Pregnant women sometimes feel that finding reliable information to make the best decisions for their own health and that of the baby is stressful [1]. It can be difficult to balance advice from healthcare providers, product advertising and marketing campaigns, and the multitude of opinions or advice on offer in the media or from friends and family. The overload of information available can feel muddled, confusing or even contradictory[1].
Weighing the risks and benefits of taking medications during pregnancy is a good example of this. For example, some may dismiss taking vitamin supplements during pregnancy it as the ‘Elevit for the Hell of it’ mentality, whereas others warn of the risks of vitamin and mineral deficiencies on the pregnancy. Pregnant women may seek relief from common discomforts associated with pregnancy such as heartburn or constipation, or mild joint or ligament pain. Many women are worried about taking any medicines during pregnancy, whether continuing a regular medication or starting a new one.
Most medicines taken in pregnancy will cross the placenta to the baby. As scientists are unable to test new medicines on pregnant women, information has been gathered by watching the effect of certain medicines during pregnancy over time. Some medicines have been taken by a large number of pregnant women without any harmful effects being found. Information about taking other medicines in pregnancy may not be available in large numbers or are only available from studies on animals. Other medicines are known to cause harm to the unborn baby, and the harm can be either temporary or permanent[2].
While wanting to avoid any harm to the unborn baby, for some women, stopping a regular medicine may cause harm to themselves. Some medical and mental health conditions such as depression and anxiety during pregnancy and early motherhood can cause substantial harm to both the mother and the baby if untreated. In these circumstances it is important that the medicine is either continued or swapped for a safer alternative. In special circumstances a medicine may be prescribed for the health of the mother that is not considered safe in pregnancy under normal circumstances, but with increased monitoring and testing during pregnancy and/or after the baby is born[2].
When trying to decide about whether to take a medicine in pregnancy, it is important to weigh up the risks and benefits on your physical and psychological health as well as the health and development of your baby[2, 3]. Ideally, before planning a pregnancy you could meet with your health professional to find all of the options available, and to weigh the risks, benefits, and suitability of each treatment option. However, as around half of all pregnancies in Australia are unplanned, for some women this is not an option, and can cause worry and concern. Getting the right information to help weigh up the risks and benefits of all options is key.
Choosing Wisely Australia [4] have developed five questions to help people get the right amount of health care – not too much and not too little. Using the Choosing Wisely questions as a guide when you talk with your midwife, doctor or pharmacist can help you decide whether or not to take a medicine during pregnancy. The five questions recommended by Choosing Wisely are:
- Do I really need this medicine?
- What are the risks? If so, how will they be watched during the pregnancy or after the baby has been born?
- Are there simpler, safer options? Would lifestyle changes help such as eating healthier foods or exercising more?
- What happens if I don’t do anything? Ask if your condition might get worse – or better- if you don’t have the medicine
- What are the costs? Costs can be financial, emotional or a cost to your time. Is the cost reasonable or is there a cheaper alternative?
Each pregnancy is unique, with different personal circumstances. When making a decision, it can be reassuring to know the risks and benefits of all of the available options and for you to be clear about what matters most to you[5]. Discussing your options with friends and family or a trusted health professional can help you get the emotional support and information to make your decision.
Sources/ further reading:
- Savory NA, Hannigan B, Sanders J: Women’s experience of mild to moderate mental health problems during pregnancy, and barriers to receiving support. Midwifery 2022, 108:103276.
- Prescribing medicines in pregnancy database [https://www.tga.gov.au/products/medicines/find-information-about-medicine/prescribing-medicines-pregnancy-database]
- Dathe K, Schaefer C: The Use of Medication in Pregnancy. Deutsches Arzteblatt international 2019, 116(46):783-790.
- 5 questions to ask your doctor or other healthcare provider before you get any test, treatment, or procedure [https://www.choosingwisely.org.au/resources/consumers-and-carers/5questions]
- Légaré F, Kearing S, Clay K, Gagnon S, D’Amours D, Rousseau M, O’Connor A: Are you SURE?: Assessing patient decisional conflict with a 4-item screening test. Canadian Family Physician 2010, 56(8):e308-314.
