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Release: Nov. 26, 2002

UI promotes understanding of medication use during pregnancy, breastfeeding

Knowing whether to take a medication during or soon after pregnancy is a source of confusion and concern for many women and even their health care providers. However, University of Iowa Health Care physicians and midwives with expertise in medication use during pregnancy and lactation (breastfeeding) are on a mission to educate patients and the professionals who care for them.

"There is general confusion out in the community on giving any woman who is pregnant any drug," said Wendy Hansen, M.D., UI assistant professor (clinical) of obstetrics and gynecology. "Providers often have difficulty finding drug information that helps them care for women during pregnancy and breastfeeding. It's also not uncommon for women to get mixed messages from doctors. We're trying to help prevent that."

Hansen recently co-authored an article on the topic for midwives in the November/December issue of the Journal of Midwifery and Women's Health. Jerome Yankowitz, M.D., UI associate professor of obstetrics and gynecology and director of Maternal-Fetal Medicine, and Anne Peacock, UI certified nurse midwife in the department, also were co-authors of the article which covers safe prescribing practices for upper respiratory conditions, pain control, gastrointestinal problems, and psychiatric illnesses and depression.

"There are so many different providers who interact with pregnant women that disseminating information to these different groups is an important part of what we do," said Hansen, who also has created a drug-appendix for emergency medicine physicians to use when they treat pregnant women.

Hansen and Yankowitz said there are misperceptions on both sides of the spectrum about medication use during pregnancy and breastfeeding, although most women and their providers lean toward not taking or administering a prescription drug.

"In part, the care providers are fearful that they will harm the baby, and so is the mother," Hansen said. "Both people have good intentions yet sometimes we find that not treating is far more dangerous than treating the person."

At UI Hospitals and Clinics, women with life-threatening conditions such as cancer have received treatment during pregnancy, delivered healthy babies and maintained wellness. Treatment for depression, which affects up to 15 percent of all women, is a condition which merits a lengthy discussion about risks and benefits between the mom-to-be and her provider, Hansen said.

"The reflex in the community is to say, 'We'll fix this after you're pregnant,'" Hansen said. "Sometimes it's appropriate for a woman to wait until after pregnancy to use a medication and sometimes it's not."

While most women hesitate to take prescription drugs during pregnancy, there also are misconceptions when it comes to "natural" and over-the-counter drugs, said Yankowitz, who is co-editor with Jennifer Niebyl, M.D., UI professor and head of obstetrics and gynecology, of the book "Drug Therapy in Pregnancy."

"Some people think that if they can get it without a prescription, then it's safe to use at any time. But pregnant and breastfeeding women should check with their physicians about all uses of drugs that can be obtained over-the-counter, as well as vitamin preparations, herbs, minerals and any type of complementary or alternative medicine," Yankowitz said.

For example, when it comes to cold, flu, allergy and runny nose treatments, women can benefit by discussing with their health care provider what specific symptoms cause them problems and get a treatment that targets only those symptoms.

"A lot of medicines are meant to cover three or four symptoms from runny nose to sore throat to cough, but a person may not have all these symptoms or even need to be treated for them," Yankowitz said.

"Women should not take unnecessary medications and should not take medications without their health care provider knowing about it. At the same time, certain medical diseases can be appropriately treated during pregnancy. It's a bit of a balancing act," he added.

The Food and Drug Administration does not approve or ban medication use during pregnancy. Instead, it categorizes medications into different safety levels based on clinical reports and, more often, on animal-based research. Yankowtiz said the system can be difficult for patients and even physicians to use. However, the FDA is refining the classification system.

"It cannot be a straightforward system that simply says a drug is safe to use or not, as some drugs may be worth taking for serious diseases but not for other conditions," he said.

In addition, to Hansen, Niebyl and Yankowitz, other UI physicians involved in research on use of medications by pregnant and breastfeeding women include Scott Stuart, M.D., UI associate professor of psychiatry, and psychology, and Alicia Weissman, M.D., UI assistant professor (clinical) of family medicine.

As with all medical conditions, it is best to consult with your health care provider before making any changes to your health care routine during or after pregnancy.

University of Iowa Health Care describes the partnership between the UI Roy J. and Lucille A. Carver College of Medicine and UI Hospitals and Clinics and the patient care, medical education and research programs and services they provide. Visit UI Health Care online at www.uihealthcare.com.