Medicine in pregnancy: safety (for both) first; effectiveness second
It is a fact of life that many - probably most - pregnant women are prescribed medicine
for brief or even prolonged periods during their pregnancy. It is also true that
since the 1960s and 70s, medication use during pregnancy has significantly declined.
Prescription drugs used mostly include the common supplements, such as iron and folic
acid. Also used commonly are drugs to combat "morning sickness" (anti-emetics), painkillers
and laxatives to combat the common complaint of constipation.
Antibiotics are also frequently prescribed, especially for urinary tract infections,
a relatively common problem in pregnancy. There are several other groups of drugs
used during pregnancy.
Common to all these is the question: Are they safe? After the tragedy of thalidomide,
this is no longer an idle muse.
As a general, rather sweeping, statement: The majority of drugs prescribed during
pregnancy are perfectly safe for the majority of women. A significant proportion
of pregnant women throughout the world use iron. It is safe. However, it may not
be safe for women with conditions such as sickle cell disease or thalassaemia, common
among people of African and Mediterranean descent respectively.
These facts need to -be established. Penicillin is a widely used antibiotic that
is quite safe at any stage of the pregnancy, but some people are allergic to them
- so such facts need to be established as well.
Some antibiotics are unsafe only at a certain stage of pregnancy, so the doctor needs
to be sure of the gestation when prescribing them.
All these and many other issues pertaining to the subject of medication during pregnancy
are discussed in this chapter.