Drugs in Pregnancy

Do the Benefits Outweigh the Risks?

Anita T. Mosley, PhD, PharmD; Amy P. Witte, PharmD

Disclosures

US Pharmacist. 2013;38(9):43-46. 

In This Article

Pain

Acetaminophen is the most commonly used OTC analgesic in pregnancy, with at least 65.5% of women taking it at some point during pregnancy and 54.2% taking it during the first trimester.[12] The use of single-ingredient acetamino-phen products during pregnancy has not been associated with increased risk of a broad range of birth defects.[13–15] Due to its antipyretic effects, single-ingredient acetaminophen products have been associated with a decreased risk of some birth defects arising from febrile infection during pregnancy.[14]

Aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) should be avoided if possible during pregnancy. A recent study found that although the use of NSAIDs in early pregnancy does not appear to be a major risk factor for birth defects, there were a few moderate associations between NSAIDs and specific birth defects.[16] Another major concern is the increased risk of miscarriage that has been associated with the use of nonaspirin NSAIDs during pregnancy.[17] The use of NSAIDs during pregnancy is also associated with premature closure of the ductus arteriosus, fetal renal toxicity, and inhibition of labor.[4,15,18] Although there are limited reproductive studies involving the use of narcotic analgesics in human pregnancies, these drugs have been used in therapeutic doses for many years by pregnant women without a link to an elevated risk of birth defects.[15,19] The use of opioids should be reserved for pain that is not managed with acetaminophen and, when possible, the lowest effective dose should be used.[15]

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