Avoid the Use of Drugs Harmful to the Fetus if at all Possible
Lee Ann Lau MD
Heidi Frankel MD
When treating pregnant patients, it is the physician’s responsibility to treat the mother as the primary patient. Fetal considerations are secondary to ensuring maternal well-being because maternal demise will generally result in subsequent fetal death. With this in mind, however, when options for treatment exist, considering fetal effects is prudent.
Many common critical care drugs are safe in pregnancy, whereas some should be used with caution and others avoided entirely. It is also essential to remember that few drugs are extensively tested in pregnant humans, so caution should be exercised with administration of any pharmaceuticals in the pregnant woman. Consulting the Physicians’ Desk Reference for the current safety ratings in pregnancy will ensure adherence to the most current recommendations.
What to Do
For analgesia, acetaminophen is generally considered safe when used in doses safe for the mother. Narcotics do not have reported teratogenicity; however, they can cause fetal respiratory depression if administered near the time of delivery. Aspirin should be avoided due to risks of intrauterine growth retardation and prolonged labor and bleeding. Although there is some controversy, nonsteroidal anti-inflammatory drugs are generally considered to be safe in the later part of pregnancy. Most inhalational agents and neuromuscular blockers are safe. Local anesthetics are able to cross the placenta but do not have fetal effects at common doses.
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