Medication During Pregnancy Shown to Cause Fetal Damage
About two-thirds of women in the United States take one or more prescription medications during pregnancy, many of which the potential effects on a fetus are unclear. In developed countries, birth defects are the leading cause of infant mortality. The complex melange of factors that contribute to a healthy pregnancy make it very difficult to specifically identify causal factors, but it is widely agreed upon that taking medication during pregnancy can result in fetal damage.
Use of Medication During Pregnancy a Dangerous Decision
In 1979, the United States Food and Drug Administration introduced a system to classify pharmaceuticals based on fetal risks. The two highest categories of risk in this system are ‘Category X,’ where fetal abnormalities could occur, and/or there is positive evidence of human fetal risk based on adverse reaction data, and the risks involved in the use of medication during pregnancy clearly outweigh potential benefits. Then there is ‘Category D,’ where it is claimed that the use of the drug will provide more benefits than risks, despite positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience or studies in humans. Needless to say, pharmaceutical drugs should be avoided, especially while pregnant.
An analysis of almost 13,000 doctor visits made by women of childbearing age between 1998-2000 showed that one out of every thirteen was on a class D or X medication, and given the steep and steady increase in prescriptions for psychotropic drugs in the past decades, it’s likely that this number is also increasing.
In addition to these medications which are known to pose a risk, the data on many other prescription drugs is limited at best. According to Dr. Cheryl Broussard, Epidemiologist with the Centers for Disease Control and Prevention, most medications have not been adequately evaluated for use during pregnancy, and one study showed that more than 90% of medications approved by the US Food and Drug Administration (FDA) from 1980 to 2000 had insufficient data to determine the risk in human pregnancy.
In response to a 1997 hearing on the inadequacy and ambiguity of the current drug labeling and categorizing system, the FDA has acknowledged the need for an updated system, but as of yet, no major changes have been enacted. It is well documented that medical training in toxicology and pregnancy risk is limited and Lydia Pace and Eleanor Bimla Schwarz’s excellent and well-balanced article published last week in the journal Women’s Health does an excellent job summarizing the problem:
“Fourth, upon this foundation of limited training, incomplete data and inadequate access to preventive services, within a short office visit, clinicians and patients must engage in decision-making that is medically complex and emotionally charged.”
The new FDA system would provide more information (from the very limited pool of what’s available) but one might also put forth the suggestion that it would also be helpful to work on a system in which medically complex and emotionally charged decision-making didn’t depend on limited training and inadequate access to preventive services, reckoned with in an ever shorter office visit.
