More than 50% of pregnant women take prescription or nonprescription (over-the-counter) drugs or use social drugs (such as tobacco and alcohol) or illicit drugs at some time during pregnancy, and use of drugs during pregnancy is increasing. In general, drugs should not be used during pregnancy unless necessary because many can harm the fetus. Less than 2 to 3% of all birth defects result from drugs that are taken to treat a disorder or symptom.
Sometimes drugs are essential for the health of the pregnant woman and the fetus. In such cases, a woman should talk with her doctor or other health care practitioner about the risks and benefits of taking the drug. Before taking any drug (including over-the-counter drugs) or dietary supplement (including medicinal herbs), a pregnant woman should consult her health care practitioner. A health care practitioner may recommend that a woman take certain vitamins and minerals during pregnancy.
Drugs taken by a pregnant woman reach the fetus primarily by crossing the placenta, the same route taken by oxygen and nutrients, which are needed for the fetus's growth and development. However, drugs that do not cross the placenta may still harm the fetus by affecting the uterus or the placenta.
Drugs that a pregnant woman takes during pregnancy can affect the fetus in several ways:
-
They can act directly on the fetus, causing damage, abnormal development (leading to birth defects), or death.
-
They can alter the function of the placenta, usually by causing blood vessels to narrow (constrict) and thus reducing the supply of oxygen and nutrients to the fetus from the mother. Sometimes the result is a baby that is underweight and underdeveloped.
-
They can cause the muscles of the uterus to contract forcefully, indirectly injuring the fetus by reducing its blood supply or triggering preterm labor and delivery.
-
They can also affect the fetus indirectly. For example, drugs that lower the mother's blood pressure may reduce blood flow to the placenta and thus reduce the supply of oxygen and nutrients to the fetus.
How Drugs Cross the Placenta
How a drug affects a fetus depends on
-
The fetus's stage of development
-
The strength and dose of the drug
-
The permeability of the placenta (how easily substances pass through it)
-
The genetic make-up of the mother, which affects how much of the drug is active and available
-
Other factors related to the mother (for example, if the mother is vomiting, she may not absorb as much of a drug, so the fetus is exposed to less of the drug)
Timing and the Effects of Drugs During Pregnancy
|
Time Frame |
Possible Drug* Effects |
Status of the Fetus |
|
Within 20 days after fertilization |
An all-or-nothing effect (death of the fetus or no effect at all) |
The fetus is highly resistant to birth defects. |
|
3‒8 weeks after fertilization |
Possibly no effect An obvious birth defect A permanent but subtle defect that is noticed only later in life An increased risk of childhood cancer, as may result from giving the mother radioactive iodine (to treat thyroid cancer) or using a radioactive substance in an imaging test (such as radionuclide scanning) |
The fetus's organs are developing, making the fetus particularly vulnerable to birth defects. |
|
2nd and 3rd trimesters |
Changes in the growth and function of normally formed organs and tissue Unlikely to cause obvious birth defects Unknown long-term effects |
Organ development is complete. |
|
* Only certain drugs are likely to have harmful effects. |
||
Until recently, the Food and Drug Administration (FDA) classified drugs into five categories according to the degree of risk they pose for the fetus if they are used during pregnancy. Drugs were classified from those with the least risk to those that are highly toxic and should never be used by pregnant women because they cause severe birth defects. One example of a highly toxic drug is thalidomide. This drug causes extreme underdevelopment of arms and legs and defects of the intestine, heart, and blood vessels in the babies of women who take the drug during pregnancy.
The FDA's classification system was based largely on information from studies in animals, which often do not apply to people. For example, some drugs (such as meclizine) cause birth defects in animals, but the same effects have not been seen in people. Taking meclizine for nausea and vomiting during pregnancy does not appear to increase the risk of having a baby with a birth defect. The classification system was based much less often on well-designed studies in pregnant women because few such studies have been done. Thus, applying the classification system in specific situations was difficult.
Because of this problem, the FDA eliminated the five risk categories. Instead, the FDA now requires that the drug label include more information about the risk of taking every drug during pregnancy. This information includes the following:
Typically, health care practitioners follow a general rule:
Often, a safer drug can be substituted for one that is likely to cause harm during pregnancy. For prevention of blood clots, the anticoagulant heparin is preferred to warfarin. Several safe antibiotics, such as penicillin, are available to treat infections.
Some drugs can have effects after they are stopped. For example, isotretinoin, a drug used to treat skin disorders, is stored in fat beneath the skin and is released slowly. Isotretinoin can cause birth defects if women become pregnant within 2 weeks after the drug is stopped. Therefore, women are advised to wait at least 3 to 4 weeks after the drug is stopped before they become pregnant.
Some Drugs That Can Cause Problems During Pregnancy*
Examples |
Possible Problems |
Antianxiety drugs |
|
|
Benzodiazepines (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 (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, the breakdown of red blood cells Possibly gray baby syndrome (a serious and often fatal disorder) |
|
|
Fluoroquinolones (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 (such as sulfasalazine and trimethoprim- sulfamethoxazole) |
When the drugs are given late in pregnancy, jaundice and, without treatment, brain damage (kernicterus) in the newborn 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 (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 (a decrease in the number of platelets, which help blood clot) in the pregnant woman, possibly resulting in excessive bleeding |
|
Warfarin |
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 (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 |
|
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) |
|
Meclizine |
Birth defects in rodents but no proof of this effect in humans |
Antihypertensive drugs |
|
|
Aldosterone antagonists (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), 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) and preterm birth 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: |
|
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), 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) |
|
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 in the newborn |
|
Nonsteroidal anti-inflammatory drugs (NSAIDs) |
|
|
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, necrotizing enterocolitis (damage to the lining of the intestine), and (occasionally) brain damage in the fetus (kernicterus) and bleeding problems in the woman during and after delivery and/or in the newborn 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 Increased risk of childhood cancer |
|
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 (rubella) and vaccine for chickenpox (varicella) |
Potential infection of the placenta and developing fetus |
|
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) |
|
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. |
|
Vaccines During Pregnancy
Immunization is as effective in women who are pregnant as in those who are not.
Vaccines made with a live virus (such as the rubella vaccine and varicella vaccine) are not given to women who are or might be pregnant.
Other vaccines (such as those for cholera, hepatitis A, hepatitis B, plague, rabies, and typhoid) are given to pregnant women only if they are at substantial risk of developing that particular infection and if the risk of side effects from the vaccine is low.
However, all pregnant women who are in the 2nd or 3rd trimester during the influenza (flu) season should be given the influenza vaccine.
All pregnant women should be given the tetanus-diphtheria-pertussis (Tdap) vaccine between 27 and 36 weeks of each pregnancy. This vaccine protects against pertussis (whooping cough).
COVID-19 vaccines are recommended for pregnant women and given based on the priority groups established by the Centers for Disease Control and Prevention (CDC) and the Advisory Committee on Immunization Practices (ACIP).
Drugs Used to Treat Heart and Blood Vessel Disorders During Pregnancy
Drugs to lower high blood pressure (antihypertensives) may be needed by pregnant women who have had high blood pressure before pregnancy or who develop it during pregnancy. Either type of high blood pressure increases the risk of problems for the woman (such as preeclampsia) and for the fetus (see page High Blood Pressure During Pregnancy). However, antihypertensives can markedly reduce blood flow to the placenta if they lower blood pressure too rapidly in pregnant women. So pregnant women who have to take these drugs are closely monitored.
Several types of antihypertensives, such as angiotensin-converting enzyme (ACE) inhibitors and thiazide diuretics, are usually not given to pregnant women. These drugs can cause serious problems in the fetus, such as kidney damage, inadequate growth before birth (growth restriction), and birth defects. Spironolactone is also not given to pregnant women. This drug may cause the development of feminine characteristics (feminization) in a male fetus.
Digoxin, used to treat heart failure and some abnormal heart rhythms, readily crosses the placenta. But at the usual doses, digoxin typically has little effect on the baby before or after birth.
Antidepressants During Pregnancy
Antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs) such as paroxetine, are commonly used during pregnancy. Use is common because about 7 to 23% of pregnant women have depression. For pregnant women, the benefits of treating depression usually outweigh the risks.
Paroxetine appears to increase the risk of heart birth defects. So if a pregnant woman takes paroxetine, echocardiography should be done to evaluate the fetus's heart. However, other SSRIs do not increase this risk.
If a pregnant woman takes antidepressants, the newborn may have withdrawal symptoms (such as irritability and shaking) after delivery. To prevent these symptoms, doctors may gradually reduce the dose of the antidepressant during the 3rd trimester and stop the drug before the baby is born. However, if the woman has significant signs of depression or if symptoms worsen as the dose is reduced, antidepressants should be continued. Depression during pregnancy can lead to postpartum depression, which involves a serious change in mood and requires treatment.
Antiviral Drugs During Pregnancy
Some antiviral drugs (such as zidovudine and ritonavir for HIV infection) have been safely used during pregnancy for many years. However, some antiviral drugs may cause problems in the fetus. For example, some evidence suggests that when some HIV regimens with a combination of antiviral drugs are given during the 1st trimester, the risk of cleft lip and palate may be increased.
If a pregnant woman gets COVID-19, her treatment team and she should discuss the risks and benefits for her and then decide whether remdesivir should be used to treat COVID-19. Generally, experts recommend that theoretical concerns about the safety of remdesivir during pregnancy should not prevent its use in pregnant women. There are little data about the effects of remdesivir on the fetus.
If a pregnant woman gets influenza, she should seek treatment as soon as possible because treating influenza within 48 hours of when symptoms begin is most effective. However, treatment at any point during the infection reduces the risk of severe complications. No well-designed studies of zanamivir and oseltamivir have been done in pregnant women. However, many studies based on observation indicate that treating pregnant women with zanamivir or oseltamivir does not increase the risk of harmful effects. There is little or no information about the use of other influenza drugs during pregnancy.
Acyclovir, taken by mouth or applied to the skin, appears to be safe during pregnancy.
Social Drugs During Pregnancy
Cigarette (tobacco) smoking during pregnancy
Although cigarette smoking harms both pregnant women and their fetus, only about 20% of women who smoke are able to quit during pregnancy.
The most consistent effect of smoking on the fetus during pregnancy is
-
A reduction in birth weight (growth restriction)
The more a woman smokes during pregnancy, the less the baby is likely to weigh. The average birth weight of babies born to women who smoke during pregnancy is 6 ounces less than that of babies born to women who do not smoke.
Birth defects of the heart, brain, and face are more common among babies of smokers than among those of nonsmokers.
Also, the risk of the following may be increased:
-
Sudden infant death syndrome (SIDS)
-
A mislocated placenta (placenta previa)
-
Premature detachment of the placenta (placental abruption, or abruptio placentae)
-
Premature rupture of the membranes (containing the fetus)
In addition, children of women who smoke have slight but measurable deficiencies in physical growth and in intellectual and behavioral development. These effects are thought to be caused by carbon monoxide and nicotine. Carbon monoxide may reduce the oxygen supply to the body's tissues. Nicotine stimulates the release of hormones that constrict the vessels supplying blood to the uterus and placenta, so that less oxygen and fewer nutrients reach the fetus.
Because of the possible harmful effects of smoking during pregnancy, pregnant women should make every effort to not smoke during pregnancy, including discussing strategies with their doctor.
Pregnant women should avoid exposure to secondhand smoke because it may similarly harm the fetus.
Alcohol during pregnancy
Drinking alcohol during pregnancy is the leading known cause of birth defects. Because the amount of alcohol required to cause fetal alcohol syndrome is unknown, pregnant women are advised to abstain from drinking any alcohol regularly or on binges. Avoiding alcohol altogether is even safer.
The risk of miscarriage almost doubles for women who drink alcohol in any form during pregnancy, especially if they drink heavily.
Often, the birth weight of babies born to women who drink regularly during pregnancy is substantially below normal. The average birth weight is about 4 pounds for babies exposed to large amounts of alcohol, compared with 7 pounds for all babies. Newborns of women who drank during pregnancy may not thrive and are more likely to die soon after birth.
Fetal alcohol syndrome is one of the most serious consequences of drinking during pregnancy. Binge drinking as few as three drinks a day can cause this syndrome. It occurs in about 2 of 1,000 live births. This syndrome includes the following:
-
Inadequate growth before birth or after birth
-
A small head (microcephaly), probably caused by inadequate growth of the brain
-
Intellectual disability
-
Abnormal behavioral development
-
Less commonly, joint abnormalities and heart defects
Babies or children of women who drank alcohol during pregnancy may have severe behavioral problems, such as antisocial behavior and attention-deficit/hyperactivity disorder. These problems can occur even when the baby has no obvious physical birth defects.
Caffeine during pregnancy
Whether consuming caffeine during pregnancy harms the fetus is unclear. Evidence seems to suggest that consuming caffeine in small amounts (for example, one cup of coffee a day) during pregnancy poses little or no risk to the fetus.
Caffeine, which is contained in coffee, tea, some sodas, chocolate, and some drugs, is a stimulant that readily crosses the placenta to the fetus.
Some evidence suggests that drinking more than seven cups of coffee a day may increase the risk of having a stillbirth, premature birth, low-birth-weight baby, or miscarriage.
Some experts recommend limiting coffee consumption and drinking decaffeinated beverages when possible.
Aspartame during pregnancy
Aspartame, an artificial sweetener, appears to be safe during pregnancy when it is consumed in small amounts, such as in amounts used in normal portions of artificially sweetened foods and beverages. For example, pregnant women should consume no more than 1 liter of diet soda a day.
Pregnant women with phenylketonuria, an unusual disorder, should not consume any aspartame.
Illicit Drugs During Pregnancy
Use of illicit drugs (particularly opioids) during pregnancy can cause complications during pregnancy and serious problems in the developing fetus and the newborn. For pregnant women, injecting illicit drugs increases the risk of infections that can affect or be transmitted to the fetus. These infections include hepatitis and HIV infection (including AIDS). Also, when pregnant women take illicit drugs, growth of the fetus is more likely to be inadequate, and premature births are more common.
Amphetamines during pregnancy
Use of amphetamines during pregnancy may result in birth defects, especially of the heart, and possibly inadequate growth before birth.
Bath salts during pregnancy
Bath salts refers to a group of designer drugs made from various substances that resemble amphetamine. More and more pregnant women are using these drugs.
The drugs may cause the blood vessels in the fetus to narrow, reducing the amount oxygen the fetus gets.
Also, these drugs increase the risk of the following:
-
Premature detachment of the placenta (abruptio placentae)
-
Possibly birth defects
Cocaine during pregnancy
Cocaine taken during pregnancy may cause the blood vessels that carry blood to the uterus and placenta to narrow (constrict). Then, less oxygen and fewer nutrients reach the fetus.
If pregnant women use cocaine regularly, risk of the following is increased:
-
Premature detachment of the placenta (placental abruption, or abruptio placentae)
-
Birth defects (including brain and spinal cord, urinary tract, and bone defects)
However, whether cocaine is the cause of those problems is unclear. For example, the cause may be other risk factors that are common in women who use cocaine. Such factors include cigarette smoking, use of other illicit drugs, deficient prenatal care, and poverty.
Hallucinogens during pregnancy
Hallucinogens may, depending on the drug, increase the risk of the following:
-
Miscarriage
-
Premature labor and delivery
-
Withdrawal syndrome in the fetus or newborn
Hallucinogens include methylenedioxymethamphetamine (MDMA, or Ecstasy), rohypnol, ketamine, methamphetamine, and LSD (lysergic acid diethylamide).
Marijuana during pregnancy
Whether use of marijuana during pregnancy can harm the fetus is unclear. The main component of marijuana, tetrahydrocannabinol, can cross the placenta and thus may affect the fetus. However, use of a small amount of marijuana does not appear to increase the risk of birth defects or to slow the growth of the fetus.
Marijuana does not cause behavioral problems in the newborn unless it is used heavily during pregnancy.
Opioids during pregnancy
Opioids are used to relieve pain, but they also cause an exaggerated sense of well-being, and if used too much, they can cause dependence and addiction.
Opioids, such as heroin, methadone, and morphine, readily cross the placenta. Consequently, the fetus may become addicted to them and may have withdrawal symptoms 6 hours to 8 days after birth. However, use of opioids rarely results in birth defects.
Use of opioids during pregnancy increases the risk of complications during pregnancy, such as
Babies of heroin users are more likely to be small.
Drugs Used During Labor and Delivery
Drugs used to relieve pain during pregnancy (such as local anesthetics and opioids) usually cross the placenta and can affect the newborn. For example, they can weaken the newborn's urge to breathe. Therefore, if these drugs are needed during labor, they are given in the smallest effective doses.
Drugs Mentioned In This Article
| Generic Name | Select Brand Names |
|---|---|
Hydroxychloroquine |
PLAQUENIL |
Cyclophosphamide |
CYTOXAN (LYOPHILIZED) |
Propylthiouracil |
No US brand name |
methamphetamine |
DESOXYN |
Pseudoephedrine |
AFRINOL, SUDAFED |
Mercaptopurine |
PURINETHOL |
Chlorpropamide |
DIABINESE |
spironolactone |
ALDACTONE |
sulfasalazine |
AZULFIDINE |
Carbamazepine |
TEGRETOL |
Buprenorphine |
BUPRENEX |
Levetiracetam |
KEPPRA |
ciprofloxacin |
CILOXAN, CIPRO |
Hydromorphone |
DILAUDID |
Chlorambucil |
LEUKERAN |
isotretinoin |
SOTRET |
Promethazine |
PROMETHEGAN |
Escitalopram |
LEXAPRO |
Methotrexate |
OTREXUP |
levofloxacin |
IQUIX, LEVAQUIN, QUIXIN |
oseltamivir |
TAMIFLU |
Haloperidol |
HALDOL |
amphetamine |
ADDERALL XR 10 |
Vincristine |
MARQIBO KIT |
thalidomide |
THALOMID |
Ondansetron |
ZOFRAN |
Terconazole |
TERAZOL 3 |
Venlafaxine |
EFFEXOR XR |
Lamotrigine |
LAMICTAL |
Methimazole |
TAPAZOLE |
Risperidone |
RISPERDAL |
rivaroxaban |
XARELTO |
Fluconazole |
DIFLUCAN |
norfloxacin |
NOROXIN |
eplerenone |
INSPRA |
Sertraline |
ZOLOFT |
alprazolam |
XANAX |
Miconazole |
MONISTAT 3 |
tobramycin |
TOBI, TOBREX |
Citalopram |
CELEXA |
Lurasidone |
LATUDA |
gentamicin |
GENOPTIC |
Olanzapine |
ZYPREXA |
Colchicine |
COLCRYS |
Meperidine |
DEMEROL |
Doxylamine |
UNISOM |
Paroxetine |
PAXIL |
Loratadine |
ALAVERT, CLARITIN |
zidovudine |
RETROVIR |
Fluoxetine |
PROZAC, SARAFEM |
Isoniazid |
LANIAZID |
Acyclovir |
ZOVIRAX |
Ibuprofen |
ADVIL, MOTRIN IB |
ritonavir |
NORVIR |
Methadone |
DOLOPHINE |
Metformin |
GLUCOPHAGE |
Phenytoin |
DILANTIN |
meclizine |
ANTIVERT |
Bupropion |
WELLBUTRIN, ZYBAN |
Glyburide |
DIABETA, GLYNASE |
ofloxacin |
FLOXIN OTIC |
zanamivir |
RELENZA |
lorazepam |
ATIVAN |
ketamine |
KETALAR |
Naproxen |
ALEVE, NAPROSYN |
diazepam |
VALIUM |
neomycin |
NEO-FRADIN |
Morphine |
DURAMORPH PF, MS CONTIN |
warfarin |
COUMADIN |
apixaban |
ELIQUIS |
edoxaban |
SAVAYSA |
nicotine |
COMMIT, NICORETTE, NICOTROL |
Busulfan |
MYLERAN |
lithium |
LITHOBID |
Digoxin |
LANOXIN |
heparin |
PANHEPRIN |
