Pregnancy and Pills
New research finds prescriptions may be safer than you think
Ask any pregnant woman and she'll tell you she'd rather swallow a live goldfish than a prescription pill. Her obstetrician likely shares the sentiment--and with good reason. Both doctors and patients are haunted by the memory of babies born severely deformed when their mothers took thalidomide as a sedative in the late 1950s. And in 1971, diethylstilbestrol, or DES, was linked to a rare form of vaginal cancer in the daughters of women who had taken the medication while pregnant. The result of these scares has been a widespread reluctance by doctors to prescribe their expectant patients so much as a cough drop.
Yet when life-threatening or chronic diseases affect pregnant women, abstaining from pharmaceutical drugs can often be more risky to a developing fetus than taking medicine to treat the illness. And while caution is still the watchword when it comes to pregnancy and drugs, new research indicates that many medications aren't nearly as dangerous to unborn children as doctors once thought.
Knowledge gap. Chemotherapy, the administration of toxic drugs that kill cancer cells, is the latest example of a treatment that is surprisingly safe in pregnancy. A study in last month's Journal of Clinical Oncology looked at 24 pregnant women with breast cancer who received an average of four cycles of chemotherapy after a malignant tumor was removed. All of the women gave birth to healthy babies. The oldest of the children studied is now 10 years old, and so far, says lead investigator Richard Theriault of the University of Texas, "all signs point to normal."
In addition to the breast cancer findings, studies published in the New England Journal of Medicine and the Journal of the American Medical Association in the past two years show that antidepressants such as Prozac appear to be safe for use by pregnant women. The researchers conclude that there is no evidence of physical or cognitive abnormalities in children exposed to certain antidepressants when their mothers were pregnant. "Most common drug exposures do not pose a great risk to a fetus," says Lewis Holmes, head of the pediatrics service of the Genetics and Teratology Unit at the University of Massachusetts. "But most doctors don't know that."
Doctors are in the dark largely because they do not have good information on the safety of drugs for expectant mothers. Before the thalidomide debacle, the placenta had been viewed as a protective barrier between the mother and the fetus that allowed only good things to reach the baby. But after the thalidomide cases and other episodes proved that the placenta was penetrable, the Food and Drug Administration banned pharmaceutical research involving women of childbearing age, for fear of causing more reproductive harm.
The fear filtered down to physicians treating pregnant women with pre-existing conditions. Wendy Hennessy, of Huntley, Ill., has panic disorder, a condition treatable by antidepressant drugs. When her illness flared up during her first pregnancy three years ago, her psychiatrist refused to prescribe any medication. "Once I got pregnant," she says, "he wanted nothing to do with me."
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