Drug-prescribing challenges during pregnancy

Thousands of pregnant and breast-feeding women take a prescribed or over-the-counter drug preparation daily. Few of these products have been specifically tested for safety and efficacy during normal pregnancy, and there is only scant information on the impact of common pregnancy complications on drug clearance and efficacy. The safety of a drug for fetuses and nursing infants often cannot be determined until it is widely used. Governmental safety categories do not inform on how either pregnancy or lactation may alter the patient's response to therapy compared with the non-pregnant state, nor do they indicate the impact of common medical diseases on a drug's efficacy. In the absence of information many women are inappropriately denied medically important agents. Funding agencies should address these knowledge deficits in a comprehensive fashion, and pharmaceutical houses should be offered incentives to perform clinically relevant studies of drugs that might be used in reproductive-age women before these drugs are marketed. Until the large gaps in the body of knowledge are filled, caregivers should seek and frequently utilise references that are updated regularly throughout the year.