Medicines During Pregnancy

I am on several medications and I would like to know if they harm a baby early in a pregnancy. I may be pregnant, less than 3 weeks along (waiting for blood tests) but I am worried that my life-long medications have already harmed the baby if I am in fact pregnant. Is it still too early for the medications to have had an effect? I have cerebral palsy and chronic pain and am on these medications to treat all my symptoms - Tramadol, Ibuprofen, Diazepam, Temazepam, Cetirizine, Paracetamol, Propanolol, Amitriptyline, Oxybutynin and Tranexamic Acid.

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Hi Emma,

Quoted below are the pregnancy warnings for each of the 10 drug names that you mentioned in your description. Some are safer than others, but I'd still highly recommend discussing this with your doctor before it's too late to make any necessary changes:

"Tramadol has been assigned to pregnancy category C by the FDA. Animal studies have revealed evidence of embryotoxicity and fetotoxicity. There are no controlled data in human pregnancy. Tramadol should only be given during pregnancy when benefit outweighs risk. Tramadol is excreted into human milk in small amounts. The manufacturer suggests that tramadol should not be administered to nursing women.

Tramadol has been shown to cross the placental barrier, with an umbilical vein to maternal vein serum concentration ratio of 0.83. A case of tramadol withdrawal in a neonate has been reported following long-term analgesic treatment of the mother. At 35 hours of age, the infant showed signs of a severe withdrawal syndrome with high-pitched crying, trembling, and shortened sleeping hours."

"Ibuprofen has been assigned by the FDA to pregnancy category C prior to 30 weeks gestation and pregnancy category D at greater than or equal to 30 weeks gestation. Animal studies have failed to reveal evidence of developmental abnormalities. There are no controlled data in human pregnancy. While there are no literature reports linking the use of ibuprofen in pregnancy with birth defects, use of ibuprofen at greater than or equal to 30 weeks gestation may cause premature closure of the ductus arteriosus and prolong labor and delivery. Ibuprofen should only be given during pregnancy when benefit outweighs risk and should be avoided on or after 30 weeks gestation."

"Diazepam has been assigned to pregnancy category D by the FDA. It has been suggested that there is an increased risk of congenital malformations and other developmental abnormalities associated with the use of benzodiazepine drugs. There may be nonteratogenic risks associated with the use of benzodiazepines during pregnancy. There have been reports of neonatal flaccidity, respiratory and feeding difficulties, and hypothermia in children born to mothers who have been receiving benzodiazepines late in pregnancy. Children born to mothers receiving benzodiazepines on a regular basis late in pregnancy may be at risk of experiencing withdrawal symptoms during the postnatal period. Diazepam has been shown to be teratogenic in animal studies at approximately eight times the maximum recommended human dose. The manufacturer recommends that the use of diazepam in women of childbearing potential, and specifically during known pregnancy, should only be considered when the clinical situation warrants the risk to the fetus. If diazepam is used during pregnancy, or if the patient becomes pregnant while taking this drug, the patient should be apprised of the potential hazard to the fetus. Patients should also be advised that if they become pregnant during therapy or intend to become pregnant they should communicate with their physician about the desirability of discontinuing the drug. Special care should be taken when diazepam is used during labor and delivery, because high single doses may produce irregularities in the fetal heart rate and hypotonia, poor sucking, hypothermia, and moderate respiratory depression in the neonate. With newborn infants, the enzyme system involved in the breakdown of the drug is not yet fully developed (especially in premature infants)."

"Temazepam has been assigned to pregnancy category X by the FDA. Animal studies have revealed evidence of increased risk of congenital malformations. One case report has suggested that maternal ingestion of diphenhydramine and temazepam may result in stillbirth in humans. There are no controlled data in human pregnancy. Temazepam use is considered contraindicated during pregnancy."

"Cetirizine has been assigned to pregnancy category B by the FDA. High dose animal studies have failed to reveal evidence of teratogenicity. There are no controlled data in human pregnancy. Cetirizine is only recommended for use during pregnancy when need benefit outweighs risk."

"Acetaminophen in oral or rectal form has not been formally assigned to a pregnancy category by the FDA. It is routinely used for short-term pain relief and fever in all stages of pregnancy. Acetaminophen is believed to be safe in pregnancy when used intermittently for short durations. Acetaminophen oral or rectal should only be given during pregnancy when need has been clearly established. Acetaminophen in IV form has been assigned to FDA pregnancy category C. There are no studies of intravenous acetaminophen in pregnant women; however, epidemiological data on oral acetaminophen use in pregnant women show no increased risk of major congenital malformations. Animal reproduction studies have not been conducted with acetaminophen, and it is not known whether IV acetaminophen can cause fetal harm when administered to a pregnant woman. IV acetaminophen should be given to a pregnant woman only if clearly needed."

"Propranolol has been assigned to pregnancy category C by the FDA. Some animal studies using high doses have revealed evidence of embryotoxicity. There are no controlled data in human pregnancy. Propranolol has been given during pregnancy to treat both maternal and fetal conditions without evidence of teratogenicity. However, fetal and neonatal adverse effects are reported and should be monitored. Propranolol should only be given during pregnancy when benefit outweighs risk."

"Amitriptyline has been assigned to pregnancy category C by the FDA. In animals, amitriptyline produces a variety of congenital malformations when administered in doses 8 to 33 times the maximum recommended human dose. Several cases of congenital malformations, including limb reduction defects, in infants whose mothers took tricyclic antidepressants during pregnancy have been reported, although no firm association has been established. Neonatal withdrawal symptoms have also been reported. There are no controlled data in human pregnancy. Amitriptyline is only recommended for use during pregnancy when there are no alternatives and benefit outweighs risk."

"Oxybutynin has been assigned to FDA pregnancy category B by the FDA. Animal reproductive studies have failed to reveal evidence of impaired fertility or fetotoxicity. There are no controlled data in human pregnancy. Oxybutynin is only recommended for use during pregnancy when benefit outweighs risk."

"Tranexamic acid has been assigned to pregnancy category B by the FDA. Animal studies have not shown evidence of an increased occurrence of fetal damage. There are no controlled data in human pregnancy however tranexamic acid is known to cross the placenta and appears in cord blood at concentrations approximately equal to maternal concentration. Tranexamic acid (Cyklokapron) is only recommended for use during pregnancy when benefit outweighs risk. Tranexamic acid (Lysteda) is not indicated for use in pregnant women."

I hope this info helps!

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