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Providing care to pregnant women: do no harm

French medical journal Prescrire devotes its annual special issue to the prudent use of medicines by pregnant women.

Some pregnant women are ill. And many pregnant women are, at some point, bothered by common ailments which may or may not be specific to pregnancy. When a woman who is pregnant, or who might be pregnant, consults a healthcare professional for a common ailment, deciding whether or not to take medication is no ordinary decision, for it affects the unborn child as well.

In order to provide care but do no harm, several questions arise: what are the consequences of the ailment, for the pregnant woman and for the unborn child? Could the pregnancy make the ailment worse? Are non-drug methods helpful and perhaps sufficient? When medication is called for, which drug would be a reasonable choice, above all so as to do no harm?

For some drugs, the risks are known or easy to gauge. But for most drugs, the absence of a specific and demonstrated risk is not enough to dispel the uncertainty: the absence of proof of toxicity is not proof of the absence of toxicity.

Drugs have been known to cause disastrous damage (thalidomide, diethylstilbestrol (DES), etc.), with birth defects or other consequences that were only linked to those drugs several years after they were used.

In the case of a pregnant woman, the use of medications must  be even more cautious than with other patients. An analytic grid is needed to estimate the risks, to avoid egregious errors, and to be aware of the most vulnerable periods. To avoid risky gambles when it comes to medications, especially for trifling ailments. To choose thoughtfully, to provide care but do no harm, either to the pregnant woman or to the unborn child.

The special issue of  Prescrire describes the approach and the basic principles governing  the choice of medication in case of pregnancy, to avoid, to the greatest possible extent, exposing the unborn child to adverse effects.

©Prescrire 1 August 2013

Source: "Femmes enceintes et médicaments" Rev Prescrire 2013 ; 33 (358).
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