Indomethacin
Ibuprofen
Diclofenac
Piroxicam
FDA PREGNANCY
CATEGORIES
B
NATURE OF EFFECT
ANTICOAGULANTS
DRUGS
Heparin
FDA PREGNANCY
CATEGORIES
C
Warfarin
ANTICONVULSANTS
DRUGS
FDA PREGNANCY
CATEGORIES
NATURE OF EFFECT
Heparin is usually the drug of choice for anticoagulation during
pregnancy, especially during the 1st trimester and intrapartum.
Warfarin may produce the Fetal Warfarin Syndrome or Warfarin
Embryopathy include nasal hypoplasia, neonatal respiratory
distress, axial skeleton and proximal femur are affected,
spontaneous abortion, stillbirths, CNS defects.
NATURE OF EFFECT
Phenytoin
Sodium
valproate
Carbamazepine
Phenobarbital
D
C
D
ANTIMICROBIAL DRUGS
DRUGS
Penicillins
Cephalosporins
Erythromycin
Aminoglycoside
s
Chloramphenic
ol
Tetracyclines
Fluoroquinolone
s
(e.g.
Ciprofloxacin,
Norfloxacin,
Ofloxacin)
Sulfonamides
(e.g.
Sulfadiazine )
FDA PREGNANCY
CATEGORIES
B
B
B
C
C
D; B (topical)
B (D at term)
NATURE OF EFFECT
Penicillins are without teratogenic risk.
Cephalosporins are thought to be without teratogenic risk.
Pregnant women are at increased risk for hepatotoxicity caused
by erythromycin estolate. There is no evidence that erythromycin
is harmful to the fetus.
Congenital hearing loss, deafness.
Risk for development of blood dyscrasias and aplastic anemia.
Particular caution should be exercised near term because the
Gray Baby syndrome is resulted.
Tetracyclines have been reported to cause congenital
abnormalities, particularly staining of the teeth and retardation of
the developing skeletal system.
Fluoroquinolones were shown to cause erosion of the cartilage
and other arthropathies in fetuses. These drugs should not be
used in pregnancy.
Co-Trimoxazole
Metronidazole
BM*
Do not use at term to avoid kernicterus in the new born and use
during pregnancy only if risk outweigh the benefits since folic
acid metabolism may be effected.
The manufacturer and the Centers for Disease Control (CDC)
consider metronidazole to be contraindicated during 1st trimester
in patients with trichomoniasis. Use for trichomoniasis during the
2nd and 3rd trimester may be acceptable if alternate therapies
have failed.
CARDIOVASCULAR DRUGS
DRUGS
FDA
PREGNANCY
CATEGORIES
NATURE OF EFFECT
-Amiodarone
-Digoxin
Antiarrhythmics
-Adrenergic blocking
agents
-Atenolol
-Pindolol
-Metoprolol
-Propranolol
Angiotensin-converting
enzyme (ACE)
inhibitors
(e.g. Captopril, enalapril,
lisinopril, fosinopril)
C
B
B
C
Calcium channel
blocking agents
(e.g. Nifedipine, diltiazem,
verapamil)
doses.
Diuretics
-Hydrochlorothiazide
(HCTZ)
-Furosemide
B
C
BM*
Isosorbide dinitrate
CM*
Hydralazine
Methyldopa
Reserpine
B (oral); C (IV)
C
GASTROINTESTINAL DRUGS
DRUGS
FDA
PREGNANCY
CATEGORIES
NATURE OF EFFECT
Antacid
-Magnesium hydroxide
-Aluminium hydroxide
-Sucralfate
Antiulcer
H2-blocker
-Cimetidine
-Famotidine
-Ranitidine
-Nizatidine
Proton-Pump Inhibitor
-Omeprazole
C
B
B
B
B
C
CM*
Laxative
-Bulk laxatives
(psyllium)
- Mineral oil
- Castor oil
Metoclopramide
C
X
B
FDA PREGNANCY
NATURE OF EFFECT
CATEGORIES
D
Neonatal depression, apnoeic spells, floppy baby syndrome
(muscular relaxation, poor sucking, disturbances in
thermoregulation and regurgitation), withdrawal symptom.
D
Neonatal depression, neonatal feeding difficulties, neonatal
bleeding, withdrawal symptom.
ANTIDIABETIC AGENTS
DRUGS
Sulfonylureas (e.g.
Chlorpropamide,
glyburide, glipizide)
Biguanides (e.g.
Metformin)
Insulin
FDA PREGNANCY
CATEGORIES
C
B
B
NATURE OF EFFECT
SEX HORMONE
DRUGS
FDA PREGNANCY
NATURE OF EFFECT
CATEGORIES
Diethyl Stilbestrol (DES)
X
DES causes a number of reproductive tract abnormalities in both
female and male offspring exposed in utero.
Estradiol
Progesterone
X
X ; B (oral capsules
per manufacturer)
RESPIRATORY DRUGS
DRUGS
Antitussives
-Codeine
-Dextromethorphan
FDA PREGNANCY
CATEGORIES
NATURE OF EFFECT
C (D if used for
prolonged periods
or in high dose at
term)
C
Bronchodilators
-Aminophylline
-Theophylline
C
C
BM*
-Terbutaline
MISCELLANEOUS
DRUGS
Smoking
Caffeine
Alcohol
Isotretinoin
Lithium
Corticosteriods
FDA PREGNANCY
NATURE OF EFFECT
CATEGORIES
X
Increased Perinatal Risk: Spontaneous abortion, Preterm birth,
Intrauterine growth restriction/small for gestation age 100 to 320
g. reduction in expected birthweight
Increased Postnatal Risk: Small head circumference; decreased
auditory, language and cognitive performance; low IQ; increased
incidence of asthma, bronchitis, pneumonia; increased risk of
sudden infant death syndrome.
Should be avoided High dose (>7 cups/day); low birth weight(<2,500 g.),
neurological impairment, growth retardation.
X
Fetal Alcohol Syndrome includes Intrauterine Growth Retardation
(IUGR), microcephaly, postnatal growth deficiency,
developmental delay, mental retardation and craniofacial
anomalies.
X
Isotretionin is potent teratogen (e.g. CNS, cardiac anomalies,
facial abnormalities, deafness and blindness)
D
Neonatal hypotonia, poor sucking power, diminished reflexes for
days.
C
When appropriate, corticosteroids can be administered by
aerosol inhalation or intrasynovial injection to minimize systemic
availability. Corticosteriods use during pregnancy may cause an
increased risk for maternal gestation diabetes, hypertension, and
excessive weight gain.
References
Barbara GW, Joseph TD, Terry LS, Cynthia WH. Pharmacotherapy Handbook. 2nd ed.
Stamford (CT): Appleton & Lange; 2000.
Charles FL, Lora LA, Morton PG, Leonard LL. Drug Information Handbook. 8th ed.
Hudson (OH):
Lexi-Comp; 2000-2001.
Gerald GB, Roger KF, Sumner JY. Drugs in Pregnancy and Lactation. 5th ed. Baltimore (MD): Lippincott
Williams & Wilkins; 1998.
Philip OA, James EK. Handbook of Clinical Drug Data. 8th ed. Stamford (CT): Appleton & Lange; 19971998.
Robert JB. Effects of Certain Prenatal Drugs on the Fetus and Newborn. Pediatrics in Review 2002 Jan; 23(1):
17-23.