Get information and reviews on prescription drugs, over-the-counter medications, vitamins, and supplements. The most commonly used drugs include antiemetics, antacids, antihistamines, analgesics, antimicrobials, diuretics, hypnotics, tranquilizers, and social and illicit drugs. For example, nausea and vomiting may decrease absorption of an oral drug.Despite widespread concern about drug safety, exposure to therapeutic drugs accounts for only 2 to 3% of all fetal congenital malformations; most malformations result from genetic, environmental, multifactorial, or unknown causes.Ototoxicity (eg, damage to fetal labyrinth), resulting in deafnessPossibly arthralgia; theoretically, musculoskeletal defects (eg, impaired bone growth), but no proof of this effectIn women or fetuses with G6PD deficiency, hemolysisContraindicated during the 1st trimester, at term (38 to 42 wk), during labor and delivery, and just before onset of laborIn women or fetuses with G6PD deficiency, hemolysisWhen the drugs are given after about 34 wk gestation, neonatal jaundice and, without treatment, In women or fetuses with G6PD deficiency, hemolysisSlowed bone growth, enamel hypoplasia, permanent yellowing of the teeth, and increased susceptibility to cavities in offspringIncreased risk of neural tube defects due to folate antagonismInadequate human data; possible harm to the fetus because these drugs appear to cross the placentaNo antidote for reversal; to be avoided during pregnancyWhen the drug is given during the 2nd or 3rd trimester, optic atrophy, cataracts, intellectual disability, microcephaly, microphthalmia, and fetal and maternal hemorrhageAbsolutely contraindicated during 1st trimester of pregnancySome risk of congenital malformations including neural tube defectsNo appreciable increased risk with dosage up to 600 mg/dayMinor skeletal malformations in animal studies, but no appreciable increased risk in humansCongenital malformations (eg, cleft lip, GU defects such as hypospadias, cardiovascular defectsPersistent risk of congenital malformations despite folic acid supplementationHigh risk of congenital malformations (eg, cleft palate; cardiac, craniofacial, hand, and abdominal defects) and risk of spontaneous abortionMajor congenital malformations (eg, neural tube defects such as Persistent risk of congenital malformations despite folic acid supplementationConflicting data on risk of congenital malformations from 1st trimester exposureWhen the drug is given during the 3rd trimester, discontinuation syndrome and persistent pulmonary hypertension of the newbornConsideration of dose tapering during the 3rd trimester in consultation with a mental health practitionerConsideration of dose tapering during the 3rd trimester in consultation with a mental health practitionerLong half-life; drug-drug interactions possibly occurring for weeks after the drug is stoppedConsideration of dose tapering during the 3rd trimester in consultation with a mental health practitionerWhen the drug is given during the 3rd trimester, discontinuation syndrome and persistent pulmonary hypertension of the newbornUse during pregnancy not recommended by some experts*Consideration of dose tapering during the 3rd trimester in consultation with a mental health practitionerConsideration of dose tapering during the 3rd trimester in consultation with a mental health practitionerDosing greatly affected by hepatic or renal impairmentConsideration of dose tapering during the 3rd trimester in consultation with a mental health practitionerNo evidence of increased risk of congenital malformationsUsed during pregnancy only for hyperemesis gravidarum when other treatments are ineffectiveGenerally no increased risk of congenital malformationsPossibly decreased platelet aggregation in neonatesMonitoring recommended for systemic toxicities (electrolyte imbalance, renal dysfunction) in the motherNo apparent increased risk of congenital malformations after a single dose of 150 mg/dayAfter higher doses (> 400 mg/day) taken for most or all of the 1st trimester, increased risk of various malformationsWhen applied to the skin, no significant risk of congenital malformationsNot to be used intravaginally during the 1st trimester unless essential to the mother's welfareNot to be used intravaginally during the 1st trimester unless benefit to the mother outweighs risk to the fetusTeratogenic in rodents, but no proof of this effect in humansWhen the drugs are given during the 2nd or 3rd trimester, fetal hypocalvaria and hypoperfusion (which can cause renal defects), renal failure, and the oligohydramnios sequence (oligohydramnios, craniofacial deformities, limb contractures, and hypoplastic lung development)Fetal bradycardia, hypoglycemia, and possibly fetal growth restriction and preterm birthWhen the drugs are given during the 1st trimester, possibly phalangeal deformitiesWhen the drugs are given during the 2nd or 3rd trimester, fetal growth restrictionPrevention of normal maternal volume expansion, reducing placental perfusion and contributing to fetal growth restrictionNeonatal hyponatremia, hypokalemia, and thrombocytopeniaTeratogenic in animals, but no proof of this effect in humansCongenital malformations (eg, fetal growth restriction, mandibular hypoplasia, cleft palate, cranial dysostosis, spinal defects, ear defects, clubfoot)Possibly congenital malformations and sperm abnormalitiesEffective contraception recommended during pregnancy and for 6 mo after treatment of male or female partnerEffective contraception recommended for 8 wk after the last doseTeratogenic in animals, but no proof of this effect in humansTeratogenic in animals, but no proof of this effect in humansBased on limited data, no increased teratogenic riskWhen benzodiazepines are given late in pregnancy, respiratory depression or a neonatal withdrawal syndrome that can cause irritability, tremors, and hyperreflexiaWith high doses, possibly 1st-trimester spontaneous abortions, delayed onset of labor, premature closing of the fetal ductus arteriosus, jaundice, occasionally maternal (intrapartum and postpartum) and/or neonatal hemorrhage, necrotizing enterocolitis, and oligohydramniosUse permitted for short durations during the 2nd trimester if the fetus is carefully monitoredAdverse effects but no teratogenicity in animal studiesRisk of a neonatal opioid withdrawal syndrome (neonatal abstinence syndrome)Improved fetal outcomes compared with those when pregnant women use illicit substancesIn neonates of women addicted to opioids, withdrawal symptoms possibly occurring 6 h to 8 days after birthWith high doses given in the hour before delivery, possibly neonatal CNS depression and bradycardiaImproved fetal outcomes compared with those when pregnant women use illicit substancesPossible need for acute short-acting analgesics to supplement maintenance dosing during labor and deliveryHigh teratogenic risk (eg, multiple congenital malformations), spontaneous abortion, and intellectual disabilityContraindicated during pregnancy and in women who may become pregnantWhen these drugs are given during the first 14 wk, masculinization of a female fetus’s genitals (eg, pseudohermaphroditism)Synthetic progestins (but not the low doses used in oral contraceptives)Fetal goiter and neonatal scalp defects (aplasia cutis)To be avoided during the 1st trimester of pregnancyFetal goiter and maternal hepatotoxicity and agranulocytosisDestruction of the fetal thyroid gland or, when the drug is given near the end of the 1st trimester, severe fetal hyperthyroidismLarge fetal goiter, which may obstruct breathing in neonatesWith rubella and varicella vaccines, potential infection of the placenta and developing fetusWhen these drugs are used during the 1st trimester, possibly orofacial cleftsPossible transient increases in maternal aminotransferase levels, peripheral neuropathyPlacental vasoconstriction and possible risk of gastroschisisIn women or fetuses with G6PD deficiency, hemolysis*The American College of Obstetricians and Gynecologists (ACOG) recommends avoiding In the amount typically present in prenatal vitamins (5000 IU/day), vitamin A has not been associated with teratogenic risk. 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