There are 5 categories for medications to note when dealing with a pregnant or lactating patient, ranging from “no risk to fetus” to “drug is contraindicated, risk outweighs the benefit.” Considerations for these patients must include the possibility of danger not only to the mother but also to the child, regardless of the stage of pregnancy or the age of the newborn. Danger can exist in the first trimester and also near term. Abnormalities generally occur in 3% to 6% of all pregnancies in the United States. There is evidence that 1% to 5% of these are caused by prescribed medications. Medications should not be administered unless the drug is safe for the fetus or newborn. Women who are nursing and need antibiotic medications should be prescribed those that do not pass well into breast milk, such as amoxicillin and clindamycin. Those needing analgesics can be prescribed acetaminophen, which is compatible with breast milk. Aspirin and ibuprofen appear to enter the breast milk and are not recommended. The effects of fluoride varnishes on pregnant and nursing women are not known at this time and are not recommended. Locally delivered medications such as Arestin and Atridox enter breast milk and may cause discoloration of teeth that are forming. The effects of chlorhexidine-based medications such as PerioChip are not known at this time. Most local anesthetics in their usual doses, with the exception of benzocaine, appear to have no effect on the nursing infant. Combination local anesthetics such as Oraqix (lidocaine and prilocaine) also appear to be safe. When medications are necessary, mothers should avoid nursing at peak concentration of the drug, take it prior to the longest sleep cycle of the baby, or suspend nursing temporarily. Checking reference guides or consulting with a pharmacist will assist in locating precautions for your patients.
(Source: Journal of Practical Hygiene, March 2007)
