The medications you take while pregnant can affect your baby’s health. The baby is exposed to most drugs the mother takes, except for large molecules (e.g. heparin) and drugs that get stuck in the placenta (e.g. buprenorphine).
So what medicine can pregnant women take, and what should they avoid? Learn the five categories of safety here.
Drug safety is hard to test in pregnant mothers because of ethical concerns – if there is risk of damage, then exposing a fraction of mothers to a drug seems unspeakable. Furthermore, medicine has a traumatic memory from the use of anti-nausea drug thalidomide in the 1950s, leading to thousands of infants with birth defects and thousands of deaths.
Therefore, many drugs that are probably safe for pregnant women don’t get an explicit clearance from the FDA.
The FDA classifies drugs into five categories (A B C D X), based on strength of evidence on safety:
Medication During Pregnancy: Category A
- Definition: Well-controlled human studies show no risk to fetus in any trimester.
- Folic acid
- Levothyroxine (hypothyroidism)
Medication During Pregnancy: Category B
- Definition: No well-controlled human studies and animal studies have shown no risk to a fetus, OR animal studies show risk but well-controlled human studies show no risk.
- Includes common substances that are unethical to experiment with by withholding from a control group, like vitamins.
- Macrobid/nitrofurantoin (antibiotic)
- Amoxicillin (antibiotic)
- Metformin (diabetes)
- Pepcid AC (heartburn)
Medication During Pregnancy: Category C
- Definition: No well-controlled human studies. Either animal studies have shown problems for the fetus, OR there have been no animal studies.
- The broadest category – includes both drugs that show no problems in small animal and human studies, and drugs that show damage in animal studies.
- Ciprofloxacin (antibiotic)
- Gabapentin (epilepsy, nerve pain)
- Vicodin/hydrocodone (pain)
- Ambien (insomnia)
- Prilosec (heartburn)
- Ibuprofen (pain)
Medication During Pregnancy: Category D
- Definition: Evidence of harm to fetus in human studies, but benefits may outweigh risks in certain situations.
- Once a drug falls in this bucket, it’s hard to get out given how difficult it is to prescribe and get new studies.
- Paxil/paroxetine (depression)
- Lorazepam (anxiety)
- Prinivil/lisinopril (hypertension)
- Tetracycline (antibiotic, acne)
Medication During Pregnancy: Category X
- Definition: Should not be taken during pregnancy under any circumstances.
- Also includes drugs that have no purpose during pregnancy, like oral contraceptives
- Accutane/isotretinoin (acne)
- Leflunomide (arthritis)
- Warfarin (anticoagulant)
- Lipitor/atorvastatin, Zocor/simvastatin (high cholesterol)
- Finasteride (enlarged prostate)