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Medication Use During Pregnancy in the Intensive Care Unit

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Principles and Practice of Maternal Critical Care

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Abstract

We summarized the medical literature regarding the safety in pregnancy of medications used in intensive care units. When considering their use, we have to weigh the benefit to the pregnant woman against the risk to the embryo and fetus. While most drugs can be used in pregnancy, it is important to avoid using those that might adversely affect the fetus, replacing them by drugs with similar pharmacologic actions. This is especially important for antiepileptic drugs, as one has to avoid using the more teratogenic drugs like valproic acid, replacing them by less teratogenic drugs such as lamotrigine or levetiracetam (Keppra).

Supported by the Harris Fund, Chicago, USA

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Authors and Affiliations

  1. Laboratory of Teratology, Department of Medical Neurobiology, Canada-Israel Medical Research Institute, Hebrew University Hadassah Medical School, Jerusalem, Israel

    Asher Ornoy

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  1. Asher Ornoy
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Correspondence to Asher Ornoy .

Editor information

Editors and Affiliations

  1. Intensive Care Unit, Shaare Zedek Medical Center and Hebrew University Faculty of Medicine, Jerusalem, Israel

    Sharon Einav

  2. Division of Anesthesia, Critical Care and Pain, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel

    Carolyn F. Weiniger

  3. Department of Anesthesiology, Columbia University Medical Center, New York, NY, USA

    Ruth Landau

Appendix

Appendix

1.1 Pregnancy and Breastfeeding Drug Classifications

Drugs are labelled with a narrative according to the recommendations for stages of pregnancy and breastfeeding. For most drugs there is no definitive answer, and clinical judgment is required. Information taken from https://www.drugs.com/pregnancy-categories.html, accessed 27th September 2019.

Pregnancy (includes Labor and Delivery):

  • Pregnancy Exposure Registry

  • Risk Summary

  • Clinical Considerations

  • Data

Lactation (includes Nursing Mothers)

  • Risk Summary

  • Clinical Considerations

  • Data

Females and Males of Reproductive Potential

  • Pregnancy Testing

  • Contraception

  • Infertility

Until 2015, drugs were labelled according to five risk categories that may still be stated on drug package labels:

Category A

Adequate and well-controlled studies have failed to demonstrate a risk to the fetus in the first trimester of pregnancy (and there is no evidence of risk in later trimesters).

Example drugs or substances: levothyroxine, folic acid, liothyronine

Category B

Animal reproduction studies have failed to demonstrate a risk to the fetus and there are no adequate and well-controlled studies in pregnant women.

Example drugs: metformin, hydrochlorothiazide, cyclobenzaprine, amoxicillin

Category C

Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.

Example drugs: gabapentin, amlodipine, trazodone

Category D

There is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience or studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.

Example drugs: losartan

Category X

Studies in animals or humans have demonstrated fetal abnormalities and/or there is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience, and the risks involved in use of the drug in pregnant women clearly outweigh potential benefits.

Example drugs: atorvastatin, simvastatin, methotrexate, finasteride

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Ornoy, A. (2020). Medication Use During Pregnancy in the Intensive Care Unit. In: Einav, S., Weiniger, C.F., Landau, R. (eds) Principles and Practice of Maternal Critical Care. Springer, Cham. https://doi.org/10.1007/978-3-030-43477-9_38

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