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Prescribing in Pregnancy

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Anaesthetics and Critical Care

Obstetrics Gynaecology

Trauma and Orthopaedics

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Urology

Version Jan 2023

Consider all fertile females pregnant until proven otherwise especially before prescribing any drug from the list below. Check all drugs in BNF.

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Many drugs can cross the placenta to the fetus and some may have adverse effects
The first trimester (weeks 1-12) is when the fetus is vulnerable to congenital malformations
In the second trimester (weeks 13-26) and third trimesters (weeks 27-42) usually results in growth retardation or has direct toxic effects upon fetal tissues.
There are no totally safe drugs to use in pregnancy, but there are drugs known to be particularly troublesome.
Always use the minimum dose and the shortest duration possible.
Avoid all drugs possible in the first trimester.

Drugs considered acceptable

Penicillins, cephalosporins, heparin
Ranitidine, paracetamol, codeine.

Known Drugs to avoid (All should be checked in BNF)

Tetracyclines, streptomycin, quinolones
Warfarin, thiazides, ACEi, lithium, NSAIDs
Alcohol, retinoids, barbiturates, opioids
Cytotoxic drugs, and phenytoin. Thalidomide
Valproate should be avoided if possible: Neurology review

Table of unsafe drugs and potential effects

Name	Advice
Lithium	Cardiac problems
Warfarin	Skeletal issues of long bones. Heparin is preferred
Sodium valproate	Neural tube defects
Retinoids	Neural tube defects, Miscarriage
Antithyroid drugs e.g. Carbimazole	Neonatal goitre (can affect or obstruct labour)
Gentamicin	Nerve deafness in newborns
Alcohol	Teratogenic, fetal alcohol syndrome, stillbirth
ACEI/AT2 Blockers	Growth retardation, birth defects
Live-virus vaccines	Should not be given to women who are or may be pregnant
Thalidomide	Limb deformity
Diethylstilbestrol	Teenage Vaginal/Cervical cancer
Phenytoin	Facial fusion problems and cleft lip and palatal issues. Needs Specialist neurology assessment
Valproate	Teratogenic - needs Specialist neurology assessment
Methotrexate	Birth defects
Chloramphenicol	Grey baby syndrome
Isoniazid	Peripheral neuropathy and seizures
Radioactive Iodine	Fetal hypothyroidism and Cretinism

PLEASE NOTE LEGAL ADVICE: The contents are under continuing development and improvements and may contain errors of omission or fact. The official launch will be at the end of 2018. Feedback vital and always welcome at drokane at gmail.com. This is not to be used for the assessment, diagnosis or management of patients. It should not be regarded as medical advice. It is only for educational purposes. Please adhere to your local protocols. If you are unwell please seek healthcare advice from your doctor. This does not replace senior or specialist advice. If you do not accept this then please do not use the website. If you need medical advice, please consult a doctor or other appropriate medical professional. If you are a medical professional and you need advice then speak to your senior or colleagues.

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