Some Drugs That Can Cause Problems During Pregnancy*
Some Drugs That Can Cause Problems During Pregnancy*
Examples | Possible Problems |
|---|---|
Antianxiety drugs | |
Benzodiazepines Misuse of Antianxiety Medications and Sedatives Antianxiety and sedative medications are prescription drugs used to relieve anxiety and/or help with sleep, but their use can result in dependency and a substance use disorder. Using prescription... read more (such as diazepam, alprazolam, or lorazepam) | When the drug is taken late in pregnancy, very slow breathing or a withdrawal syndrome (causing irritability, shaking, and exaggerated reflexes) in the newborn |
Antibiotics | |
Aminoglycosides Aminoglycosides Aminoglycosides are a class of antibiotics used to treat serious bacterial infections, such as those caused by gram-negative bacteria (especially Pseudomonas aeruginosa). Aminoglycosides... read more (such as amikacin, gentamicin, neomycin, streptomycin, and tobramycin) | Damage to the fetus's ear (ototoxicity), resulting in deafness |
In women or fetuses with G6PD deficiency Genetic Makeup and Response to Drugs , the breakdown of red blood cells Possibly gray baby syndrome (a serious and often fatal disorder) | |
Fluoroquinolones Fluoroquinolones Fluoroquinolones are a class of broad-spectrum antibiotics that are used to treat a variety of infections. Fluoroquinolones include the following: Ciprofloxacin Delafloxacin Gemifloxacin read more (such as ciprofloxacin, ofloxacin, levofloxacin, and norfloxacin) | Possibility of bone and joint abnormalities (seen only in animals) |
In women or fetuses with G6PD deficiency, the breakdown of red blood cells | |
In women or fetuses with G6PD deficiency, the breakdown of red blood cells | |
Sulfonamides Sulfonamides Sulfonamides are a class of antibiotics that are effective against many and . Some sulfonamides are applied directly to the skin (topically) to treat burns and skin, vaginal, and eye infections... read more (such as sulfasalazine and trimethoprim- sulfamethoxazole) | When the drugs are given late in pregnancy, jaundice and, without treatment, brain damage ( kernicterus Complications of jaundice With sulfasalazine, much less risk of problems In women or fetuses with G6PD deficiency, the breakdown of red blood cells |
Slowed bone growth, permanent yellowing of the teeth, and increased risk of cavities in the child Occasionally, liver failure in the pregnant woman | |
Defects of the brain and spinal cord Overview of Brain and Spinal Cord Birth Defects Birth defects of the brain and spinal cord can occur in early or late fetal development. Typical symptoms include intellectual disability, paralysis, incontinence, or loss of sensation in some... read more (neural tube defects), such as spina bifida | |
Factor Xa inhibitors such as rivaroxaban, apixaban, or edoxaban | Possible risk of bleeding in the pregnant woman or fetus |
Heparin | Thrombocytopenia Overview of Thrombocytopenia Thrombocytopenia is a low number of platelets (thrombocytes) in the blood, which increases the risk of bleeding. Thrombocytopenia occurs when the bone marrow makes too few platelets or when... read more |
Warfarin | Birth defects Overview of Birth Defects , intellectual disability, cataracts, and other problems with the eyes in the fetus Bleeding problems in the fetus and the pregnant woman |
Antidepressants | |
Bupropion | Harmful effects seen in animals, but conflicting evidence for risk of birth defects in newborns |
Citalopram | When citalopram is taken during the 1st trimester, increased risk of birth defects (particularly heart defects) When citalopram is taken during the 3rd trimester, discontinuation syndrome (which includes dizziness, anxiety, irritability, fatigue, nausea, chills, and muscle aches) and persistent pulmonary hypertension of the newborn Persistent Pulmonary Hypertension of the Newborn Persistent pulmonary hypertension of the newborn is a serious disorder in which the arteries to the lungs remain narrowed (constricted) after delivery, thus limiting the amount of blood flow... read more (the arteries to the lungs remain narrowed after delivery, limiting blood flow to the lungs and thus the amount of oxygen in the bloodstream) |
Escitalopram | When escitalopram is taken during the 3rd trimester, discontinuation syndrome and persistent pulmonary hypertension of the newborn |
Fluoxetine | When fluoxetine is taken during the 3rd trimester, discontinuation syndrome and persistent pulmonary hypertension of the newborn |
Paroxetine | When paroxetine is taken during the 1st trimester, increased risk of birth defects, particularly heart defects When the drug is taken during the 3rd trimester, discontinuation syndrome and persistent pulmonary hypertension of the newborn |
Sertraline | When sertraline is taken during the 3rd trimester, discontinuation syndrome and persistent pulmonary hypertension of the newborn |
Venlafaxine | When venlafaxine is taken during the 3rd trimester, discontinuation syndrome |
Antiemetic drugs (used to relieve nausea) | |
Doxylamine and pyridoxine (vitamin B6) | No increased risk of birth defects |
Meclizine | Birth defects seen only in animals |
Ondansetron | No conclusive evidence of birth defects in animals When ondansetron is taken during the 1st trimester, possible risk of congenital heart disease Overview of Heart Defects About one in 100 babies is born with a heart defect. Some are severe, but many are not. Defects may involve abnormal formation of the heart's walls or valves or of the blood vessels that enter... read more |
Promethazine | No conclusive evidence birth defects in animals Possible risk of bleeding in the newborn |
Antifungal drugs | |
Amphotericin B | No increased risk of birth defects, but no well-designed studies done in pregnant women |
Fluconazole | No increased risk of birth defects after a single low dose When high doses are taken for most or all of the 1st trimester, increased risk of birth defects, such as abnormalities in the heart, face, skull, ribs, and limbs |
Miconazole | No increased risk of birth defects when applied to the skin When taken by mouth, side effects in animal studies When inserted into the vagina, no increased risk of birth defects |
Terconazole | No increased risk of birth defects When inserted into the vagina, no increased risk of birth defects |
Antihistamines | |
Loratadine | Possibly in sons, a birth defect of the urethra in which the opening of the urethra is in the wrong place on the penis ( hypospadias Hypospadias Birth defects of the genitals can involve the penis, scrotum, or testes (testicles) in boys and the vagina and labia in girls. Sometimes the genitals are ambiguous, that is, not clearly female... read more |
Meclizine | Birth defects in rodents but no proof of this effect in humans |
Antihypertensive drugs | |
Aldosterone antagonists Aldosterone antagonists Heart failure is a disorder in which the heart is unable to keep up with the demands of the body, leading to reduced blood flow, back-up (congestion) of blood in the veins and lungs, and/or... read more (drugs that block the action of the hormone aldosterone), such as spironolactone and eplerenone | With spironolactone, possible development of feminine characteristics in male fetuses With eplerenone, no increased risk of birth defects in animals, but no well-designed studies done in pregnant women |
When the drugs are taken late in pregnancy, kidney damage in the fetus, a reduction in the amount of fluid around the developing fetus ( amniotic fluid Problems With Amniotic Fluid Amniotic fluid is the fluid that surrounds the fetus in the uterus. The fluid and fetus are contained in membranes called the amniotic sac. Problems with amniotic fluid include Too much amniotic... read more ), and defects of the face, limbs, and lungs | |
When some beta-blockers are taken during pregnancy, a slowed heart rate, a low blood sugar level, and possibly inadequate growth of the fetus ( growth restriction Small-for-Gestational-Age (SGA) Newborns A newborn who weighs less than 90% of newborns of the same gestational age at birth (below the 10th percentile) is considered small for gestational age. Newborns may be small because their parents... read more ) and preterm birth Preterm (Premature) Newborns A preterm newborn is a baby delivered before 37 weeks of gestation. Depending on when they are born, preterm newborns have underdeveloped organs, which may not be ready to function outside of... read more Low blood pressure in the mother | |
When calcium channel blockers are taken during the 1st trimester, possibly birth defects of the fingers and/or toes When calcium channel blockers are taken later in pregnancy, inadequate growth of the fetus | |
A decrease in the levels of oxygen, sodium, and potassium and in the number of platelets in the fetus's blood Inadequate growth of the fetus | |
Antipsychotic drugs | |
Haloperidol | Harmful effects in animals When haloperidol is taken during the 1st trimester, possibly birth defects in the limbs When haloperidol is taken during the 3rd trimester, increased risk of the following:
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Lurasidone | No evidence of harmful effects in animals When lurasidone is taken during the 3rd trimester, increased risk of the following:
|
Olanzapine | Harmful effects in animals When olanzapine is taken during the 3rd trimester, increased risk of the following:
|
Risperidone | Harmful effects in animals No evidence of increased risk of birth defects, but no well-designed studies done in pregnant women When risperidone is taken during the 3rd trimester, increased risk of the following:
|
Carbamazepine | Increased risk of birth defects, including neural tube defects (such as spina bifida) Bleeding problems in the newborn (hemorrhagic disease of the newborn), which can be prevented if pregnant women take vitamin K by mouth every day for a month before delivery or if the newborn is given an injection of vitamin K soon after birth |
Lamotrigine | No substantial increased risk of birth defects |
Levetiracetam | Minor bone abnormalities seen in animals No substantial increased risk in people |
Phenobarbital | Increased risk of birth defects, including neural tube defects (such as spina bifida) Bleeding problems in the newborn |
Phenytoin | Increased risk of birth defects (such as cleft lip and heart defects) Bleeding problems in the newborn |
Trimethadione | High risk of birth defects (such as cleft palate and defects of the heart, skull, face, hands, and abdomen) Risk of a miscarriage |
Valproate | Increased risk of birth defects, including cleft palate, neural tube defects (such as a meningomyelocele Spina bifida ), and defects of the heart, face, skull, spine, and limbs |
Chemotherapy drugs | |
Actinomycin | Possibility of birth defects (seen only in animals) |
Busulfan | Birth defects such as underdevelopment of the lower jaw, cleft palate, abnormal development of the skull bones, spinal defects, ear defects, and clubfoot Inadequate growth of the fetus ( growth restriction Small-for-Gestational-Age (SGA) Newborns A newborn who weighs less than 90% of newborns of the same gestational age at birth (below the 10th percentile) is considered small for gestational age. Newborns may be small because their parents... read more ) |
Chlorambucil | Same as those for busulfan |
Colchicine | Possibility of birth defects (seen in animals) Abnormalities in sperm in sons |
Cyclophosphamide | Same as those for busulfan |
Doxorubicin | Heart problems, depending on the dose taken Birth defects |
Mercaptopurine | Same as those for busulfan |
Methotrexate | Same as those for busulfan |
Vinblastine | Possibility of birth defects (seen only in animals) |
Vincristine | Possibility of birth defects (seen only in animals) |
Mood-stabilizing drug | |
When lithium is taken during the 1st trimester, increased risk of birth defects (mainly of the heart) When lithium is taken later in pregnancy, lethargy, reduced muscle tone, poor feeding, underactivity of the thyroid gland, and nephrogenic diabetes insipidus Nephrogenic Diabetes Insipidus In nephrogenic diabetes insipidus, the kidneys produce a large volume of dilute urine because the kidney tubules fail to respond to vasopressin (antidiuretic hormone) and are unable to reabsorb... read more in the newborn | |
Aspirin and other salicylates Ibuprofen Naproxen | When the drugs are taken in large doses, possibly miscarriages during the 1st trimester, a delay in the start of labor, premature closing of the connection between the aorta and artery to the lungs (ductus arteriosus), jaundice Jaundice in the Newborn Jaundice is a yellow color to the skin and/or eyes caused by an increase in bilirubin in the bloodstream. Bilirubin is a yellow substance formed when hemoglobin (the part of red blood cells... read more When the drugs are taken late in pregnancy, a reduction in the amount of fluid around the developing fetus When low doses of aspirin are taken, no significant risk of birth defects |
Buprenorphine | No evidence of increased risk of birth defects but may have other harmful effects on the fetus or newborn Restlessness, irritability, shaking, difficulty breathing, and feeding problems (symptoms of drug withdrawal) in the newborn because at birth, passage of the drug from the mother through the placenta stops |
Codeine Hydrocodone Hydromorphone Meperidine Morphine | Restlessness, irritability, shaking, difficulty breathing, and feeding problems (symptoms of drug withdrawal) in the newborn, possibly occurring 6 hours to 8 days after birth If high doses are given in the hour before delivery, possibly drowsiness and a slowed heart rate in the newborn |
Methadone | Restlessness, irritability, shaking, difficulty breathing, and feeding problems (symptoms of drug withdrawal) in the newborn |
Chlorpropamide Glyburide Metformin Tolbutamide | A very low blood sugar level in the newborn |
Sex hormones | |
Danazol | When this drug is taken very early in pregnancy, masculinization of a female fetus’s genitals, sometimes requiring surgery for correction |
Synthetic progestins (but not the low doses used in oral contraceptives) | Same as those for danazol |
Skin treatment | |
Isotretinoin | Birth defects, such as heart defects, small ears, and hydrocephalus (sometimes called water on the brain) Intellectual disability Risk of miscarriage |
Thyroid drugs | |
Methimazole | An enlarged or underactive thyroid gland in the fetus Scalp defects in the newborn |
Propylthiouracil | An enlarged or underactive thyroid gland in the fetus Liver damage in the mother |
Radioactive iodine | Destruction of the thyroid gland in the fetus When the drug is given near the end of the 1st trimester, a very overactive and enlarged thyroid gland in the fetus |
Triiodothyronine | An overactive and enlarged thyroid gland in the fetus |
Vaccines | |
COVID-19 vaccines | Limited data about the safety of the COVID-19 vaccines in pregnant women Recommended that pregnant and breastfeeding women discuss the risks and benefits of vaccination with their health care practitioner |
Vaccine for German measles Measles, Mumps, and Rubella Vaccine The measles, mumps, and rubella (MMR) vaccine is a combination vaccine that helps protect against these three serious viral infections. The vaccine contains live but weakened measles, mumps... read more (rubella) and vaccine for chickenpox Varicella Vaccine The varicella vaccine helps protect against chickenpox (varicella), a very contagious infection caused by the varicella-zoster virus. It causes an itchy rash that looks like small blisters with... read more (varicella) | Potential infection of the placenta and developing fetus |
Vaccine for measles, mumps Measles, Mumps, and Rubella Vaccine The measles, mumps, and rubella (MMR) vaccine is a combination vaccine that helps protect against these three serious viral infections. The vaccine contains live but weakened measles, mumps... read more , polio Polio Vaccine The polio vaccine protects against polio, a very contagious viral infection that affects the spinal cord and brain. Polio can cause permanent muscle weakness, paralysis, and sometimes death... read more , or vaccine for yellow fever Prevention | Potential but unknown risks |
Other drugs | |
Corticosteroids | Possibly a cleft lip when these drugs are taken during the 1st trimester |
Hydroxychloroquine | No increased risks at the doses usually used |
Isoniazid | Possible harmful effects on the liver or damage to the peripheral nerves (causing abnormal sensations and/or weakness) |
Pseudoephedrine (a decongestant) | Narrowing of the blood vessels in the placenta, possibly reducing the amount of oxygen and nutrients the fetus receives and thus resulting in inadequate growth before birth Possible risk of a defect in the wall of the abdomen that allows the intestines to protrude outside the body (called gastroschisis Gastroschisis In abdominal wall defects, the muscles surrounding the abdominal cavity are weak or develop holes, allowing the intestines to spill out. The two main abdominal wall defects are omphalocele and... read more ) |
Vitamin K | In women or fetuses with G6PD deficiency, destruction of red blood cells (hemolysis) |
* Unless medically necessary, drugs should not be used during pregnancy. However, drugs can be essential to maintain the health of the pregnant woman and the fetus. In such cases, a woman should talk with her health care practitioner about the risks and benefits of the prescription drugs she is taking before she stops taking them. She should not stop taking them on her own. | |
† Opioids are used to relieve pain. However, they also cause an exaggerated sense of well-being, and if used too much, they can cause dependence and addiction. | |
‡ Insulin is usually preferred. | |
G6PD = glucose-6-phosphate dehydrogenase. | |
