What is advice regarding commonly used sedatives such as Diazepam?
There is no known harm in one-off use of drugs such as Diazepam. However, long-term use during pregnancy has been associated with defects such as cleft lip and palate, particularly so if taken in the critical first eight weeks.
Late pregnancy use, just before delivery, is associated with depression of respiration and very low muscle-tone of the newborn. In fact, this may be so bad that the baby may not cry and may be unable to feed for up to twenty four hours after birth. This will require special care and can be extremely worrying to the parents.
What is the effect of commonly used anti-depressant medication?
The older commonly used drugs for depression are the tricyclic antidepressants. The commonly known drugs are Imipramine (Tofranyl®), Amitriptyline (Lentizol®, Triptafen®) and Dosulepin, formerly called Dothiepin (Prothiaden®).
These are not known to cause any birth defects.
Another group of drugs which have been around only for a few years are the SSRIs. The name stands for Serotonin Selective Re-uptake Inhibitors. The most famous SSRII antidepressant is Prozac®. Its generic name is Fluoxetine.
There are other, less famous SSRIs, including Seroxat® (Paroxetine), Lustral® (Sertraline) , Cipramil® (Citalopram) and Faverin® (Fluvoxamine).
All these have no known detrimental effect on the fetus in the womb. However, there is a risk of withdrawal for the baby after birth. Paroxetine has also been associated with toxicity in animal studies.
The advice is to avoid them unless necessary. This is because doctors do not have enough experience of these drugs to be sure.
What about drugs used in psychotic conditions?
The most common anti-psychotic drugs are the group known as phenothiazines. These include chlorpromazine (Largactil®), haloperidol (Serenace®), fluphenazine (Modecate®), and thioridazine (Melleril®). There is no known evidence of birth defects as a result of using these drugs.
Another commonly used anti-psychotic drug is lithium (LI-Liquid®, Priadel®). This is to be avoided in pregnancy at all costs. Lithium is known to cause major heart defects and more than 10 per cent of babies born to mothers using the drugs in pregnancy will be affected.
Morning sickness is the bane of early pregnancy. What of the drugs commonly used to remedy this?
Nausea and/or vomiting is quite common, especially in the initial ten to fourteen weeks of pregnancy. Many women manage without any drugs but some need some kind of medication to relieve the symptoms.
Commonly used drugs are Stemetil® (generic name Prochlorperazine), Buccastem® - which is the same as stemetil, Maxolon® (Metoclopromide) and occasionally Cyclizine (Valoid®) and Promethazine (Phenergan®). All these are regarded to be safe in pregnancy as there have never been any reports of birth defects associated with their use in pregnancy. Generally, as for all drugs, use is recommended only when necessary.
However, for promethazine (Phenergan®) there is a slight worry that it may increase incidence of congenital dislocation of the hip. Evidence to this effect is weak.
This is the most widely used (in the UK) of the anti-sickness drugs known as 5HT3 antagonists. It is available under the brand name Zofran®. Other drugs in this group include Dolasetron, Palonosetron, Granisetron etc. There is little information about their effect on the pregnancy and therefore the standard advice is to avoid unless absolutely necessary. They are quite potent anti-sickness drugs and sometimes when the problem is very severe and intractable they are employed.