Most medications used during pregnancy are considered safe, or some cannot be given a clear explanation because of limited information. I do not recommend that pregnant women give up their children easily because they do not know that they are using medications during pregnancy. The reasons are as follows! 1. Teratogenic studies: we know very little There are few drugs that are clearly teratogenic because it is impossible to have information on all drugs used during pregnancy. And it is also difficult to summarize these data, because some defects are not necessarily apparent before and after the birth of the fetus. For example, the relationship between a drug and a tumor in childhood, unless the tumor is a rare tumor, and then the drug is used retrospectively during pregnancy so as to summarize the correlation between the disease and the drug used during pregnancy; if it is a common tumor, it is likely not to be taken seriously at all. The drugs that more clearly cause malformations or have a greater impact are mostly chemotherapy drugs, or hormonal drugs. In addition, research on the effects of drugs on the fetus is still limited to the structural abnormalities of the fetus. There is no mention of the effects on “fetal intelligence”, “organ function”, or later “sexual orientation” or social skills. Also, the ability to metabolize drugs differs from person to person. The point I want to make is that we know very little about the effects of drugs on the fetus. Nowadays, many people worry about the effect on the child’s intelligence, but I think that’s just hearsay, so why don’t you worry about the effect on the child’s “sexual orientation” or “social skills” later on. Because many people only hear about intelligence, but “sexual orientation” is something that you don’t think about but drug research is concerned about, but it’s just as hard to do as intelligence assessment. What do you think is the best way to assess intelligence? IQ? Intelligence? Not to mention the fetus, an adult is difficult! The biggest difference between taking medicine and drinking water is the dose. One of the mainstream views on medication and teratogenicity during pregnancy is: “Any drug or substance can cause fetal malformation, including the water we drink every day. But it’s related to the dose you ingest, and you can’t drink water at a teratogenic dose.” This is translated from a foreign language, and I like this quote because he’s very objective. Drugs are the same way, and the potential to cause malformations usually only occurs at more than ten or tens of times the regular dose, and even then they are not absolutely teratogenic. The vast majority of drugs are safe at regular doses. Caffeine, for example, is a popular saying that you should not drink coffee or tea during pregnancy because it contains caffeine. Caffeine is indeed very clearly teratogenic, and an increased incidence of limb and palate malformations in fetuses was observed in experiments with pregnant mice and rats. At higher doses of caffeine exposure, fetal mortality, growth retardation and skeletal variation were observed. In primates, an increased incidence of stillbirths and abortions was also observed in offspring of female crab-eating monkeys exposed to caffeine during pregnancy. However, in humans, caffeine has not been reported to cause fetal birth defects because a person cannot drink hundreds of cups of coffee a day, yet in animal studies, the daily dose of coffee given to monkeys was much higher than the daily dose consumed by a normal person. In other words, “caffeine is teratogenic does not mean that drinking coffee is teratogenic.” Whether a drug is teratogenic or not is highly dependent on the dose used. Usually a drug is considered to be a potent teratogen if it produces toxic effects on the embryo at less than 10 times the conventional dose. Therefore, the potential risk of the drug to the fetus should be 10 times or even tens of times more than the conventional human recommended dose. 3, “all or nothing” theory Are you eating before ovulation or after ovulation Secondly, drug teratogenicity and the period of use of drugs also have a great relationship. If the fertilized egg is already formed and in place when you use the drug, the embryo will have access to body fluids and may have an effect on the embryo. However, in the early stages, the fertilized egg has very few cells and if the embryo is affected by adverse stimuli such as drugs or radiation, the embryo will die and miscarry. If the embryo survives, it is considered unaffected, which is the current “all or nothing” theory of drug teratogenesis. If the drug is administered before ovulation or before implantation, it is not considered to have an effect because the fertilized egg is not formed or does not come into contact with body fluids. Unless the drug has a long half-life and takes a long time to metabolize cleanly in the body. Contact between the fertilized egg and body fluids is often not possible until after 7 to 10 days after ovulation. 4, FDA drug classification There are still many shortcomings and defects in one of the most serious drug teratogenic events in human history – “reaction stop event”. The drug was used in pregnant women who had a significant reaction to early pregnancy, and about one-third of the babies were born with limb defects. It was because of the “Reactivation Incident” that people began to pay attention to the safety of drugs used during pregnancy. The U.S. Food and Drug Administration began to require all drugs to include studies on the risk of fetal teratogenicity. The FDA established a classification system, which classifies drugs into five categories: A, B, C, D, and X for their teratogenicity. Class A and B drugs are relatively safe for use during pregnancy, and Class X drugs are prohibited during pregnancy. class C and D drugs are to be used when the benefits outweigh the disadvantages. Many of our pregnant women are now aware of the US FDA classification through internet knowledge. Sadly, many of our medical professionals only know the FDA classification. Some of them are based on “a few case reports” or “limited animal data” and are slow to be updated, which may not be appropriate for counseling pregnant women. For example, common oral contraceptives are classified by the FDA as “Category X” prohibited during pregnancy. I believe that pregnancy testing on animals may induce malformations, but humans use emergency contraceptives around the time of ovulation or before the fertilized egg is laid, so who knows how to take a pill after pregnancy? Right now there are no reports of fetal teratogenicity due to the use of oral contraceptives. In fact, there are many foreign standards for classifying drug safety in addition to the FDA classification. For example, Wayne State University’s Teratogenicity Rating System. The system classifies oral contraceptives as a very small teratogenic risk. The FDA classification has many shortcomings and needs to be changed. The Chinese government directly applied the ready-made FDA classification, but did not make a little effort themselves. We can look at proprietary Chinese medicines, which are poisonous in three ways, so why are we so sure that they do not have teratogenic risks. The instructions for proprietary Chinese medicines are either prohibited, or used with caution, or no relevant data. The banned and cautionary ones do not say why and provide data from animal studies. As for the question of proprietary Chinese medicines, if you use them and the instructions say they are prohibited, I would also suggest that you do not worry too much. The prohibitions mentioned above are often due to the fact that pCms have some blood-activating ingredients, and from a TCM point of view using drugs with blood-activating ingredients during pregnancy increases the risk of miscarriage and is therefore not recommended or prohibited. The prohibition here does not mean that it has a serious teratogenic risk. In fact, from another point of view, the Chinese medicine is more mild, many Chinese medicine itself is not good, but the Chinese mind is easy to accept, in fact, many drugs are not recognized in foreign countries. The effect of the cure is not obvious, not to mention teratogenic. As an example, Cordyceps we all know that this herb is very good, but made into a proprietary drug effect is not known. 6, kimchi, MSG, computer radiation or something, you think too much In addition, there are patients have asked me: pregnant eat MSG on the child has an impact? Eat kimchi on the child is affected? Will it affect the baby if I take pictures with the camera? Can I turn on the flash when I’m pregnant? There is no data on MSG and kimchi teratogenicity in books or instructions. From the point of view of protecting the fetus, we should be less exposed to drugs and semi-processed foods or some food additives during pregnancy, but there is no need to be nagged by the exposure, and even now it is misunderstood that the child will have problems because of the exposure. The Chinese are still worried that computer radiation is bad for children. According to the World Health Organization, there is no evidence so far that computer radiation has increased the rate of miscarriage, but the rate of miscarriage of pregnant women working with computers has increased, mainly because of the high concentration of long hours of computer work, resulting in back pain, fatigue, runny nose and other cold symptoms increase the risk of miscarriage, so in foreign countries it is recommended that pregnant women working with computers should not exceed 6 hours a day, and Therefore, it is recommended in foreign countries that pregnant women should not work more than 6 hours a day on a computer and should get up frequently to change their position. I think radiation protection clothing only in China to have a consumer market, if in foreign countries will be involved in commercial fraud is prosecuted. 7, in addition to medical, there are many social problems I have witnessed a lot of very sad stories. Because pregnant women use a little bit of medicine during pregnancy, do not yet know whether the drug has an impact on the fetus, or even for example, amoxicillin, cephalosporins and other drugs that can be used during pregnancy. Then the abortion was performed. I would like to say, “This is your child.” Some medical professionals are also advising patients to get rid of their children, and that pains me. I think that some medical professionals advise pregnant women to abort their babies for the following reasons. First of all, because maternal-fetal medicine in China is slow to develop, there is no registration for geneticists to practice until now. The patient may have found some OB/GYNs who specialize in OB/GYN surgery. It may be theoretically possible to explain to the patient “lack of communication experience and skills”. Furthermore, the conflict between doctors and patients in China is too complex and the government does not provide enough protection for medical professionals. When counseling patients on pregnancy medications, they take a lot of risks. In the patient’s mind, it is a simple process to go to a doctor for a consultation on pregnancy medications and for the doctor to give an answer. But often the way the patient asks the question makes it awkward for the medical staff: “Do you think there is something wrong with my baby?” Many patients who come in during early pregnancy have not even seen a fetal heart yet, knowing that the spontaneous abortion rate during early pregnancy is 15%. Putting it in perspective, this question is actually a risk transfer to the medical staff. Who dares to say there is no problem? You are advised to do away with it, the child is dead without proof. If you are not advised to do it, who will be responsible if there is a problem? Or simply say, this may have a problem, may not have a problem, said very vague, the risk back to you. 8, doctors really care about the numbers In view of the unreliability of the limited data of the study of teratogenicity of drugs during pregnancy, and the unpredictability of the risk of personalized drug regimen. I believe that the scope of pregnancy medication and drug teratology consultation should be limited to maternal diseases, such as “epilepsy, gestational hypertension, diabetes, thyroid disease, rheumatic immune disease” and other conditions that require long-term high dose medication during pregnancy, rather than the use of a drug in regular doses before pregnancy, around the time of ovulation, once or several times. In these cases, the medication or the adverse factor is not the same as the medication used during pregnancy. In these cases, there is no way to talk about whether or not the medication or adverse factors have affected the embryo, nor is there any basis to talk about it. When you ask me around the 30th day of pregnancy whether the occasional unintentional use of medication has affected the embryo, the following figures appear in my eyes: you are facing a natural rate of 15% spontaneous abortion, 2% ectopic pregnancy, 3-5% natural birth defects, including 1 in 700 births of Down’s syndrome (trisomy 21, mental retardation), 1 in 700 birth rate of Creutzfeldt-Jakob (47, XXY, infertile), etc. The last words I would like to give to you all: “But do good, don’t ask about the future”.