Medications not recommended during pregnancy: what's the deal when TTC?
August 24, 2022 12:51 PM   Subscribe

YANMD, but hopefully YAAD or even if I'm lucky an obstetrician: what's the deal with medicines and herbs that are considered potentially harmful in pregnancy but not so harmful they come with big warning labels that say DO NOT TAKE IF YOU ARE PREGNANT OR TRYING TO BECOME PREGNANT?

Like, is ibuprofen or Robax or raspberry leaf tea or a big dose of caffeine going to harm a zygote/blastocyst/embryo that's too new for a pregnancy test to detect? Or are those really concerns for once you're past six weeks or so of gestational age? Are the risks with these sorts of things more like risk of miscarriage or risk of severe congenital abnormalities?

Basically how careful do I have to be with what I put in my body during the dreaded "two-week wait"?

Help me know how anxious to be and about what! Thank you!
posted by cabbage raccoon to Health & Fitness (7 answers total)
For ibuprofen specifically, I was told to avoid it after all of my IUIs and my embryo transfer, because (if I recall correctly) NSAIDs can affect implantation or increase risk of early miscarriage.

Hopefully someone with more knowledge can address your question more fully, but that’s what my dr said.
posted by tan_coul at 1:16 PM on August 24, 2022 [1 favorite]

It depends what it is - most things haven't been precisely studied during that exact window for ethical and logistical reasons so it's tough to say what the real risk is. The 2 week wait is before/around implantation (gestational weeks 2-4) so the embryo is still separate from the maternal blood supply and less likely to be affected by most things then compared to later in the first trimester. For commonly used things like alcohol and caffeine, most people don't yet know they're pregnant during the 2 week wait so you can imagine how common exposure in that window is. Still, it's hard to definitively say it's safe then, or draw a line for when it becomes unsafe, particularly for things like alcohol that are known to be unsafe in the first trimester.

There are definitely some things that can cause birth defects, miscarriages, etc before 6 weeks. Not everything on the long "avoid in pregnancy list" by any means, but some things, yes. You could ask your doctor about which things are the biggest concerns. I personally avoided anything that was known to be seriously harmful in the first trimester even during the two week wait, but didn't stress too much about more minor things like caffeine, listeria-risk foods, or "we don't know if it's safe" stuff during that window.
posted by randomnity at 1:25 PM on August 24, 2022 [2 favorites]

I am not a doctor (well not a medical sort anyhow), but I do know that some drugs are simply completely unstudied during pregnancy, or at least unstudied during human pregnancy. Drugs are classed by the FDA into 5 cases, see HHS description of these categories.

For X drugs, you can't take them if there's any chance you are pregnant or if you are TTC, because we know they cause big risks for human pregnancies. For C or D drugs, you should be talking with a physician to see if the benefits for you outweigh the risks. For A or B drugs the concern is low. (Note B just doesn't have studies in humans that indicate safety; but there's plenty of reason studies like that never get done. B drugs *also* don't have any studies that indicate possible harm in animal models either.).

Ibuprofen specifically is B in the first two trimesters, but D in the third.

So it isn't binary; rather it's range of risk, and where you fall on that range vs. the possible benefit for you is something you'll have to talk out with your doctor (because it depends on your own specific medical condition).
posted by nat at 1:33 PM on August 24, 2022 [4 favorites]

Yes--despite attempts to prod change in that direction, drugs are rarely tested in pregnant women so most of those kinds of labels are based on lack of evidence for nonharmfulness/benefits outweighing harm rather than evidence of harm/harm outweighing benefits.
posted by praemunire at 1:34 PM on August 24, 2022 [1 favorite]

Oh -- the easy way to find out which class the FDA puts a drug in is to google for "drugname pregnancy category". E.g. for Robax it's Category C, which means there aren't human studies but some animal studies indicate a possible risk. Is it ok for you to take? Depends on your personal medical situation.
posted by nat at 1:35 PM on August 24, 2022

Best answer: Some specific information:

Methocarbamol (robax) can cause birth defects in animals and may contribute to birth defects in people - these are usually first trimester problems. Ibuprofen is known to be a third trimester concern, but also may increase the risk of miscarriage in early pregnancy.

In general:

Medications and supplements that are active in your body are chemicals that have the capability to pass through the digestive system and get absorbed, then stick around long enough to have an effect on you. That means that many of them can have an effect on an embryo.

Early life uses a whole suite of genes that help to define patterns and structures in the developing body. Most of these don't do anything else later, or they may have a radically different role later. Unfortunately that means that drugs developed for people can have completely unexpected effects when taken in early pregnancy because they interact with some signal that isn't present in adults.

Back to you:

With that being said, you likely have a good reason to take these medications. There are some studies of specific medications/conditions in pregnancy that show that treating a pregnant person with a potentially harmful medication leads to better pregnancy outcomes than avoiding treatment. Also most people who become pregnant seem to have ingested something that they might have chosen not to if they knew they were pregnant. Most pregnancies end well despite this. If you have the ability to avoid those medications, do so. If you can talk to your doctor and find a safer treatment (acetaminophen, heat, cold, stretching, avoiding strain), do so as well. If you are prone to anxiety and regret, do your best to make a plan that takes care of you and lowers pregnancy risks and then do your best to let go of that anxiety.
posted by Emmy Noether at 1:38 PM on August 24, 2022 [2 favorites]

Others have addressed some of the broad points - most of the time we just have animal or no data so we can't make good quality recommendations. Ethics of doing human pregnancy drug testing is a pretty high bar, so it's not coming out anytime soon.

But raspberry leaf tea, specifically, is known as a 'menstrual regulator' in herbal books. That is, it's a big no for wanted early pregnancies. Some people use it in late late pregnancy to help labor.
posted by cobaltnine at 6:14 PM on August 24, 2022 [2 favorites]

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