The moment you realize you’re pregnant prompts a wave of emotions. Some people are overjoyed. Some are shocked. Some are scared.
We’re seeing more patients who are making an immediate decision based on these emotions – the decision to stop taking their medications when they find out they’re pregnant. Many of them tell us they were afraid that staying on the medication would harm the baby or cause a birth defect.
Every week there seems to be a new report in the media about medications causing birth defects. It’s understandable that pregnant women would be concerned or frightened. However, it can be dangerous to make the decision to stop taking a medication without guidance from a physician. In some cases, stopping the medication may do more harm than if you continue taking it. In this blog post, let’s discuss what you should do about your medications when you become pregnant and what factors we consider when we evaluate your options.
Weighing the risks of medication during pregnancy
About 90 percent of women take at least one medication during pregnancy, and 70 percent take at least one prescription medication, according to the Centers for Disease Control and Prevention.
There are dozens of medications available, and they’re all different. So it’s important to understand:
- What is the medication treating?
- What are the risks of not taking the medication?
- What are the risks to the baby if you continue taking the medication?
It truly is a balancing act. Here’s an example: If a woman has an artificial heart valve, she likely takes blood thinners to prevent clotting. Some blood thinners can cause birth defects, but if she stops the medication – without taking a replacement – it could lead to a life-threatening condition.
The same goes for a woman who is on medication to prevent seizures. If she decides to stop taking that medication when she gets pregnant, she may have a seizure that could endanger her pregnancy.
As with any decision like this, we weigh the risks in collaboration with the physician who prescribed the medication. What does research tell us about the risks of this medication? Are there any links to birth defects? How can we give ourselves the best chance for a healthy patient and a healthy baby?
Understanding the real risks of medication during pregnancy
Even when a woman doesn’t take any medication, 3 percent to 5 percent of all babies born in the United States will be born with a birth defect. It’s really a fairly high risk when you think about it – one out of every 20 or 30 babies will be affected.
Very few medications will lead to birth defects 100 percent of the time. Some prescription medications, however, increase the risk for birth defects. As you look at the numbers, it’s important to understand the absolute risk associated with the medication compared with the relative risk.
For example, a study may find that a medication doubles the relative risk of a certain birth defect. That statistic may seem jaw-dropping, but that could mean that the absolute risk of that birth defect goes from occurring in 1 in 1000 pregnancies to 1 in 500 pregnancies, which is still a pretty small risk. It’s important to understand the real numbers.
A recent, highly publicized study suggested that the use of certain antidepressant medications during the second and third trimester of pregnancy increases the risk of autism by 87 percent. However, the absolute risk seen in this study was still less than 1 percent.
Our goal is to balance fetal and maternal risk while understanding that the risk will never be zero. At the end of the day, we know there will be women who need to be on medications that may pose an increased risk to the baby.
To help make recommendations to patients, we rely on the labeling of prescription medications. In June 2015, a new labeling system designed to give doctors more information went into effect. The old system classified medications as Category A through D and X, based on existing knowledge – or lack of knowledge – on fetal risk. But because research is pretty limited on medications in pregnancy, the classifications frequently were not useful. The goal with the new system is to better help doctors and patients understand the risks of taking a specific medication during pregnancy and breastfeeding.
What medications should you stop taking when pregnant?
There are only a couple prescription medications that I would recommend stopping immediately if you become pregnant. These are acne medications that include a vitamin A derivative that has been directly linked to an increased risk of birth defects:
- Retinoic acid
And unlike stopping other medications, worsening of acne isn’t a significant threat to your immediate health.
If you are on these medications – or others that are known to be associated with an increased risk of birth defects – and are not pregnant, it’s important to use reliable contraception. These medications are frequently prescribed to women, and research suggests that only about 30 percent of young women had information about contraception documented when these medications were prescribed for them.
Any over-the-counter medications you’re taking when you become pregnant can be stopped until you meet with your Ob/Gyn. These kinds of medications (for allergies or acid reflux, for example) are frequently used for symptoms rather than conditions.
Decisions about any other medications should be made only after a discussion with your Ob/Gyn and the specialist you see for your specific condition. That way we can assess all the risks.
The best scenario: Plan ahead
The best time to switch your medication is before you become pregnant. Ideally, you would understand what medications you are taking and the implications they can have on a pregnancy. If necessary, we would transition you to a different medication prior to conception. It’s much easier to get used to a new medication before pregnancy.
That’s our hope, but of course, we know things don’t always work out that way. About half of all pregnancies in the United States are unplanned.
If you’re not sure how your prescription medication could affect a pregnancy, I’d encourage you to meet with your doctor.
Many times there are alternatives to the medications you are taking. We typically prescribe the medication that has proven to be most effective. When you’re pregnant, we may be willing to accept a medication that is slightly less effective but safer for you and your baby.
My advice: Temper your response if you become pregnant while you’re on a prescription medication, especially if it’s for high blood pressure, diabetes, seizures, or depression. Having these conditions under control during pregnancy leads to better outcomes for both you and the baby. Just give your Ob/Gyn a call to discuss possible changes you need to make during pregnancy.
Are you on prescription medication and hoping to get pregnant soon? Request an appointment with one of our Ob/Gyns to discuss your best course of action.