|
Drug
|
FDA use-in-
pregnancy rating
[dagger]
|
Crosses placenta
|
Major maternal toxicities
|
Fetal toxicities
|
Lactation
|
Fertility
|
|
|
Aspirin
|
C; D in third trimester
|
Yes
|
Anemia, peripartum hemorrhage, prolonged labor
|
Premature closure of ductus, pulmonary hypertension,
ICH
|
Use cautiously; excreted at low concentration; doses
>1 tablet (325 mg) result in high concentrations in infant plasma
|
No data
|
|
NSAIDs
|
B; D in third trimester
|
Yes
|
As for aspirin
|
As for aspirin
|
Compatible according to AAP
|
No data
|
Corticosteroids
Prednisone
Dexamethasone
|
B
C
|
Dexamethasone and beta-methasone
|
Exacerbation of diabetes and hypertension, PROM
|
IUGR
|
5-20% of maternal dose excreted in breast milk; compatible,
but wait 4 hours if dose >20 mg
|
No data
|
| Hydroxychloroquine
|
C
|
Yes: fetal concentration 50% of maternal
|
Few
|
Few
|
Contraindicated (slow elimination rate, potential
for accumulation)
|
No data |
| Gold
|
C
|
Yes
|
No data
|
1 report of cleft palate and severe CNS abnormalities
|
Excreted into breast milk (20% of maternal dose);
rash, hepatitis,
and hematologic abnormalities reported, but AAP considers
it compatible
|
No data |
|
D-penicillamine
|
D
|
Yes
|
No data
|
Cutis laxa connective tissue abnormalities
|
No data
|
No data
|
|
Sulfasalazine
|
B; D if near term
|
Yes
|
No data
|
No increase in congenital malformations, kernicterus
if administered near term
|
Excreted into breast milk (40-
60% maternal dose); bloody diarrhea in 1 infant;
AAP recommends caution
|
Females: no effect; males: significant oligospermia
(2 months to return to normal)
|
| Azathioprine
|
D
|
Yes
|
No data
|
IUGR (rate up to 40%) and prematurity, transient
immunosuppression
in neonate, possible effect on germlines of offspring
|
No data; hypothetical risk of immunosuppression outweighs
benefit
|
Not studied; can interfere with effectiveness of
IUD
|
|
Chlorambucil
|
D
|
Teratogenic effects potentiated by caffeine
|
No data
|
Renal angiogenesis
|
Contraindicated
|
No data |
| Methotrexate
|
X
|
No data
|
Spontaneous abortion
|
Fetal abnormalities (including cleft palate and hydrocephalus)
|
Contraindicated; small amounts excreted with potential
to accumulate in fetal tissues
|
Females: infrequent long-term effect; males: reversible
oligospermia
|
|
Cyclophosphamide
|
D
|
Yes: 25% of maternal level
|
No data
|
Severe abnormalities; case report: male twin developed
thyroid papillary cancer at 11 years and neuroblastoma at
14 years
|
Contraindicated; has caused bone marrow depression
|
Females: age >25 years, concurrent radiation,
and prolonged
exposure increase risk of infertility; males: dose-dependent
oligospermia and azoospermia regardless of age or exposure
|
|
Cyclosporin A
|
C
|
Yes
|
No data
|
IUGR and prematurity; 1 case report: hypoplasia of
right leg; not an animal teratogen and unlikely to be a
human one
|
Contraindicated due to potential for immunosuppression
|
No data |
* ICH = intracranial
hemorrhage; AAP = American Academy of Pediatrics; PROM = premature
rupture of membranes; IUGR = intrauterine growth retardation; CNS
= central nervous system; IUD = intrauterine device.
[dagger] Food
and Drug Administration (FDA) use-in-pregnancy ratings are as follows:
A = Controlled studies show no risk. Adequate, well-controlled studies
in pregnant women have failed to demonstrate risk to the fetus.
B = No evidence of risk in humans. Either animal findings show risk
but human findings do not, or, if no adequate human studies have
been performed, animal findings arenegative. C = Risk cannot be
ruled out. Human studies are lacking and results of animal studies
are either positive for fetal risk or lacking as well. However,
potential benefits may justify the potential risk. D = Positive
evidence of risk. Investigational or post-marketing data show risk
to the fetus. Nevertheless, potential benefits may outweigh the
potential risk. X = Contraindicated in pregnancy. Studies in animals
or humans, or investigational or post-marketing reports, have shown
fetal risk which clearly outweighs any possible benefit to the patient.
