Not enough is known about the effects of prescription drug use during pregnancy, a review out today has concluded.
There are still big gaps in knowledge and little is known about the potential damage to the foetus if women use prescriptions drugs.
However, the prevalence of congenital malformations is estimated at two to three per cent of all births, of which approximately one per cent is believed to be attributable to prescription drug use during pregnancy.
A review, published in The Obstetrician & Gynaecologist (TOG) today (April 27) explores the use of anti-epileptic drugs, the most studied group of drugs in pregnancy, and antidepressants among pregnant women.
It also looks at preliminary data collated from the UK Epilepsy and Pregnancy Register, which found that the risk of congenital malformations with the use of one AED was 3.7 per cent (n = 2598), compared with 6.0 per cent (n = 770) in those women taking two or more AEDs.
Up to four per cent of women use antidepressants during pregnancy, with 2.3 per cent taking selective serotonin reuptake inhibitors (SSRIs).
A large birth defect registry study found no association between maternal SSRI use and cardiac malformations.
However, Alastair Sutcliffe, reader in Child Health, UCL Institute of Child Health and co-author of the review, said that antidepressant use in late pregnancy is associated with neonatal complications such as premature birth, feeding problems, respiratory distress syndrome, endocrine and metabolic disorders and temperature regulation disorders.
He concluded that not enough is known about prescription drug use in pregnancy and that drug companies do not recruit pregnant women to their clinical trials unless the drug in question is aimed at pregnancy-related disease.
“Many pregnant women use prescription drugs, however, the risk to the foetus remains unknown,” said Mr Sutcliffe.
“Pregnant women are excluded from clinical trials, which means when new drugs are released there is almost no information on their safety and efficacy in pregnancy.”
Jason Waugh, TOG’s editor-in-chief, said: “The maternal physiological changes that occur during pregnancy can alter what the body does to the drug in some cases. More research is needed into the foetal effects of some drugs as there are big gaps in our knowledge.”
Prescription drug use in pregnancy: more evidence of safety is needed. Chan M,Wong ICK, Sutcliffe AG. The Obstetrician & Gynaecologist 2012;14:87.92.
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