Pregnancy and Pills
New research finds prescriptions may be safer than you think
Aging mothers. Recognizing the need to correct the situation, the FDA reversed its position in 1993 when it began requesting information from drug companies on how experimental drugs work in women. That information is seen as increasingly critical: As more and more women choose to have babies after age 40, the number of women who become pregnant with underlying medical conditions (currently 1 in 10) is expected to rise.
But seven years later, the system for collecting this vital medical information remains severely limited. Drugs are rated according to a system of alphabetical categories that in most cases only serve to tell the doctor that the safety of a drug isn't known. Adding to the uncertainty are drug companies that openly discourage contact between their products and pregnant women. Merck, for example, is currently running a television ad for its baldness drug Propecia that tells expectant mothers they literally should not touch crushed or broken tablets.
Experts in the field of teratology (the study of birth defects) say drug companies are sometimes too cautious. "Talk about hype," says Kathy Johnson, coordinator of the California Teratogen Information Service and Clinical Research Program. "This just heightens fear. Someone is going to touch [a Propecia pill] and is going to abort her baby over it."
Animal studies over the years have helped point researchers to potential problems with drugs in pregnant women, but they don't tell the whole story. And clinical trials on expectant mothers are considered unethical. So doctors rely on case reports of pregnant women who have used medications in the past. "When we get enough of that anecdotal experience [that a drug is safe], then people will start using it," says Dr. John Gianopoulos of Loyola University Medical Center in Chicago. For example, 30 years ago a woman with a seizure disorder would have been advised against pregnancy because both the seizures and the medication to treat the disorder were thought to be equally harmful for the fetus. But now, based on years of case reports, doctors know that the risk of birth defects from anticonvulsant drugs is relatively low.
That was good news for Lori Kim of South Orange, N.J., who suffers from a seizure disorder. She and her husband, a doctor, agreed that during her pregnancy she would continue using Tegretol, the medication that had kept her seizure free for years. She had a healthy baby, but only after an ultrasound in the 26th week brought a scare about birth defects.
But while fear of deformities may tempt a woman to stop taking her medication, diseases that are left untreated may do as much harm to a developing baby as a drug would. Asthma that goes untreated can deprive a fetus of oxygen, which can lead to low birth weight or even fetal death. A diabetic who does not control her blood sugar increases her odds of a problem pregnancy to 30 percent.
Mary Beth Barnes of Pasadena, Md., has had diabetes since she was 11 years old. Early in her first pregnancy, she injected herself with insulin but her blood sugar was not well managed. As a result, she says, her baby was born with a heart defect and died one month later. In later pregnancies, Barnes was vigilant about controlling her disease: She used an insulin pump to regulate her intake of the drug, and she ate meals and exercised at the same time every day. She is now the mother of three healthy boys.
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