiazide-related diuretics may
cause increased risk of congenital defects if
taken during first trimester. May also cause
hypoglycemia, thrombocytopenia,
hyponatremia, hypokalemia, and death. May
inhibit labor. Use in pregnancy only if
required for patients with heart disease.
Monitor infant's electrolytes, platelet count,
and serum glucose carefully after birth.

Chlorpheniramine Category B. Possible association with fetal
malformations reported, but statistical
significance unknown. Increased risk of
retrolental fibroplasia in premature infant
exposed to antihistamines during last 2 weeks
in utero.

Chlorpromazine Category C. Probably safe and effective for
treatment of vomiting and nausea of
pregnancy when used occasionally at low
doses. Avoid administration at term because
it may cause hypotension. May cause
extrapyramidal syndrome (tremors and
increased muscle tone) in infant when
administered near term.

Chlorpropamide Category C. Pregnant diabetics should be
managed with insulin, not oral
hypoglycemics. Causes symptomatic
hypoglycemia as a result of hyperinsulinemia
in newborn. Monitor infant's serum glucose
for 5 days after birth.

Chlortetracycline Category D. Tetracyclines should be avoided
during pregnancy because they may cause
adverse effects, including yellow staining of
teeth, inhibition of bone growth, maternal
liver toxicity, and congenital defects.

Chlorthalidone Category D. Thiazide-related diuretics may
cause increased risk of congenital defects if
taken during first trimester. May also cause
hypoglycemia, thrombocytopenia,
hyponatremia, hypokalemia, and death. May
inhibit labor. Use in pregnancy only if
required for patients with heart disease.
Carefully monitor infant's electrolytes,
platelet count, and serum glucose after birth.

Cholecalciferol Category A for RDA amounts; category D for
higher doses. Vitamin D analog. High doses
of vitamin D teratogenic in animals but not in
humans. Because vitamin D raises calcium
levels, it may be associated with
supravalvular aortic stenosis syndrome,
which is often associated with hypercalcemia
of infancy.

Cholera vaccine Category C. Inactivated bacterial vaccine.
Indications for vaccine not altered by
pregnancy, but should be given only in
unusual outbreak situations.

Cholestyramine Category B. Not systemically absorbed but
may bind fat-soluble vitamins in GI tract and
cause vitamin deficiency in fetus, although
this effect not reported.
Ciclopirox Category B. No adverse effects reported.
Cimetidine Category B. One report of transient liver
impairment in newborn not confirmed by
other investigators. Has antiandrogenic
effects; feminization observed in some
animals and in nonpregnant humans. More
data needed.

Ciprofloxacin Category C. No congenital defects reported.
Use a safer alternative in pregnancy because
of arthropathy in immature animals.

Cisapride Category C. Does not appear to be a major
human teratogen.

Cisplatin Category D. Data limited. A few case reports
document normal infants after use of cisplatin
during pregnancy.

Citrate and citric acid
(Shohl solution,
Bicitra, Polycitra)
Category C. Avoid sodium citrate in toxemic
patients (contains 1 mEq/mL sodium).

Clemastine Category B. Possible association with limb
reduction defects, but other factors may have
been involved. Increased risk of retrolental
fibroplasia in premature infant exposed to
antihistamines during last 2 weeks in utero.

Clindamycin Category B. No adverse effects reported.

Clofazimine Category C. May cause temporary skin
pigmentation.

Clofibrate Category C. No adverse effects reported;
however, data limited. Avoid administration
near term, especially in preterm infant,
because of limited capacity for
glucuronidation of this compound.

Clomiphene Category X. May cause neural tube defects
and other fetal malformations. Start each new
course after pregnancy excluded.

Clomipramine Category D. Infant lethargy, hypotonia,
cyanosis, jitteriness, irregular respirations,
respiratory acidosis, hypothermia, seizures,
and withdrawal may occur.

Clonazepam Category C. May cause apnea.

Clonidine Category C. Data limited; however, no
adverse effects reported.

Clorazepate Category D. Multiple anomalies with firsttrimester
exposure in one case. Congenital
malformations associated with in utero
exposure to other benzodiazepines.

Clotrimazole Category B. No adverse effects reported.

Cloxacillin Category B. No adverse effects reported.

Coal tar Category C. No adverse effects reported.

Cocaine Category C; category X for nonmedicinal use.
May cause withdrawal syndrome,
multisystem abnormalities as a result of
vasoconstrictive properties of the drug,
including urogenital anomalies, prematurity,
spontaneous abortions, fetal growth
retardation, neurobehavioral deficits,
electroencephalogram abnormalities, cerebral
infarctions, cardiorespiratory pattern
abnormalities, and abruptio placentae.

Codeine Category C. May cause malformations,
respiratory depression, and withdrawal
syndrome.

Colchicine Category D. Use by father before conception
possibly associated with atypical Down
syndrome. No malformations reported from
maternal consumption. Teratogenicity occurs
in animals. Use with caution. Limited data.

Colestipol Category B. Not systemically absorbed but
may bind fat-soluble vitamins in GI tract and
cause vitamin deficiency in fetus, although
this effect not reported.

Colistimethate Category C. No adverse effects reported.

Contraceptives, oral Category X. May affect development of
sexual organs and may cause
hyperbilirubinemia in newborn.

Corticotropin Category C. No adverse effects reported.

Cortisone Category C (D if used in first trimester). No
association with congenital malformations
found in 1 large study; however, other studies
reported abnormalities, including cataracts,
cyclopia, intraventricular septal defect,
gastroschisis, and other abnormalities.

Coumadin See warfarin.

Cromolyn Category B. Generally considered safe for use
in pregnancy.

Crotamiton Category C. No adverse effects reported. One
of the preferred drugs for treatment of scabies
in pregnant women.

Cyclacillin Category B. Has been used in a large number
of pregnancies and has not been associated
with malformations.

Cyclamate Category C. No adverse effects reported.

Cyclizine Category B. Teratogenic in animals but not in
humans. Increased risk of retrolental
fibroplasia in premature infant exposed to
antihistamines during last 2 weeks in utero.

Cyclophosphamide Category D. May cause fetal malformations
from first-trimester exposure, possible
pancytopenia, and low birth weight. Use by
father before conception may cause
malformations in infant.

Cycloserine Category C. No adverse fetal effects reported.
Use with caution. Limited data.

Cyclosporine Category C. Not a human teratogen, based on
limited data.

Cyproheptadine Category B. No adverse effects reported.

Cytarabine Category D. May cause chromosomal
abnormalities and congenital anomalies with
maternal or paternal use before conception
and low birth weight; however, normal
infants have been delivered.

Alphabet D: ShowHide

Dacarbazine Category C. No data available.

Dactinomycin Category C. Stillbirth and low birth weight
may occur; however, normal infants have
been delivered.

Dalteparin Category B. Probably no more fetal or
newborn risk than from standard,
unfractionated heparin.

Danazol Category X. May cause virilization with
ambiguous genitalia of female infants.

Danthron Category C. One study reported higher than
expected risk of benign tumors, but
confirmation needed.

Dantrolene Category C. No fetal or newborn adverse
effects reported when used in a limited
number of patients shortly before delivery.

Dapsone Category C. Does not present a major risk to
fetus or newborn.

Daunorubicin Category D. Successful pregnancies with
normal infants reported; however,
abnormalities such as low birth weight,
anemia, hypoglycemia, intrauterine death,
and myocardial necrosis may occur. Paternal
use may result in congenital defects in infant.

Deferoxamine Category C. No abnormalities reported. May
cause low iron levels in infant, requiring iron
supplementation.

Demeclocycline Category D. Tetracyclines should be avoided
during pregnancy because they may cause
adverse effects, including yellow staining of
teeth, inhibition of bone growth, maternal
liver toxicity, and congenital defects.

Desipramine Category C. Withdrawal syndrome reported.

Desmopressin Category B. No adverse effects reported.

Dexamethasone Category C (D if used in first trimester). No
known congenital defects reported. Given in
premature labor to stimulate fetal lung
maturation.

Dextroamphetamine Category C. May cause congenital defects
such as cardiac abnormalities, biliary atresia,
and eye defects; may cause withdrawal
syndrome.

Dextromethorphan Category C. Not a major teratogen.

Diatrizoate Category D. Monitor thyroid function
because this drug may suppress fetal thyroid
gland when administered by intra-amniotic
injection.

Diazepam Category D. May cause hypotonia, lethargy,
sucking difficulties, and withdrawal
syndrome. May also cause craniofacial
abnormalities, sullen and expressionless face,
low Apgar scores, apneic spells, delayed
motor development, and hypotonia.

Diazoxide Category C. May cause transient fetal
bradycardia and hyperglycemia.

Diclofenac Category B (D if used in third trimester). May
close ductus arteriosus in utero, cause PPHN,
inhibition of labor, and spontaneous abortion.

Dicloxacillin Category B. No adverse effects reported.

Dicumarol Category D. Coumadin (warfarin) derivative.
Significant risk of congenital defects. May
cause fetal warfarin syndrome (hypoplastic,
flattened nasal bridge; stippled epiphyses; and
possibly other features, such as low birth
weight, eye defects, developmental
retardation, congenital heart disease, and
death). May also cause hemorrhage. If
anticoagulation required during pregnancy,
heparin given at lowest effective dose is
probably safer choice.

Didanosine Category B. CDC recommends that
antiretrovirals be continued during pregnancy
with the possible exception of the first
trimester).

Dienestrol Category X. Contraindicated during
pregnancy. May lead to high estrogen
concentrations in blood, leading to fetal
malformations.

Diethylstilbestrol Category X. May result in complications of
reproductive system, including carcinoma of
cervix and vagina. Hirsutism and irregular
menses may result, but this is controversial.
Genitourinary abnormalities, including
neoplasms, may also occur in male offspring.

Digitalis, digoxin, and
digitoxin
Category C. No congenital defects reported.
Neonatal death has resulted from maternal
overdose of digitoxin.

Dihydrotachysterol Category A for RDA amounts; category D for
therapeutic and higher doses. Vitamin D
analog. High doses of vitamin D teratogenic
in animals but not in humans. Because
vitamin D raises calcium levels, it may be
associated with supravalvular aortic stenosis
syndrome, which is often associated with
hypercalcemia of infancy.

Diltiazem Category C. Compared with controls, no
increase in the risk of major congenital
malformations was found in 78 women
exposed to calcium channel blockers in the
first trimester.

Dimenhydrinate Category B. Has not been associated with
major or minor fetal malformations. May
have oxytocic effect. Increased risk of
retrolental fibroplasia in premature infant
exposed to antihistamines during last 2 weeks
in utero.

Diphenhydramine Category B. May cause cleft palate,
withdrawal. Probably safe for use in
pregnancy. Increased risk of retrolental
fibroplasia in premature infant exposed to
antihistamines during last 2 weeks in utero.

Diphenhydramine taken concurrently with
temazepam has resulted in stillbirth; avoid
this combination.

Diphenoxylate
(combined with
atropine, Lomotil)
Category C. No abnormalities reported.

Diphtheria and tetanus
toxoids
Category C. No data available on safety of
diphtheria toxoid; therefore, manufacturer
does not recommend use of combination
product in pregnancy.

Dipyridamole Category C. No abnormalities reported.

Disopyramide Category C. No abnormalities reported.

Disulfiram Category C. Not a major teratogen. Of course,
alcohol should not be consumed while on this
drug.

Dobutamine Category B. No adverse effects reported, but
data limited.

Docusate Category C. No fetal malformations reported.
Possible hypomagnesemia with use
throughout pregnancy.

Dopamine Category C. No adverse effects reported.

Doxepin Category C. Possible decrease in GI motility
if given at term.

Doxorubicin Category D. Normal pregnancies have
occurred in mothers treated with this drug;
however, fetal malformations have also been
reported.

Doxycycline Category D. Tetracyclines should be avoided
during pregnancy because they may cause
adverse effects, including yellow staining of
teeth, inhibition of bone growth, maternal
liver toxicity, and congenital defects.

Doxylamine Category B. Probably not associated with
malformations.

Droperidol Category C. No adverse effects reported.

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Alphabet E: ShowHide

Echinacea Category C. Safety in pregnancy needs to be
established.

Echothiophate Category C. No information available, but
transplacental passage not likely because of
chemical structure.

Edrophonium Category C. No adverse effects reported. May
cause premature labor.

Enalapril Category D (category C in first trimester).
Discontinue as soon as pregnancy detected.
ACE inhibitors have caused malformations
and fetal death.

Encainide Category B. Not teratogenic, but experience
limited.

Enoxaparin Category B. Because of relatively high
molecular weight, not expected to cross
placenta to fetus.

Ephedrine Category C. Minor fetal malformations may
be associated with use during first trimester.
May cause fetal tachycardia.

Epinephrine Category C. May cause fetal malformations
with first-trimester use and inguinal hernia
with use any time during pregnancy. May
cause decreased uterine blood flow.

Epoetin alfa Category C. No major risk to fetus, but
experience limited.

Epoprostenol Category B. Not teratogenic in animals, but
human data are limited. Transplacental
passage of this drug is unlikely. Benefits of
this drug in treating maternal pulmonary
hypertension appear to outweigh potential
risks to fetus.

Ergocalciferol Category A for RDA amounts; category D for
therapeutic and higher doses. Vitamin D
analog. High doses of vitamin D teratogenic
in animals but not in humans. Because
vitamin D raises calcium levels, it may be
associated with supravalvular aortic stenosis
syndrome, which is often associated with
hypercalcemia of infancy.

Ergotamine derivatives Category X. May cause intrauterine fetal
death from drug-induced increase in uterine
motility and placental vasoconstriction. The
combination of ergotamine, caffeine, and
propranolol potentiates vasoconstriction.

Erythromycin Category B. No abnormalities reported.

Esmolol Category C. May decrease uterine blood flow,
resulting in fetal hypoxia. Bradycardia,
hypoglycemia, poor feeding, and hypotonia
may occur.

Estradiol Category X. Estrogenic hormones
contraindicated during pregnancy. In utero
exposure may cause developmental changes
in psychosexual performance of boys, less
heterosexual experience, and fewer masculine
interests.

Estrogens (conjugated) Category X. Estrogenic hormones
contraindicated during pregnancy. May cause
fetal malformations.

Ethacrynic acid Category D. May decrease placental
perfusion and may cause ototoxicity. Not
recommended for use in pregnancy.

Ethambutol Category B. No abnormalities reported.

Ethinylestradiol Category X. Estrogenic hormones
contraindicated during pregnancy. In utero
exposure may cause developmental changes
in psychosexual performance of boys, less
heterosexual experience, and fewer masculine
interests.

Ethiodized oil Category D. May cause neonatal
hypothyroidism.

Ethionamide Category C. May cause Down syndrome (2
cases). Some reports documented no
association with birth defects.

Ethisterone Category D. Possible association with
congenital anomalies.

Ethosuximide Category C. May cause congenital anomalies
and spontaneous hemorrhage in neonate.

Ethynodiol Category D. May cause modified
development of sexual organs and
hyperbilirubinemia of the newborn.

Alphabet F: ShowHide

Famotidine Category B. No adverse effects reported, but
data limited.

Felodipine Category C. Compared with controls, no
increase in the risk of major congenital
malformations was found in 78 women
exposed to calcium channel blockers in the
first trimester.

Fenoprofen Category B; category D if used near term. No
congenital malformations reported. May
cause constriction of ductus arteriosus in
utero, PPHN, and inhibition of labor.

Fenoterol Category B. No malformations reported.
Inhibits uterine activity at term.

Fentanyl Category C; category D with prolonged high
doses. No malformations reported. May cause
respiratory depression and withdrawal
syndrome.

Ferrous sulfate Category B. No adverse effects reported.

Flecainide Category C. No congenital defects reported.
May cause hyperbilirubinemia. Several
publications report successful use of
flecainide for treatment of fetal tachycardia.

Fluconazole Category C. Continuous first trimester doses
of 400 mg/day or more may be teratogenic.

Flucytosine Category C. No defects reported, although its
metabolite (fluorouracil) may produce fetal
malformations.

Fludrocortisone
(Florinef)
Category C. Observe infant for signs of
adrenocortical insufficiency, and treat if
required.

Fluoride Category C. Crosses placenta. No information
available on fetal effects.

Fluorouracil Category D. May cause fetal malformations
(first-trimester use), cyanosis and jerking
extremities (third-trimester use), and low
birth weight (used any time during
pregnancy).

Fluoxetine Category C. Not associated with increased
risk of major congenital defects. More studies
are needed of the potential effects on the
developing CNS to exclude the possibility of
permanent changes. Weigh maternal benefits
against fetal risks before use.

Fluphenazine Category C. Extrapyramidal effects; possible
congenital malformations in 1 infant.

Flurazepam Category X. Active metabolite crosses
placenta. Drowsiness if given preceding
delivery. No congenital anomalies reported;
however, other agents in this class may cause
fetal abnormalities.

Folic acid Category A. Folate deficiency may result in
congenital anomalies.

Foscarnet Category C. Observe for fetal renal toxicity
by monitoring amniotic fluid volume.

Fosinopril Category D. Discontinue as soon as
pregnancy detected. ACE inhibitors have
caused malformations and fetal death.

Furazolidone Category C. No congenital defects reported.
Could cause hemolytic anemia in G6PDdeficient
infant if given at term.

Furosemide Category C. No congenital defects reported.
Generally not indicated in pregnancy except
in patients with cardiovascular disorders.

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Alphabet G: ShowHide

Gabapentin Category C. Limited data. No pattern of
malformations reported.

Ganciclovir Category C. Toxic effects in animals.
Potential for fetal toxicity. Reserve use for
life-threatening disease or in
immunocompromised patients with major
CMV infections such as retinitis.

Gentamicin Category C. No congenital defects reported.
Potentiation of magnesium sulfate-induced
neuromuscular weakness. Monitor infant for
ototoxicity because this has occurred with
other aminoglycosides (eg, kanamycin and
streptomycin).

Ginkgo biloba Category C. Controversial. Limited data.
Avoid.

Glyburide, glipizide Category C. May cause neonatal
hypoglycemia. Insulin is drug of choice for
treating diabetes during pregnancy.

Glycopyrrolate Category B. Minor fetal malformations may
occur but are unlikely.

Gold sodium
thiomalate
Category C. Probably no risk to fetus, but
experience limited.

Griseofulvin Category C. Teratogenic in animals, but no
data available for humans.

Guaifenesin Category C. May cause inguinal hernias with
first-trimester use.

Alphabet H: ShowHide

Haloperidol Category C. Limb reductions in 2 reports, but
other studies have not confirmed this.

Heparin Category C. No reports of congenital defects
reported. Heparin preferred over oral
anticoagulants during pregnancy.

Hepatitis B immune
globulin (HBIG)
Category B. No adverse effects reported.

Hepatitis B vaccine Category C. No adverse effects reported.

Heroin Category B; category D with prolonged highdose
use. May cause congenital
malformations, jaundice, RDS, low Apgar
scores, withdrawal, low birth weight, and
increased perinatal mortality.

Hexachlorophene Category C. Increased risk of anomalies with
excessive first-trimester use.

Hexamethonium Category C. No congenital abnormalities
reported.

Homatropine Category C. Possible association with minor
malformations.

Hyaluronidase Category C. No adverse effects reported.

Hydralazine Category C. No congenital abnormalities
reported.

Hydrochlorothiazide Category D. See Chlorothiazide.

Hydrocodone Category B; category D with prolonged highdose
use. No malformations reported;
however, respiratory depression or
withdrawal syndrome may occur.

Hydromorphone Category B; category D with prolonged highdose
use. No malformations reported;
however, respiratory depression or
withdrawal syndrome may occur.

Hydroxychloroquine Category C. Probably not a significant risk to
fetus, especially at lower doses. CDC states
that it may be used for malaria prophylaxis
because not shown to be harmful at
prophylactic doses (400 mg/week).

Hydroxyprogesterone Category D. May cause ambiguous genitalia.
In males, may cause less heterosexual
experience and fewer masculine interests.

Hydroxyzine Category C. Possible relation between fetal
malformations and use during first trimester,
but statistical significance not known.

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Ibuprofen Category B; category D in third trimester. No
congenital anomalies reported. May cause
closing of ductus arteriosus in utero, PPHN,
and inhibition of labor.

Idoxuridine Category C. No data available on use in
human pregnancy.

Imipramine Category D. May cause fetal malformations,
withdrawal syndrome, and urine retention.

Immune globulin,
intravenous
Category C. No adverse effects reported.

Indomethacin Category B; category D if taken after 34
weeks' gestation or if used for longer than 48
h. May cause delayed labor, premature
closure of ductus arteriosus, PPHN, renal
failure, intestinal perforation, and death.

Insulin Category B. Insulin rather than oral
hypoglycemics should be used to control
diabetes. Poorly controlled diabetes
associated with increased risk of congenital
defects.

Interferon alfa Category C. Not a significant risk. Limited
data. Because of the antiproliferative activity
of these agents, use cautiously during
gestation.

Intravenous fat
emulsion
Category C. One case of placental fat deposits
and fetal demise after 8 weeks of IV
parenteral nutrition and lipid emulsion for
hyperemesis gravidarum.

Iodine Category D. Topical use may result in
significant absorption of iodine, resulting in
transient hypothyroidism in newborn. (See
also Potassium iodide and Povidone iodine.)

Iron (ferrous sulfate) Category B. No adverse effects reported.

Isocarboxazid Category C. Increased risk of fetal
malformations.

Isoetharine Category C. Use in first trimester associated
with possible increased risk of minor fetal
malformations.

Isoniazid (INH) Category C. Increased risk of fetal
malformations found in 1 study but not
confirmed by other studies. Use of INH for
TB occurring during pregnancy is
recommended because untreated TB
represents far greater hazard to mother and
fetus than does INH.

Isoproterenol Category C. Use of sympathomimetics in first
trimester associated with possible increased
risk of minor fetal malformations. Inhibits
contractions of pregnant uterus.

Isosorbide dinitrate Category C. No data available.

Isotretinoin
(Accutane, retinoic
acid)
Category X. With first-trimester use, causes
severe birth defects, including exter- nal ear,
CNS, craniofacial, cardiac, and thymic
anomalies. Prevent pregnancy during use.
Use effective contraception 1 month before
use, during therapy, and for 1 month after
discontinuation.

Isoxsuprine Category C. No congenital defects reported;
however, fetal tachycardia and neonatal ileus
may occur, and infants with cord levels
exceeding 10 ng/mL may have RDS,
hypotension, hypocalcemia, and death.

Itraconazole Category C. Risk to fetus is probably low.
However, avoid during first trimester if
possible because fluconazole, a related
antifungal, causes possible dose-related major
malformations.

Alphabet K: ShowHide

Kanamycin Category D. May cause eighth cranial nerve
damage.

Ketoconazole Category C. No major birth defects reported.
Labetalol Category C. May cause hypotension and
bradycardia. Monitor infant for 48 h after
birth.

Alphabet L: ShowHide

Lactulose Category B. No information available.

Laetrile Category C. Theoretic risk of cyanide
poisoning.

Lamotrigine Category C. Probably not a major risk for
congenital malformations or fetal loss in first
trimester.

Levallorphan Category D. May cause neonatal respiratory
depression.

Levarterenol Category D. No fetal malformations reported,
but may cause reduction of uterine blood flow.

Levofloxacin Category C. Avoid in pregnancy because of
arthropathy in immature animals. Use safer
alternative.

Levorphanol Category B with therapeutic doses; category
D if used at high doses for prolonged periods.
May cause respiratory depression and
withdrawal syndrome.

Levothyroxine Category A. First-trimester use possibly
associated with cardiovascular anomalies,
Down syndrome, and polydactyly, but
confirmation needed.

Lidocaine Category B. No association with
malformations found.

Lindane (Kwell) Category B. May cause neurotoxicity and
aplastic anemia. Use pyrethrins with
piperonyl butoxide rather than lindane to treat
lice during pregnancy.

Liothyronine Category A. No adverse effects reported.

Liotrix Category A. First-trimester use possibly
associated with cardiovascular anomalies,
Down syndrome, and polydactyly, but
confirmation needed.

Lisinopril Category D. Discontinue as soon as
pregnancy detected. ACE inhibitors have
caused malformations and fetal death.

Lithium Category D. May cause cardiac congenital
defects when used in first trimester and
toxicity in newborn (cyanosis, hypotonia,
bradycardia, nephrogenic diabetes insipidus,
and other disorders) when used near term.
Reduce risk by using lowest dose possible,
monitoring serum concentrations, and
avoiding sodium-restricted diets and sodiumwasting
diuretics.

Loperamide Category B. No adverse effects reported.

Loratadine Category B. Data too limited to assess safety.
Consider chlorpheniramine or tripelennamine
instead.

Lorazepam Category D. May cause neonatal respiratory
depression and hypotonia. Other drugs in this
class have been suspected of causing
malformations.

Losartan Category C first trimester (category D in
second and third trimesters). Drugs that act on
the renin-angiotensin system can cause fetal
and neonatal morbidity and death when
administered in pregnancy. Monitor
newborn's BP and renal function closely.
Avoid use during pregnancy.

Lovastatin Category X. May cause malformations.
Monitor renal function of newborn. Avoid
using in pregnancy.

LSD Category C. Available data indicate that pure
LSD does not cause chromosomal
abnormalities, spontaneous abortions, or
congenital malformations.

Lynestrenol Category D. Use of progestogens not
recommended during pregnancy.

Lypressin Category C. No adverse effects reported.
Magnesium salts Category B. May cause neonatal respiratory
depression and muscle weakness if used just
before delivery and congenital rickets with
prolonged infusion. Possible respiratory arrest
when gentamicin given to newborns with
high magnesium levels. Inhibits indomethacin
effect for ductal closure.

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Mannitol Category C. No adverse effects reported.

Maprotiline Category B. May cause oral cleft, but other
factors may be involved. Very limited data.

Marijuana Category C. May cause impaired fetal growth
and acute nonlymphoblastic leukemia.
Conflicting reports on safety.

Measles vaccine Category C. Not for use during pregnancy
because of risk of fetal malformations and
abortion from this live virus vaccine.

Mechlorethamine Category D. Possible fetal malformations
with first-trimester use and low birth weight
with use any time during pregnancy.

Meclizine Category B. Possible fetal malformations
reported; however, 3 studies involving large
numbers of patients concluded that meclizine
is not a human teratogen. Increased risk of
retrolental fibroplasia in premature infant
exposed to antihistamines during last 2 weeks
in utero.

Meclofenamate Category B; category D if taken in third
trimester near delivery. May cause delayed
labor, premature closure of ductus arteriosus,
and PPHN.

Medroxyprogesterone Category X. Not recommended for use in
pregnancy because of risk of fetal
malformations associated with use of female
sex hormones.

Melphalan Category D. May cause low birth weight.
Structurally similar to other alkylating agents
that have produced defects.

Meperidine Category B; category D with prolonged use
of high doses. May cause respiratory
depression and withdrawal syndrome. Firsttrimester
use possibly associated with
inguinal hernia, but confirmation needed.

Mephentermine Category C. No adverse effects reported.

Mephenytoin Category C. No adverse effects reported.

Mephobarbital Category D. May cause withdrawal and
hemorrhagic disease of newborn.

Mepindolol Category C. May cause bradycardia and
hypotension in infant exposed near term.
Carefully monitor blood pressure and heart
rate.

Meprobamate Category D. May be associated with fetal
malformations when used in first trimester.
Avoid during pregnancy.

Mercaptopurine Category D. May cause fetal malformations,
pancytopenia, and low birth weight.

Meropenem Category B. Most likely safe to use in
perinatal period, 28 weeks' gestation or later.

Mesalamine Category B. No teratogenic effects reported.
Maternal benefits appear to outweigh
potential risks to fetus.

Mesoridazine Category C. No adverse effects reported.

Mestranol Category X. May cause fetal malformations.
Avoid estrogenic hormones during pregnancy.

Metaproterenol Category C. Prevents premature labor. May
cause fetal tachycardia and neonatal
hypoglycemia.

Metaraminol Category D. May reduce uterine blood flow.

Methadone Category B; category D with prolonged use
of high doses. May cause withdrawal
syndrome, low birth weight, and death.

Methamphetamine Category C. With amphetamine abuse,
increased incidence of preterm labor,
placental abruption, fetal distress, postpartum
hemorrhage, IUGR, feeding difficulty,
drowsiness, and lassitude that may last
several months.

Methantheline Category C. Possibly associated with minor
fetal malformations.

Methaqualone Category D. Not recommended during
pregnancy.

Methenamine Category C. Associated with fetal
malformations, but confirmation needed.

Methicillin Category B. No adverse effects reported.

Methimazole Category D. May cause aplasia cutis (scalp
defects) and other malformations. Use
propylthiouracil rather than carbimazole or
methimazole to treat hyperthyroidism during
pregnancy.

Methotrexate Category X. Associated with fetal
malformations and low birth weight.

Methoxsalen Category C. Probably not a significant human
teratogen. Long-term effects of in-utero
exposure need to be studied.

Methsuximide Category C. No adverse effects reported.
Methyldopa Category C. Probably not associated with
fetal malformations. Monitor neonate for
hypotension for 48 h after delivery.

Methylene blue Category C; category D if injected intraamniotically.
Possibly associated with fetal
malformations, but confirmation needed. May
cause hemolytic anemia, hyperbilirubinemia,
and methemoglobinemia with intra-amniotic
injection of large doses.

Methylergonovine Category C. Stimulates contractions of uterus.
Indicated only for postpartum use and as an
alternative to oxytocin for management of the
third stage of labor.

Methylphenidate Category C. No adverse effects reported.

Methysergide Category X. Do not use in pregnancy because
of oxytocic properties.

Metoclopramide Category B. No adverse effects reported, but
data limited.

Metolazone Category D. Thiazide-related diuretics may
cause increased risk of congenital defects if
taken during first trimester. May also cause
hypoglycemia, thrombocytopenia,
hyponatremia, hypokalemia, and death and
may inhibit labor. Use during pregnancy only
if required for patients with heart disease.
Carefully monitor infant's electrolytes,
platelet count, and serum glucose after birth.

Metoprolol Category D. Hypotension and bradycardia
may occur. Monitor infant for 48 h after birth.

Metrizamide Category D. Monitor infant's thyroid function
at birth. A related drug, diatrizoate, has
suppressed fetal thyroid gland when
administered by intra-amniotic injection.

Metronidazole Category B. Possible fetal malformations
with first-trimester use. Contraindicated in
first trimester in patients with trichomoniasis
and bacterial vaginosis. Use in second and
third trimesters for these indications is
acceptable.

Miconazole Category C. No adverse effects reported.

Mineral oil Category C. No adverse effects reported but
may inhibit maternal absorption of fat-soluble
vitamins (A, D, E, and K).

Minocycline Category D. Tetracyclines should be avoided
during pregnancy because they may cause
adverse effects, including yellow staining of
teeth, inhibition of bone growth, maternal
liver toxicity, and congenital defects.

Minoxidil Category C. May cause hypertrichosis that
gradually disappears over 2-3 months.

Misoprostol Category X. Contraindicated in pregnancy
because of risk of uterine bleeding and
contractions, which may result in abortion.
May cause malformations.

Mithramycin
(Plicamycin)
Category X. May cause fetal harm. Avoid
during pregnancy.

Molindone Category C. No adverse effects reported.

Montelukast Category B. Not a teratogen in animals, but
human data are lacking.

Morphine Category C; category D with prolonged use
of high doses. May cause respiratory
depression and withdrawal syndrome. Firsttrimester
use possibly associated with
inguinal hernia, but confirmation needed.

Mumps virus vaccine Category X. Not for use in pregnancy because
of risk of malformations. Live, attenuated
vaccine.

Alphabet N: ShowHide

Nadolol Category D. May cause bradycardia and
hypotension in infants exposed near term.
Carefully monitor blood pressure and heart
rate.

Nafcillin Category B. No adverse effects reported.

Nalbuphine Category B. May cause respiratory depression
and withdrawal syndrome.

Nalidixic acid Category C. No adverse effects reported.

Naloxone Category B. No adverse effects reported.

Naltrexone Category C. Embryocidal in rats and rabbits.
Human data are lacking. Concern is
warranted regarding potential long-term
behavioral effects based on results of animal
studies.

Naproxen Category B; category D if given near term.
May cause closure of ductus arteriosus, with
resulting pulmonary hypertension of
newborn. Avoid use near term.

Neomycin Category C. No fetal malformations reported.
May cause ototoxicity, which has been
reported with use of other aminoglycosides.

Neostigmine Category C. No fetal malformations reported.

Niacin/niacinamide Category A for RDA doses; category C for
doses above the RDA and for doses used to
treat lipid disorders. No adverse effects
reported.

Nicardipine Category C. No adverse effects in treating
hypertension during pregnancy, except a
lower birth weight in the nicardipine group in
1 study.

Nicotine Category X. May cause dose-related low birth
weight, decreased placental blood flow,
increased risk of stillborn or neonatal death,
and SIDS.

Nifedipine Category C. Experience limited. Severe
adverse effects when combined with
magnesium sulfate. Causes fetal hypoxemia
and acidosis in pregnant rhesus monkeys. Try
standard therapy first for severe hypertension.

Nitrofurantoin Category B. No adverse effects reported. May
theoretically cause hemolysis if given near
term in patient with G6PD deficiency.

Nitroglycerin Category C. No adverse effects reported. Data
limited, especially with first-trimester use.

Nitroprusside Category C. May cause fetal bradycardia.
Avoid prolonged use.

Nonoxynol-9/
octoxynol-9
Category C. Vaginal spermicides do not pose
a risk of congenital malformations.

Norethindrone Category X. May cause masculinization of
female infants.

Norethynodrel Category X. May cause masculinization of
female infants.

Norfloxacin Category C. Not a risk of major
malformations. Use caution in pregnancy,
especially during first trimester. Best to avoid
use in pregnancy and use a safer alternative.

Nortriptyline Category D. May cause fetal malformations,
but confirmation needed. May cause urinary
retention in newborn.

Novobiocin Category C. No adverse effects reported, but
may cause hyperbilirubinemia if used near
term.

Nystatin Category C. No adverse effects reported.

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Alphabet O: ShowHide

Octreotide Category B. Not a teratogen in animals.
Normal outcome in 4 human pregnancies.
Does cross the placenta. Data too limited to
assess safety.

Oleandomycin Category C. No adverse effects reported.

Omeprazole Category C. No adverse effects reported in 20
infants of mothers given omeprazole the night
before C-section. Teratogenic risk probably
low. Dose-related gastric tumors occurred in
rats given omeprazole. Avoid if possible,
especially in first trimester.

Ondansetron Category B. No adverse effects reported.

Oral contraceptives See Contraceptives, oral.

Oxacillin Category B. No adverse effects reported.

Oxazepam Category C. No adverse effects reported.

Oxprenolol Category D. May cause bradycardia and
hypotension in infants exposed near term.
Carefully monitor blood pressure and heart
rate.

Oxtriphylline Category C. No adverse effects reported.

Oxycodone Category B for therapeutic doses; category D
for prolonged use of high doses. May cause
withdrawal syndrome and respiratory
depression. No congenital malformations
reported.

Oxymetazoline Category C. Does not pose risk when
administered at recommended frequency to
healthy patient. High dose and frequency
higher than recommended may cause
persistent late fetal heart rate decelerations.

Oxymorphone Category B for therapeutic doses; category D
for prolonged use of high doses. May cause
withdrawal syndrome and respiratory
depression. No congenital malformations
reported.

Oxytetracycline Category D. Tetracyclines should be avoided
during pregnancy because they may cause
adverse effects, including yellow staining of
teeth, inhibition of bone growth, maternal
liver toxicity, and congenital defects.

Alphabet P: ShowHide

Pancuronium Category C. No data on use in early
pregnancy. Has been administered to mother
at C-section and to fetus during last half of
pregnancy without harm to fetus.

Pantothenic acid Category A for RDA doses; category C for
excessive doses. No adverse effects reported.

Paraldehyde Category C. Easily diffuses across placenta
and may cause neonatal respiratory
depression when used at term.

Paramethadione Category D. Increased risk of spontaneous
abortion and other abnormalities, including
tetralogy of Fallot, mental retardation, and
failure to thrive.

Paregoric Category B for therapeutic doses; category D
for prolonged use of high doses. May cause
withdrawal syndrome and respiratory
depression. No congenital malformations
reported.

Parenteral nutrition See Intravenous fat emulsion.


Paroxetine Category C. May cause withdrawal. Also, see
Fluoxetine.

Penicillamine Category D. May cause connective tissue
abnormalities (cutis laxa).

Penicillin G/penicillin
G benzathine/penicillin
V
Category B. Association with adverse effects
very unlikely.

Penicillin G procaine Category B. Association with congenital
malformations unlikely.

Pentamidine Category C. Aerosolized pentamidine 300 mg/
month in 15 women in second and third
trimesters had no adverse effects on fetus or
newborn.

Pentazocine Category B for therapeutic doses; category D
for prolonged use of high doses. May cause
withdrawal syndrome and respiratory
depression. No congenital malformations
reported.

Pentobarbital Category D. May cause withdrawal syndrome
and hemorrhage in newborn.

Pentoxifylline Category C. Possibly associated with
congenital defects, but other factors may be
involved.

Permethrin Category B. No adverse effects reported.
Recommended by CDC as one treatment for
pubic lice in pregnant women.

Perphenazine Category C. No adverse effects reported.

Phenacetin Category B. May cause fetal malformations
(musculoskeletal malformations and kidney
and adrenal anomalies), but confirmation
needed.

Phenazopyridine Category B. No adverse effects reported.

Phencyclidine (PCP) Category X. May cause dysmorphic features,
nystagmus, hypertonicity, respiratory distress,
and withdrawal syndrome.

Phenelzine Category C. May cause fetal malformations.

Pheniramine Category C. First-trimester use possibly
associated with fetal malformations;
confirmation is needed. Increased risk of
retrolental fibroplasia in premature infants
exposed to antihistamines during last 2 weeks
in utero.

Phenobarbital Category D. May cause withdrawal
syndrome, hemorrhagic disease in newborn,
major and minor fetal malformations, and
neurodevelopmental problems. Use at lowest
possible level to control seizures.

Phenylephrine Category C. Fetal malformations reported,
but confirmation needed. May cause
constriction of uterine vessels.

Phenylpropanolamine Category C. May cause constriction of uterine
vessels. May also cause malformations, but
confirmation needed.

Phenytoin Category D. May cause fetal hydantoin
syndrome (craniofacial [broad nasal bridge,
low-set hairline, short neck, and
microcephaly]; limbs [hypoplasia of nails and
distal phalanges]; impaired growth; and many
other abnormalities). May also cause tumors
and hemorrhage in newborn at delivery.

Phytonadione Category C. No adverse effects reported.

Pindolol Category D. May cause bradycardia and
hypotension in infants exposed near term.
Carefully monitor blood pressure and heart
rate. May cause IUGR.

Piperacillin Category B. No adverse effects reported.

Piperazine Category B. Adverse effects unlikely.
Pneumococcal vaccine Category C. No adverse effects reported;
however, use during pregnancy for high-risk
patients only.

Poliovirus vaccine Category C. No adverse effects reported;
however, use during pregnancy for patients
with high risk of exposure only.

Polymyxin B Category B. No adverse effects reported.

Potassium chloride/
citrate/acetate/gluconate
Category A. No adverse effects reported.
Potassium iodide Category D. May cause hypothyroidism and
goiter with prolonged use; however, 10-day
preparation for thyroid surgery is safe.
Povidone iodine Category D. Topical use may result in
significant absorption of iodine, resulting in
transient hypothyroidism with goiter in
newborn.

Pravastatin Category X. Contraindicated in pregnancy.

Prazosin Category C. No adverse effects reported.

Prednisone/
prednisolone
Category C (Category D in first trimester).
May cause immunosuppression and cataracts;
carries small risk of fetal malformations such
as orofacial clefts.

Primaquine Category C. No adverse effects reported. May
theoretically cause hemolysis if given near
term in patients with G6PD deficiency.

Primidone Category D. Possible risk of fetal
malformations similar to those associated
with phenytoin and of tumors and
hemorrhage of newborn at birth.

Probenecid Category C. No adverse effects reported.

Procainamide Category C. Not associated with congenital
anomalies or adverse fetal effects.

Procarbazine Category D. May cause fetal malformations
and low birth weight.

Prochlorperazine Category C. Fetal malformations reported
rarely.

Promazine Category C. Fetal malformations reported
rarely.

Promethazine Category C. May cause respiratory depression
when given at term (controversial).

Propantheline Category C. No adverse effects reported.

Propofol Category B. When used during C-section,
most studies show no difference in Apgar
scores of infants exposed to propofol.

Propoxyphene Category C. May cause fetal malformations
and has caused neonatal withdrawal
syndrome.

Propranolol Category D. May cause low birth weight,
fetal depression at birth, prolonged labor,
neonatal hypoglycemia, hypotension, and
bradycardia. Carefully monitor blood
pressure, respirations, and heart rate for 24-48
h in infants exposed near term.

Propylthiouracil Category D. Fetal malformations reported,
but association with this drug unclear. May
cause reversible hypothyroidism and goiter in
infant. Drug of choice for treatment of
hypothyroidism during pregnancy.

Protamine Category C. No adverse effects reported.

Pseudoephedrine Category C. May cause minor fetal
malformations with first-trimester use.

Psyllium (Metamucil) Category B. Psyllium or another bulkproducing
laxative is preferred if laxative
needed during pregnancy.

Pyrantel pamoate Category C. No adverse effects reported.

Pyrethrins with
piperonyl butoxide
Category C. No adverse effects reported.

Pyridostigmine Category C. May cause premature labor when
given near term.

Pyridoxine Category A. Probably does not cause fetal
malformations.

Pyrilamine Category C. May cause fetal malformations
and benign tumors. Increased risk of
retrolental fibroplasia in premature infant
exposed to antihistamines during last 2 weeks
in utero.

Pyrimethamine Category C. Probably does not cause birth
defects. Administer with folinic acid or folic
acid supplementation, especially during first
trimester to avoid birth defects.

Pyrvinium pamoate Category C. No adverse effects reported.

[Forte]

Alphabet Q: ShowHide

Quinacrine Category C. May cause fetal malformations
with first-trimester use.

Quinidine Category C. Considered relatively safe for
fetus. High doses have oxytocic properties
and may cause abortion.

Quinine Category X. Has caused malformations of
limbs, CNS, heart, and GI tract as well as
deafness and other abnormalities. Avoid
during pregnancy.

Alphabet R: ShowHide

Rabies immune
globulin
Category B. No adverse effects reported.
Ranitidine Category B. Not a major teratogen.

Reserpine Category C. Nasal discharge, cyanosis,
hypothermia, lethargy, and anorexia have
occurred when used near term.

Ribavirin Category X. Teratogenic in animals. No
abnormalities seen, however, in 1 human
exposure reported. Avoid in pregnancy.

Rifampin Category C. Probably not a teratogen. May
cause hemorrhagic disease of newborn;
prevent with vitamin K administration.

Ritonavir Category B. If indicated, do not withhold
during pregnancy (with the possible
exception of first trimester) because the
benefit to HIV-positive mother probably
outweighs the unknown risk to the fetus.

Rubella vaccine Category X. This live virus vaccine should
not be used during pregnancy because of risk
of congenital rubella syndrome.

Alphabet S: ShowHide

Scopolamine Category C. May cause tachycardia, fever,
and lethargy when given to mother during
labor.

Secobarbital Category D. May cause hemorrhagic disease
of newborn; prevent with vitamin K
administration. May cause withdrawal.

Selegiline Category C. Limited data. No teratogenesis
reported. Avoid, if possible, until more data
available.

Selenium sulfide Category C. No adverse effects reported.

Senna Category C. No adverse effects reported.

Simethicone Category C. No adverse effects reported.

Sodium iodide (131I) Category X. Has caused fetal malformations,
damage to fetal thyroid gland, and
hypothyroidism.

Sodium polystyrene
sulfonate (Kayexalate)
Category C. No adverse effects reported.

Spectinomycin Category B. No adverse effects reported.

Spironolactone Category D. No adverse effects reported;
however, potential risk of antiandrogenic
effects.

Streptokinase Category C. No adverse effects reported.

Streptomycin Category D. May cause eighth cranial nerve
damage.

Succinylcholine Category C. Not teratogenic.

Sucralfate Category B. No adverse effects reported.

Sufentanil Category C (category D for prolonged use or
high doses). Not a significant risk. Doserelated
depression of fetus and newborn.

Sulfasalazine Category B (category D when administered
near term). May increase risk of kernicterus
when given near term.

Sulfonamides Category C (category D when administered
near term). May increase risk of kernicterus
when given near term.

Sulindac Category B; category D if used during last
trimester. No congenital anomalies reported.
May cause closing of ductus arteriosus in
utero, PPHN, and inhibition of labor.

[Forte]

Alphabet T: ShowHide

Tacrolimus Category C. May cause reversible
hyperkalemia, renal toxicity, IUGR, and
premature delivery.

Tamoxifen Category D. Avoid during pregnancy because
of toxicities reported in animals, increased
incidence of abortions, and possible human
teratogenicity. Ambiguous genitalia reported
in 1 female infant.

Temazepam Category X. Potential drug interaction
between temazepam and diphenhydramine
resulted in stillbirth. Avoid this combination.

Terbutaline Category B. May cause fetal tachycardia and
neonatal hypoglycemia.

Tetanus immune
globulin
Category B. No adverse effects reported.

Tetanus toxoid Category C. No adverse effects reported.

Tetracyclines Category D. Tetracyclines should be avoided
during pregnancy because they may cause
adverse effects, including yellow staining of
teeth, inhibition of bone growth, maternal
liver toxicity, and congenital defects.

Thalidomide Category X. Contraindicated. A potent
teratogen involving limbs, skeleton, head,
face, eyes, ears, tongue, teeth, CNS, and
respiratory, cardiovascular, GU, and GI
systems.

Theophylline Category C. May cause transient tachycardia,
irritability, and vomiting at birth, especially if
mother's serum concentrations above
therapeutic range. No congenital defects
reported. Theophylline withdrawal with
apneic spells responsive to theophylline
therapy reported.

Thiabendazole Category C. No adverse effects reported, but
data limited.

Thiethylperazine Category C. Do not use during pregnancy
because of risk of fetal malformations.

Thioguanine Category D. May cause fetal malformations
and chromosomal abnormalities.

Thioridazine Category C. Probably safe for use in
pregnancy.

Thiotepa Category D. No adverse effects reported, but
data limited.

Thiothixene Category C. No information available.

Thyroid extract Category A. Probably safe for use in
pregnancy.

Ticarcillin Category B. No adverse effects reported.

Timolol Category D. May cause bradycardia and
hypotension in infants exposed near term.
Carefully monitor blood pressure and heart
rate.

Tobacco Category X. Dose-related risk of low birth
weight, decreased placental blood flow,
decreased fetal breathing movements,
stillbirth, neonatal death, and SIDS.

Tobramycin Category D. No congenital defects reported.
Potentiation of magnesium sulfate-induced
neuromuscular weakness. Monitor infant for
ototoxicity because this has occurred with
other aminoglycosides (eg, kanamycin and
streptomycin).

Tolazamide Category C. May cause prolonged neonatal
hypoglycemia when given near term.

Tolazoline Category C. May cause fetal malformations.

Tolbutamide Category C. May cause prolonged neonatal
hypoglycemia when given near term.

Tolmetin Category C; category D if given near term.
No congenital anomalies reported. May cause
closing of ductus arteriosus in utero, PPHN,
and inhibition of labor.

Tranylcypromine Category C. May cause fetal malformations.

Tretinoin Category D. When used topically, teratogenic
risk thought to be minimal.

Triamterene Category D. No adverse effects reported.

Trifluoperazine Category C. Probably safe for use in
pregnancy.

Trihexyphenidyl Category C. May cause congenital defects.

Trimeprazine Category C. Has been associated with
congenital defects, but confirmation needed.

Trimethadione Category D. Causes adverse effects on fetus,
including IUGR, mental and physical
retardation, impaired hearing, cardiac defects,
abnormally set ears, oral clefts, fetal demise,
and GU, skeletal, and other abnormalities.
Use other, safer anticonvulsants to treat petit
mal.

Trimethaphan Category C. No adverse effects reported.

Trimethobenzamide Category C. May cause congenital defects
and extrapyramidal dysfunction in neonate.

Trimethoprim Category C. Folate antagonist, so there is risk
of fetal malformations.

Tripelennamine Category B. No adverse effects reported.

Alphabet U: ShowHide

Urokinase Category B. No adverse effects reported.

Ursodiol Category B. No adverse effects reported.

Alphabet V: ShowHide

Valproic acid Category D. Increased risks of neural tube
defects and defects of head, face, digits, GU
tract, and mental and physical growth.

Vancomycin Category B. No reports of congenital defects.

Vasopressin Category B. No fetal malformations reported.
May cause uterine contractions (infrequent).

Verapamil Category C. May cause decreased uterine
blood flow, hypotension, and fetal
bradycardia.

Vidarabine Category C. Insufficient data available.

Vincristine Category D. Congenital defects may occur.

Vitamin A Category A (category X with doses above
RDA). Excessive doses are teratogenic as is
marked maternal vitamin A deficiency.

Vitamin B12 Category A. No adverse effects reported.

Vitamin C Category A. No reports directly link this
vitamin to congenital defects in humans. May
cause scurvy in infant if used at high doses
during pregnancy.

Vitamin D Category A for RDA dose; category D for
therapeutic and higher doses. High doses of
vitamin D teratogenic in animals but not in
humans. Because vitamin D raises calcium
levels, may be associated with supravalvular
aortic stenosis syndrome, which is often
associated with hypercalcemia of infancy.

Vitamin E Category A. No adverse effects reported.

Vitamin K See Phytonadione.

Alphabet W: ShowHide

Warfarin Category X. Significant risk of congenital
defects. May cause fetal warfarin syndrome
(hypoplastic, flattened nasal bridge; stippled
epiphyses; and other features, such as low
birth weight, eye defects, development
retardation, congenital heart disease, and
death). May also cause hemorrhage. If
anticoagulation is required during pregnancy,
heparin given at lowest effective dose is
probably safer choice.

Alphabet Z: ShowHide

Zidovudine Category C. Neonatal anemia may occur. No
pattern of birth defects found. If indicated,
benefits of maternal AZT treatment to the
infant outweigh the risks of AZT-induced
toxicity.

Zinc sulfate Category C. No information available.
Manufacturer recommends that
supplementation not be given during
pregnancy.
ACE, angiotensin-converting enzyme; BP, blood pressure; CDC, Centers
for Disease Control and Prevention; CMV, cytomegalovirus; CNS,
central nervous system; C-section, cesarean section; GI, gastrointestinal;
G6PD, glucose-6-phosphate dehydrogenase; GU, genitourinary. IUGR,
intrauterine growth retardation; PPHN, persistent pulmonary
hypertension of the newborn; RDA, recommended daily allowance; RDS,
respiratory distress syndrome; SIDS, sudden infant death syndrome; t-
PA, tissue-plasminogen activator.