Prescription drug use in pregnancy: more evidence of safety is needed

Abstract

Key content: Prescription drug use during pregnancy is prevalent, with 44–99% of women being prescribed medication during pregnancy. Pregnant women and their unborn children are considered a vulnerable population; recent public health scares, such as H1N1, have highlighted the need for more detailed research into medication use in pregnancy. The teratogenic risk of more than 80% of 468 drugs released in the USA over the last 20 years remains to be clarified. Maternal physiological changes during pregnancy can alter drug pharmacokinetics, with poorly understood effects, while placental transfer of medications may have unknown fetal consequences. There is an urgent need for further research into the adverse effects of drugs used in pregnancy. Learning objectives: To know about the prevalence of prescription medication use during pregnancy. To be aware of the lack of safety data available on fetal adverse effects for commonly prescribed drugs. Ethical issues: Drug companies are reluctant to carry out phase III clinical trials in pregnant women and they rely on animal models and post-marketing surveillance for the identification of adverse effects. Is it unethical to prescribe drugs in pregnancy for which there is little concrete safety data?