Most medications used during pregnancy are considered safe, but some cannot be given a clear explanation because of limited information. Therefore, it is not recommended, that pregnant women give up their children easily because they do not know that they are using drugs during pregnancy. The reasons are as follows: Teratogenic studies: we know very little There are few drugs that are clearly teratogenic, because it is not possible to have information on all drugs used during pregnancy. At present, research on the effects of drugs on the fetus is still limited to the structural abnormalities of the fetus caused by drugs. There is no information on the effects on fetal intelligence, organ function, or later sexual orientation and social skills. Moreover, the ability to metabolize drugs differs from person to person.
The biggest difference between taking medicine and drinking water is the dosage. One of the mainstream views on medication and teratology 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 has been 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 to the fetus is 10 or even tens of times greater than the recommended dose for conventional human use.
The “all or nothing” theory
Do you take them before ovulation or after ovulation. There is also a strong relationship between drug teratogenicity and the period of time when the drug is used. If the fertilized egg is already formed and implanted when you use the drug, it is then that the embryo has access to body fluids and can be affected.
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.
The FDA drug classification leaves much to be desired and flawed
In one of the most serious drug teratogenic events in human history – “Reactive Stop Event”. The drug was used in pregnant women who had a significant reaction to early pregnancy, and approximately one-third of the babies born had limb defects. It was because of the incident that people became concerned about 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. This system classifies oral contraceptives as a very small teratogenic risk.
There are many deficiencies in the FDA classification of proprietary Chinese medicines, let alone teratogenic ones, and many changes are needed. The Chinese government has directly applied the ready-made FDA classification without making a little effort of its own. We can look at proprietary Chinese medicines, which are three kinds of drugs, so why are you 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 advise you not to worry too much. The above mentioned prohibitions are often due to the fact that pCms have some blood-activating ingredients, and from a TCM point of view the use of drugs with blood-activating ingredients during pregnancy increases the risk of miscarriage and is therefore not recommended or prohibited.
Just because it is banned during pregnancy does not mean 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. In addition, there are patients who have asked me: pregnant eating MSG has an effect on the child? I’ve also been asked by patients: Will eating kimchi affect the baby? Will it affect the baby if I take pictures with the camera? Can I turn on the flash when I’m pregnant?
Where can I find data on MSG and kimchi teratogenicity in books, and there is no indication in the manual. 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.
Chinese people worry that computer radiation is bad for children
According to the World Health Organization, there is no evidence so far that computer radiation increases the rate of miscarriage, but the miscarriage rate of pregnant women working with computers is 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 It is recommended abroad that pregnant women should not work more than 6 hours a day on a computer and get up frequently to change their position.
A pregnant woman needs to have an abortion after using a little medicine during pregnancy?
I am saddened by the fact that when a pregnant woman goes to a doctor to have her baby aborted, some medical professionals also advise the patient to have the baby aborted. I believe that some medical professionals advise pregnant women to have their babies aborted 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?” There are many patients who come in during early pregnancy who have not even seen a fetal heart yet, knowing that the spontaneous abortion rate during early pregnancy is 15 percent. Thinking about it differently, 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 or may not be a problem, to be very vague and put the risk back on you.
The numbers that doctors are really concerned about are given the unreliability of the limited data from studies of teratogenicity of medications during pregnancy and the unpredictability of the risks of individualized medication regimens. I believe that the scope of medication and drug teratology counseling during pregnancy should be limited to cases that require high doses of medication during pregnancy due to maternal diseases such as “epilepsy, gestational hypertension, diabetes mellitus, thyroid disease, rheumatic immune diseases”, rather than regular doses of a drug before pregnancy, around the time of ovulation, once or several times, or topical use by the male partner. 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 the medication or adverse factors have affected the embryo, nor is there any basis to do so.
You asked me around the 30th day of pregnancy if the occasional unintentional use of medication had an effect on the embryo.
These figures appear in my eyes: you face a natural rate of 15% spontaneous miscarriage inherent to pregnancy, 2% incidence of ectopic pregnancy, 3-5% natural rate of birth defects, including 1 in 700 births of Down’s syndrome (trisomy 21, mental retardation), 1 in 700 births of Creutzfeldt-Jakob (47, XXY, infertile) in male babies, etc.
The last words I would like to give to everyone: “But do good, don’t ask questions about your future”.