The Cleveland Clinic Foundation A Controlled studies in women fail to demonstrate a risk to the fetus in the first trimester,

and the possibility of fetal harm appears remote. B Either animal studies do not indicate a risk to the fetus and there are no controlled studies in pregnant women, or animal studies have indicated fetal risk, but controlled studies in pregnant women failed to demonstrate a risk. C Either animal studies indicate a fetal risk and there are no controlled studies in women, or there are no available studies in women or animals. D There is positive evidence of fetal risk, but there may be certain situations where the benefit might outweigh the risk (lifethreatening or serious diseases where other drugs are ineffective or carry a greater risk). X There is definite fetal risk based on studies in animals or humans or based on human experience, and the risk clearly outweighs any benefit in pregnant women WHO juga memiliki penggolongan obat untuk kehamilan yang lebih mudah dipahami oleh awam: Golongan Arti

A Proved safe B Not proven risk C Possible risk D Proven risk X Do not use Table 2: Drugs Used in the Management of Nausea and Vomiting During Pregnancy Drug Pregnancy Risk Category Metoclopramide (Reglan ) B Cyclizine (Marezine) B Ondansetron (Zofran) B Promethazine (Phenergan ) C Prochlorperazine (Compazine) C Chlorpromazine (Thorazine ) C Table 3: Drugs Used for the Management of Hypertension during Pregnancy Drug Class Example Pregnancy Comment Risk Category Central Methyldopa (Aldomet) C Drug of choice by the agonist NHBPEP* Working Group Blockers Atenolol (Tenormin) Metoprolol (Lopressor) Labetolol ( and )(Normodyne) C C C

Calcium antagonists

Diltiazem (Cardizem CD, Dilacor XR, C Trizac) Verapamil (Calan, CoveraHS, Verelan) C

Potential synergism with magnesium sulfate may lead to precipitous hypotension

ACE inhibitors

Captopril (Capoten)

Fetal abnormalities including death, can be caused, and should not be used in pregnancy

Angiotensin IIReceptor blockers

Enalapril (Vasotec) Lisinopril (Prinivil, Zestril) Losarten (Cozaar) Valsarten (Diovan)

D D D D

Diuretics

Bumetanide (Bumex) Frosemide (Lasix) Hydrochlorothiazide (HydroDIURIL) Indapamide (Lozol) Spironolactone (Aldactone) Triamterine (Dyrenium)

D C C B B D B

Recommended for chronic hypertension if prescribed before gestation or if patients are saltsensitive. Not recommended in preclampsia

Table 4: Drugs Used in the Treatment of Migraines during Pregnancy Drug Pregnancy Risk Category Acetominophen (Tylenol ) B Ibuprofen (Motrin) B Ergotamine tartrate (Ergotrate ) D Dihydroergotamine (Migranal) X Prochlorperazine (Compazine ) C Sumatriptan (Imitrex) C Naratriptan (Amerge) C Zolmitriptan (Zomig ) C Tabel 5. Obat yang beredar di Indonesia dan penggolongan serta kemungkinan ESO Obat Accupril (quinopril HCl) Alupent (metaproterenol sulfat) Golongan C C Kemungkinan ESO/saran Resiko pada trimester 2 & 3

Amaryl (glimepirid) Amoksil (amoksisilin) ampicillin Android / andro gel (testosterone) Anusol HC/supositoria aspirin Bactrim (cotrimoksasol) Ergotamin cafein captopril ciprofloksasin deksametason Dietil stilbesterol/DES Flagyl (metronidasol) Lipitor Kontrasepsi oral Tamiflu (oseltamivir fosfat)=obat flu burung Tetrasiklin Voltaren (natrium diklofenak) Vitamin A dosis tinggi

C B B X C ? C X C/D C ? X B X X C B B B

Dapat menyebabkan penurunan kadar gula darah bayi yang baru lahir (syok hipoglikemi) Keamanan belum terbukti Gunakan bila benarbenar membutuhkan Mengakibatkan maskulinisasi pada bayi perempuan yang baru lahir Jangan digunakan secara berlebihan/lama Hindari pemakaian pada trimester 3, menunda kelahiran Hindari pada trimester 1, mengganggu metabolisme asam folat Jangan digunakan Hindarkan selama kehamilan Gunakan bila benarbenar membutuhkan Menyebabkan gangguan fungsi kelenjar adrenalin pada bayi Menyebabkan kanker organ reproduksi bayi Jangan digunakan pada trimester 1 Jangan digunakan Jangan digunakan Menunggu hasil penelitian lanjut Menyebabkan kerapuhan gigi dan pewarnaan gigi bayi Tidak boleh digunakan pada trimester 3, menunda persalinan Menyebabkan tak terbentuknya langit langit bayi