Pregnancy and prescriptions

A brand-new study published in the medical journal Obstetrics & Gynecology found physicians today prescribe drugs at an amazing rate to pregnant women.

When I was in medical school 40 years ago, my professors taught us to never prescribe drugs to pregnant women–except in life-threatening situations. We all remembered vividly how the FDA made a name for itself in the mid-20th century in the U.S. by banning Thalidomide–which caused horrendous birth defects in Europe.

So pregnant women of my generation did everything they could to avoid taking any drugs during pregnancy.

But my, how times have changed.

As I recently reported, new research links maternal antidepressant use during pregnancy with birth defects and developmental problems. Yet one-third of women still think it’s safe to take these drugs while pregnant or breastfeeding.

But the problem is not limited to antidepressant drugs, as the new study in Obstetrics & Gynecology shows.

The new study followed more than one million women enrolled in Medicaid before the onset of pregnancy between 2000 and 2007. So, we can also assume Medicaid also paid for the disturbing number of drugs doled out.

Researchers found physicians prescribed at least one drug to 83 percent of the pregnant women. That’s more than four out of every five pregnant women. And they prescribed a drug that could potentially harm the baby to 42 percent of pregnant women.

The top-five most commonly prescribed drugs were:

  1. nitrofurantoin (22 percent)
  2. azithromycin (20 percent)
  3. metronidazole (19 percent)
  4. amoxicillin (18 percent)
  5. cephalexin (14 percent)

As you might guess, these drugs are all antibiotics.

Interestingly, physicians wrote enough prescriptions so that 103 percent of the women in the study could receive one of these antibiotic drugs.

How’s that even possible?

Well–it means there were enough prescriptions doled out for every pregnant woman in the study (more than one million) to receive at least one prescription. Plus, clearly, some women received more than one prescription.

Why dole out so many antibiotics, given the known dangers?

I often report on the problems of prescribing too many antibiotics. It has resulted in antibiotic-resistant “superbugs.”

The government does a lot of hand-wringing about the superbug problem (while simple hand-washing would actually be a big help), but they don’t really have a clue about how to put an end to their new, permanent war.

If the CDC really wanted to solve the problem of antibiotic resistance, here is one place I’d start looking. (Medicaid could even save the taxpayers some money by cutting back on all the antibiotics). I’d also look at all the natural ways to boost the immune system so fewer people would get sick in the first place–starting with good nutrition and nutritional status. But we never seem to hear about those natural approaches from the CDC.

The physicians also prescribed many Category D medications to the pregnant women in the study. We have very little hard data on women who use these drugs during pregnancy, but based on adverse reaction data, we do know they can affect fetal development.

In this study, the top-five category D medications prescribed to pregnant women were:

  1. codeine (12 percent)
  2. hydrocodone (10 percent)
  3. ibuprofen (5 percent)
  4. sulfamethoxazole (4 percent)
  5. hydrocortisone (4 percent)

The researchers also noted that nine out of the 20 most commonly prescribed medications during pregnancy only have “limited” to “fair” data regarding their potential to cause birth defects in humans, according to the Teratogen Information System (TIS). ‘Tis a pity indeed.

Teratogenicity is the technical term for the ability to cause birth defects. Teratos comes from the ancient Greek word for “monster,” as in casting a spell or curse to create a monster. You have to wonder what spell the prescribers are under to perform such monstrous medical practices.

Plus, whatever happened to screening drugs for teratogenicity? Does that still happen anymore?

Last June, the FDA did change labeling requirements for drugs used during pregnancy and breastfeeding. The new labels will include a summary of the risks the drugs can potentially cause during pregnancy.

But why do physicians prescribe drugs to so many pregnant women in the first place? As I said earlier, doctors certainly didn’t prescribe them as commonly in the old days.

Perhaps obstetricians who deliver babies should be asked to deliver us from this evil.

 

Source:

  1. “The Most Commonly Dispensed Prescription Medications Among Pregnant Women Enrolled in the U.S. Medicaid Program,” Obstet Gynecol 2015;126:463-478

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