Pregnancy

Medication and pregnancy: which to avoid when you are pregnant?

Médicaments et grossesse : lesquels éviter quand on est enceinte ?

Many drugs are not recommended or even contraindicated during pregnancy. It is therefore important to be particularly vigilant. Professor Philippe Deruelle, obstetrician gynecologist, gives us his advice for a healthy and safe pregnancy.

During the pregnancy, expectant mothers sometimes find it difficult to heal themselves since many medication are not recommended. “Self-medication must be avoided at all costs during pregnancywarns Professor Philippe Deruelle, obstetrician gynecologist. Even if these medications have been prescribed for you in the past and even if they are over the counter medications. “A lot of drugs are not recommended or even contraindicated in pregnant women. We can notably cite anti-inflammatory drugs, acne treatments such as Roaccutane®, antiepileptics, hypertensives or immunosupressants. Vigilance is also required with psychotropic “continues the practitioner. According to the CRAT website (Reference Center for Teratogens), “around fifteen substances are teratogenic in humans (apart from antimitotics), and around forty are fetotoxic, which represents around 10% of the specialties on the market“.

  • Some commonly used medications are strictly contraindicated during pregnancy. This is particularly the case with aspirin, strongly discouraged during pregnancy because it promotes bleeding and can lead to fetal heart defects. It is advisable to replace it with a pain reliever, like paracetamol.
  • Anti-inflammatory drugs are completely prohibited. The risk is lower in the first trimester of pregnancy, but they are completely prohibited at the end of the second trimester. “This prohibition applies to both tablets and ointments “, specifies Doctor Deruelle. “There is no authorized drug with the same effect, adds the practitioner, but the doctor may prescribe a paracetamol type pain reliever or a class 2 painkiller containing a morphine derivative such as Tramadol, to be used with caution. ”
  • The drugs based modafinil (Modiodal® and its generics), must no longer be used during pregnancy or in women of reproductive age, without effective contraception, said the ANSM in June 2019. In question: “the use of modafinil during pregnancy is suspected to be the cause of birth defects, “says the National Medicines Safety Agency.
  • The Gylénia, prescribed for women who suffer from multiple sclerosis, not suitable for pregnant women. Treatment should therefore be discontinued during pregnancy, recommends the European Medicines Agency, due to the risk of birth defects.
  • The ANSM also warns expectant mothers, women who are breastfeeding or of childbearing age not to use the Mycophenolate drug (indicated in the event of rejection of organ transplant), because of the risks of miscarriages and congenital malformations.

When a pregnant woman takes medication, this can be transmitted to the fetus via the placenta. Be aware that the risk differs depending on the stage of pregnancy and that certain drugs may be contraindicated in early pregnancy and present less danger in the third trimester, and vice versa.

  • In the first trimester of pregnancy: At the stage of embryogenesis, the risk is above all malformative. The embryo is in full development and certain molecules can cause malformations. Indeed, from conception to about the 10th week of pregnancy, the organs develop (at an early stage), and miscarriages are possible. It is a natural reaction: the woman’s body understands that in case of malformation, the embryo will not be viable. As a result, during this period, taking medication is critical.
  • In the second quarter and in the third quarter: The risk is functional. The drug can have consequences on the growth of the fetus, but also on the functioning of the organs. In the most serious cases, this can lead to spontaneous abortion, miscarriage, premature delivery or even fetal death in-utero.
  • Antidiabetics and pregnancy. Some women take long-term treatment before pregnancy and should continue it even if they are pregnant. It is important toto discuss the pregnancy project with the doctor and to study with him the different therapeutic alternatives. “A woman who was taking oral anti-diabetics most of the time will be on insulin during pregnancy, as it is easier to change the doses ” explains the doctor.
  • The anti-epileptic treatments are also the subject of particular attention, all the more since the scandal of the anti-convulsant Depakine. This sodium valproate drug, the teratogenic effects of which are well known, has long been prescribed to pregnant women, with dramatic consequences. “Consideration may be given to stopping treatment with the neurologist or changing the medication to another“specifies Doctor Deruelle. In addition, the Medicines Agency recently announced that five epilepsy treatments (topiramate: Epitomax® and its generics, phenobarbital (Gardénal®), primidone (Mysoline®), carbamazepine (Tégrétol®) and (fos) phenytoin (Prodilantin®) could cause birth defects and developmental disorders in the newborn.
  • About the taking antidepressants during pregnancy, the doctor wants to be measured. “If we regularly hear that they could increase the risk of diabetes, autism or obesity, serotonin reuptake inhibitors would have a real impact on the neurobehavioural development of the baby., studies are contradictory“, details the practitioner. In case of serious psychiatric pathology, It is essential that the pregnant woman discuss her desire for pregnancy with her psychiatrist. In all cases, the treatment should be reassessed and the need for continued medication management determined. If it proves useful, the minimal effective treatment will be prescribed.

The “Pregnant Woman” pictogram on medicine boxes

pictogram-pregnant-woman-drugs

Teratogenic or fetotoxic drugs have been indicated since the decree of October 17, 2017 by a pictogram representing a pregnant woman on the external packaging of the drug. There are two signs. A prohibited drug is indicated by a round panel, a dangerous drug is indicated by a triangular panel.

Before taking any medicine during pregnancy, make sure that it is safe. As Professor Deruelle explains, “any healthcare professional is able to get information and consult the CRAT website in order to provide the patient with a clear answer“. You can also consult the pharmacovigilance center in your region which gives very precise date information, in particular on new drugs. To view the updated list of hazardous drugs during pregnancy, see CRAT website

Thank you to Professor Philippe Deruelle, obstetrician gynecologist and to Doctor Elisabeth Paganelli, medical gynecologist and secretary at SYNGOF

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