What drugs are safe for pregnant women?
A recent study reveals that one in four pregnant Norwegian women takes medications that are considered risky. Some of the drugs help with pain or nausea, but can have negative side effects on the mother or child.
Several thousand pregnant women in 15 European countries took part in the multinational study that surveyed the women’s medication use during pregnancy. Eight out of ten respondents stated that they had used both prescriptive and over-the-counter drugs during pregnancy.
Pregnant Norwegian women use fewer medicines classified as risky compared to pregnant women in many other European countries, according to the study published in the journal PDS, Pharmacoepidemiology and Drug Safety.
"You have to weigh the risks versus benefits for both mother and child when considering whether pregnant women should take medication during pregnancy," Professor Hedvig Nordeng at the University of Oslo (UiO)’s School of Pharmacy tells forskning.no. In some cases, failing to treat a chronic disease entails greater risk than using the drugs.
Seven out of ten women used safe medicine
8300 pregnant women and new mothers from 15 countries responded to the study’s electronic questionnaire. Of these, 6600 women, including 994 Norwegians, reported that they were using or had used medication. The purpose was to evaluate the safety of medications that pregnant women were using.
Participants indicated that they had used 587 different drugs, which were classified as safe or potentially risky by UiO PhD candidate Johanne N. Trønnes. A small percentage of medicines had an unknown risk profile.
Seven out of ten pregnant women in the study had used safe medication. Around 70 per cent of the medicines with unknown risk profiles were used by pregnant women in Eastern Europe.
Norwegian women cautious
Overall in Europe, 28 per cent of women reported that they had used medicines that were potentially risky.
One in four Norwegian women stated that they had used drugs classified as potentially risky during pregnancy, which was lower than in many other countries.
A greater proportion of pregnant women in Iceland, Finland and Sweden, as well as Switzerland, Croatia, the Netherlands and Russia reported a higher use of risky drugs than in Norway.
The wide discrepancy could arise from the fact that advice given to pregnant women varies between countries.
Ibuprofen poses a risk to pregnant women
The most common potentially risky drugs taken were ibuprofen (e.g. Ibux) for pain relief, and metoclopramide (e.g. Afipran) for nausea.
Norwegian authorities recommend limiting the use of metoclopramide to a maximum of five days, both in pregnant and non-pregnant women, due to the risk of unwanted muscle contractions if used for longer periods, according to Nordeng.
The potential risk of ibuprofen is related to the renal and cardiac function of the foetus, if taken in the last three months of pregnancy.
"Some pregnant women don’t know that over-the-counter Ibux isn’t recommended for pregnant women, and take Ibux for pain instead of paracetamol, which should be their first choice," Nordeng says.
She advises pregnant women to ask for advice at the pharmacy if they’re not sure about which non-prescription drugs are safe.
Nordeng ran the study with Trønnes and Postdoc Angela Lupattelli, in collaboration with UiO’s School of Pharmacy and the Department of Child Health at the Norwegian Institute of Public Health.
Women with chronic disorders face greater risks
In order to help study participants remember what drugs they had taken, they were first asked if they had become acutely sick during their pregnancy and if they had any chronic illness.
Pregnant women with chronic disorders used four times more potentially risky drugs than women without chronic disorders.
"This isn’t that surprising and may simply be due to the fact that failing to treat an underlying disease can pose a greater health risk than the drug itself," Nordeng said.
Pregnant women with chronic ailments who suffer from anxiety and depression had the greatest risk of using potentially risky drugs.
"Most women with chronic disorders have asthma or allergies, and seem to receive good advice on safe drugs from their doctor," says Nordeng.
However, a previous study from 2014 showed that some pregnant women still choose not to follow the doctor's instructions.
"We believe there’s still a great need to inform women to help them make safe choices," she adds.
Dangerous to stop infection treatment
Although the focus of this study was to map the use of safe and risky medicines, the researchers feel it is just as important to address treating ailments.
Numerous respondents indicated that they had infections, mostly urinary tract infections, or UTIs.
"Treating infections is better than leaving them untreated," emphasizes Nordeng.
An untreated UTI may pose a greater risk to mother and child than taking the medication for it.
“Urinary tract infections in pregnant women should be treated with antibiotics. Otherwise the infection could spread up into the urinary tract and lead to kidney damage. In the worst case, an untreated UTI can expose the unborn child to danger by increasing the risk of low birth weight and premature birth,” Nordeng says.
Where are medicines purchased?
One question the researchers did not ask is where pregnant women bought their medications. Healthcare professionals know a lot about which medicines are and aren’t safe.
"If pregnant women end up picking something up at a gas station or the grocery store for some emergency pain, they may miss information about what’s safe for them to use," Nordeng says.
She believes the study shows that the authorities still have a way to go in getting information to pregnant women who treat themselves for pregnancy-related ailments like nausea, headache, sore throat and constipation with non-prescription drugs.
The researchers plan to investigate whether a conversation about safe medications in early pregnancy can improve the mother's health, and lead to safer drug use and better quality of life in pregnancy. Nordeng believes that pharmacists, doctors and midwives need to work together to achieve this.
- Johanne N. Trønnes mf: Safety profile of medication used during pregnancy: results of a multinational European study. Summary. Pharmacoepidemiology and Drug Safety, 27 April 2017.DOI: 10.1002/pds.4213