The medic's guide to prescribing: Prescribing in pregnancy
Pregnancy may be the trickiest situation in which doctors prescribe. Sarah Thomas and colleagues offer valuable advice in the last article of the series
When a baby is born with a congenital defect, parents and professionals look for a cause. As most women use over the counter or prescription drugs at some stage of their pregnancy, drugs are often indicted as the probable culprit-guilt by association.
Studies that look at causality are less impressive-teratogens (drugs or chemicals that cause abnormal development in cells and tissues) are thought to contribute to a minority (2.5%) of all congenital malformations.1 Nevertheless the thalidomide tragedy of the 1960s, when thousands of babies were born with short or absent limbs after their mothers had taken thalidomide as a treatment for morning sickness, still colours the perception of patients and doctors.
Prescribing practice is shaped by anecdotal reports, retrospective series, and extrapolations from animal studies, especially as randomised placebo controlled trials in pregnancy are exceedingly rare. Prescribing in this emotionally charged setting without the backup of strong scientific evidence is