DRUGS BRJ3GNANCY

VIRGINIA  GAR

Since the thalidomide tragedy of
1960 to 1962, pregnant women have
been in a quandry about taking com-
mon medications on their own in-
itiative, and physicians have been
troubled about prescribing drugs for
them. Peckham and King have shown
recently that 92 percent of women
have at least one drug prescribed by
their physicians during pregnancy,
and 3.9 percent are given 10 or more
( 1). There is no count of babies who
have survived because of drugs ad-
ministered during pregnancy, infants
who escaped birth defects because
their mothers were given certain
drugs, or full-tern babies who might
have been born prematurely without
drugs. Both physicians and patients
rightly demand to know what infor-
mation is available about drugs and
human pregnancy.
Very little is known that can actu-
ally be applied to all pregnancies.
According to Lenz, 80 percent of the
mothers who took thalidomide dur-
ing the period of fetal sensitivity had
normal infants (2). What was it in the
genetic background of the mother or
the father that caused the serious
anomalies that occurred in 20 per-
cent of the infants? What environ-
mental associations were related?
The answers to these questions are a
long way off.

This past year, two useful reviews
appeared, by Cohlan and Lucey,
about the effect of medication ad-
ministered during pregnancy on the
fetus and newborn infant, from which
these comments are largely drawn
(3,4). Two other reviews, which dis-
cuss in detail the problems of human
teratogenesis, were written by Wark-
any and Kalter and by Fraser. All are

~

DR. AF'GAR is o member of the pediatrics
panel of the hrican Medical Association
Registry on Ad\lase Reactions.

highly recommended (5,6).

The table lists some relationships
observed between maternal medica-
tion and fetal or neonatal changes.
Only a few are proved beyond a shad-
OW of doubt, but until further data
are collected, caution should be exer-
cised in administering these sub-
stances to pregnant women.

The best way to determine a post
hoc ergo propter hoc relationship
between maternal medication and
changes in the fetus and newborn
infant is to conduct a prospective
study in a population of women who
enter the study by the eighth week of
pregnancy. They shdd be frequent-
ly observed and interrogated by only
one, two, or three astute clinicians,
and the data should be entered and
analyzed within a few hours' time.
Such a study, a continuation of the
Fetal Life Study of McIntosh and
Menitt begun in 1947, is being con-
ducted by Mellin (8). Routine ques-
tioning about the intake of certain
drugs formed the basis of their re-
port that meclizine hydrochloride
( Bonadettes, Bonine Hydrochloride)
was not under suspicion as a terato-
genic agent (9). Other prospective
studies, such as that of the Kaiser
Permanente group, and the Collabo-
rative Study of the National Institute
of Neurological Disease and Blind-
ness can be expected to show certain
relationships between medication ad-
ministered during pregnancy and fe-
tal and neonatal changes. But these
studies lack the accuracy achieved
by a small, closely controlled group
of pregnant women, observed by the
same professional team.
The greatest danger of inducing
malformations is in the first trimester
of pregnancy. Since this includes the
period before a woman may be aware
that she is pregnant, and since we
know very little about the effects of
drugs on the fetus, physicians are

AMERICAN JOURNAL OF NURSING

MEDICATION AND CHANGES PRODUCED

FETAL OR NEONATAL EFFECT

MATERNAL MEDICATION

Oral progestogens
Androgens
Estrogens
Cortisone Acetate (Cortogen

Acetate, Cortone Acetate)
Potassium iodide
Ropylthiouracil
Methimazole (Tapazole)
lophenoxic acid (`reridax)
Sodium aminopterin
Methotrexate (Amethopterin)
Chlorambucil (Leukeran)
Bishydroxyeoumarin (Dicumrd)
Ethyl bicoumacetate

(Tromexan Ethyl Acetate)

Sodium warfarin (Coumadin
Sodium. Panwadin,
Prothromadin)

Salicylates (large amounts)
Streptomycin
Sulfonamides
Chloramphenicol (Chloromycetin)
Sodium novobiocin (Albamycin
Sodium. Cathomycin Sodium)
Erythromycin (Ilwone)
Nitrofurantoin (Furadantin)
Tetracyclines

Vitamin K Analogues (in excess)
Ammonium chloride
Intravenous fluids (in ~xcSS)
Reserpine (Rauloydin. Raurine.

~au-sod, Reserpoid. Sandril.
Serfin. Serpasil. Serpate.
VleSerpine)

Hexamethonium bromide

(Birtrium Bromide)
Herdn and morphine
phenobarbital Qn axcast)
Smoking
Sulphonylurea derivatives
phenformin hydrochloride (DBI)
phenothlulnes
MoprobanutO (Equanll. weals.

Mwrormn. Meprotab
,MlWn) .- _: .

chloruqulrhe phosphate (Anlen
I. ,PhOa*tO)
minlno --
ThaIMomlde .
V~IUUO~. imailpox
V.cclnaUon. Influenza

Antihlstamlnes
Thlulde dluretlcs

Masculinization and advanced

bone age

Anomalies: cleft palate (1)

Goiter and mental retardation

Elevation of P.B.I.
Anomalies and abortion

Fetal death; hemorrhage

Neonatal bleeding
Possible 8th nerve deafness
Kernicterus
"Grey" syndrome: death
Hyperbilirubinemia

Uver damage (?I
Hemolysis I
Inhibition of bone growth
Discoloration of teeth
Hyperbilirubinemia
Acidosis
Electrolyte Abnormalities
Stuffy nose: respiratory

obstruction

Neonatal ileus

Neonatal death
Neonatal bleeding: death
Birth of small babies
Anomalies Cn
Lactic acidosis 0
Hyperbilimblnemia (?I
~etaded development 0

Retinal damage or death 0

Thrybocytopenia ..

phocomelia: death; hearing 1-
Fetal vaccinia
i&a~d antiA ad B titers in
mothers
~nmiies (?I: Infedlity Cn
Thrombocytopenia 0)

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