Mums-to-be & medications

All expectant mothers want the best for the baby growing inside them, but what if you get sick? Naomi Perks looks at the issues that apply to medications and their use during pregnancy

Certain forms of suffering go hand in hand with pregnancy. These “badges of pregnancy” include the well-known ailments of morning sickness, heartburn and then, of course, the delivery and everything that goes with that. But there is another type of suffering that we don't plan for, which comes from falling ill while we are expecting. Be it the common cold, allergies or even a headache, we're used to benefiting from modern medicine to make the suffering go away. However, once you're pregnant, the ability to just pop into the chemist for whatever ails you is no longer so simple. Thoughts of thalidomide babies from the late 1950s pop into our heads, and we run as far and fast from the chemist as we can. Just suck it up , we say to ourselves, it's for the baby . So instead of taking the medicine we suffer, all too often, needlessly.

Within this article I hope to introduce you to some of the language and issues that apply to medications and their use. So, if you do fall ill while pregnant, you will hopefully be a little less afraid and have some resources available to make an informed decision, and maybe even suffer a bit less.

The first thing to understand is that all therapeutic medications in Australia fall into one of seven categories, as defined by the Department Of Health And Ageing – Therapeutic Goods Administration (TGA). Medications range from category A, where research definitively suggests the drug will have no effect on the foetus and is perfectly fine to take while pregnant, to category X, where research clearly shows the drug is definitely not safe to take during pregnancy as it can cause irreversible damage to the foetus. In between categories A and X are B1, B2, B3, C and D. This is where things go a little grey and can require more information or consultation with a pharmacist before you are able to make a decision about whether to take it or not.

As you can imagine, pharmaceutical companies cannot test drugs on pregnant women so they must rely on extensive animal testing. Drugs in category B are most likely fine to take during pregnancy. However, because they may be newer to the market or have not been taken by a significant number of pregnant women, the drug manufacturers cannot unequivocally state that there will not be any unforeseen effects to the foetus.

Warwick Plunkett, the president of the Pharmaceutical Society Of Australia, explains, ‘Because the only human test is when the substance is out there, you may want to put a question mark on drugs in categories B where the research is not definitive, and evaluate taking them on a case by case basis.' Category B is broken down into three subcategories where, according the TGA, B3 is the only category that research indicates there is increased occurrence of foetal damage in animals, t he significance of which is considered uncertain in humans. While off-putting, this information should not be a show stopper. Before making a decision to take or not take the medication, you should discuss the issue in greater detail with your doctor and pharmacist. It is important to keep in mind that we may all react differently to medication and aggregate data may be misleading for your unique situation.

The ambiguity continues with the remaining two categories, C and D. According to Plunkett, ‘The administration of drugs in category C would also be evaluated per situation, as they are known to have some affect on the foetus, however it is not associated with long-term damage.' Finally, medication in category D will rarely be prescribed to a pregnant woman as the research is indicative that they have caused irreversible foetal damage. However, according to the TGA, these drugs are not absolutely contraindicated in pregnancy (for example anticonvulsants). And some medications are categorised here based on suspicion. Since we live in highly litigious times and pregnancies are fragile – birth defects and miscarriages are a natural part of the process, not solely caused by external factors – this is enough for pharmaceutical companies to scale back the availability of a drug for fear that if a complication did arise, the blame would be laid on them, resulting in lawsuits and a lot of negative press. As a result, companies err on the side of caution, restricting the availability to pregnant women. This is why having a good rapport with your pharmacist and doctor is so important.

Non-steroidal anti-inflammatory drugs, such as ibuprofen, provide an example of the ambiguities associated with the administration of medicine to pregnant women. Until writing this article I was under the impression that under no circumstance should a pregnant woman take ibuprofen. However, I have since discovered that while this category of drug is contraindicated in the third trimester as it may be linked with premature delivery or miscarriage and should not be taken after week 32, it may be fine to take during the second trimester if there is a medical requirement. The blanket statement on the label not to consume during pregnancy is there to protect the manufacturer, but with proper consultation it may turn out to be fine for you to use.

If you take nothing else from this article, if you are pregnant and deciding whether to take a medication (prescription or over-the-counter), you should seek the advice of a doctor and pharmacist as they are in the best position to provide you with all of the information you need. If you are still unsure or would like to discuss the issue further see the resources box for a number to call in your state or territory.

MY STORY

When Melissa, 34, mum to Olivia, three, and Piper, five months, began experiencing anxiety during her second pregnancy, she didn't want to take antidepressant medication because she was worried about her baby's safety.

Around six months after my first pregnancy, I was diagnosed with postnatal anxiety. I was off the medication when I fell pregnant the second time, but at about week 25 I started to feel anxious again. My doctor wanted to put me on Zoloft to help me cope. Of course, I didn't want to take anything, fearing that if I did it might harm the baby. My doctor explained that the drug was a category C and although considered safe it was not without complications. There was an increased risk that the baby would be unsettled and her chance of having respiratory issues in the first few days might also be greater. I battled with the decision for a few days, but my doctor really did a lot of research and explained that even the elevated risk of complications were minor compared to the stress that I was putting myself through. At the end of the day, Piper was born a very happy and settled baby. She did have to spend a couple of days in special care for respiratory problems, but so did my first child and I wasn't on any medication at that time. So it could have been the medication or it could have just been a coincidence. The key thing is that taking the medication helped me immensely. Piper is now five months, I'm still breastfeeding her and I am still on the medication. I am thankful that my doctor did so much research and really helped put me at ease.

Drugs safe to use in pregnancy

This list is taken from the Department Of Health And Ageing – Therapeutic Goods Administration website (tga.gov.au) and is a sampling of category A drugs by illness/disease. This is by no means an extensive list of medications that are safe to take during pregnancy. None of the below medications should be taken without prior consultation with a physician and pharmacist.

RESOURCES

USEFUL CONTACTS

• Mothersafe, NSW Phone 02 9382 6539 (Sydney) or 1800 647 848 (non-metropolitan areas).
• ACT Drug Information Service Phone 02 6244 3333.
• The Royal Women's Hospital Victoria Phone 03 8345 2000 or visit thewomens.org.au.
• Monash Medical Centre Phone 03 9594 2361.
• The Women's And Children's Hospital Phone 08 8161 7222 or visit wch.sa.gov.au.
• Women's & Children's Health Services Phone 08 9340 2723 or wchs.health.wa.gov.au.
• National Prescribing Service Medicines Line Phone 1300 633 424 or visit nps.org.au.
• Organisation Of Teratology Information Specialists (OTIS) Visit otispregnancy.org.
• Department Of Health And Ageing – Therapeutic Goods Administration Visit tga.gov.au.

This article is brought to you by My Child Magazine.

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