Prescribing or continuing medications in pregnancy is a cause for significant concern and anxiety for health professionals for fear of causing harm to the fetus. However, it is important to also consider the risks of not adequately treating the underlying condition as this can have an impact on both the woman and developing fetus. For example, we know that uncontrolled autoimmune disease is associated with a higher risk of preterm birth, fetal growth restriction, preeclampsia, venous thromboembolism, and other pregnancy complications.
Therefore, you need to balance the risks and benefits of starting/continuing the medication against the risks and benefits of stopping or withholding them.
Unfortunately, there is a lot of outdated and misguided information with regards to medication, and very few medications are licensed in pregnancy. However, many medications are safe to continue in pregnancy. It is important to refer to and use reputable evidence-based resources and guidelines to adequately inform and counsel the woman on the safety of medications in pregnancy.
Please see links below for recommended resources for information on prescribing in pregnancy and breastfeeding.
Research into the effects of taking different medications is a slow growing field. Here are some resources that bring together existing knowledge:
This website provides reliable, evidence-based, and accurate information about use of medicines in pregnancy, in the form of freely available patient information leaflets called ‘Bumps‘ (‘Best Use of Medicines in Pregnancy’).
This is effectively the professional’s version of bumps. It is free but requires registration.
This resource provides accurate and independent information about medications to treat mental health conditions during pregnancy and breastfeeding. Several are available in multiple languages.
Consensus advice on Prescribing of Corticosteroids and Immunomodulatory. Medications during pregnancy and breastfeeding. Full reference link available in Rheumatology section
The LactMed® database contains information on drugs and other chemicals to which breastfeeding mothers may be exposed. It includes information on the levels of such substances in breast milk and infant blood, and the possible adverse effects in the nursing infant.