Medication Safety During Early Pregnancy: Concerns and Guidance

Medication consultation

Dear Dr.
Tsao,
As of today, I am 7 weeks and 2 days pregnant (this is my first pregnancy).
I found out about my pregnancy on December 26, 2017, and have been taking "Ujietong" for pregnancy support since then.
However, during this period, I have been suffering from a prolonged cold and have intermittently taken cold medications from both the ENT and obstetrics departments for nearly a month (I have received medication seven times due to persistent coughing that has not improved).
Below are the details of my last menstrual period and the medications taken:
1.
Last menstrual period: November 14, 2017, to November 20, 2017.
2.
Medication dates and details:
- First visit: November 27, 2017 (ENT, total of 9 packets, 3 days' supply)
1.
Diclofenac Sodium
2.
Dexchlorpheniramine
3.
Cetirizine Dihydrochloride
Since I did not experience relief after taking 3 packets of this medication, I stopped and sought another clinic on November 28, 2017.
- Second visit: November 28, 2017 (ENT, total of 12 packets, 3 days' supply)
1.
Cefadroxil 500 mg
2.
Ponstan
3.
Kompimin (Rotec) 0.5 tablet
4.
Fucou Capsules H....
(uncertain if it is H.H or H.S due to the long name)
5.
Cowemin Tablets 30
6.
Levozine F.C.
Tablet
I took this medication from November 28 to December 1, 2017.
- Third visit: December 4, 2017 (ENT, total of 9 packets, 3 days' supply)
1.
Amoxicillin 250 mg
2.
Lactam-acetaminophen 0.5 tablet
3.
Dex CTM 2 mg 0.5 tablet
4.
Fucou Capsules H....
(uncertain if it is H.H or H.S) 0.5 Cp
The doctor inquired if I was pregnant, and upon my response indicating a pregnancy plan, he switched me to medications suitable for pregnant women.
- Fourth visit: December 7, 2017
- Fifth visit: December 16, 2017
- Sixth visit: December 23, 2017 (all ENT, each with 12 packets, 3 days' supply)
Medications were:
1.
Amoxicillin 250 mg
2.
Lactam-acetaminophen 0.5 tablet
3.
Dex CTM 2 mg 0.5 tablet
4.
Fucou Capsules H....
(uncertain if it is H.H or H.S) 0.5 Cp
5.
Cowemin Tablets 30
After learning about my pregnancy on December 26, I did not dare to continue taking the remaining two packets of medication from the December 23 visit.
- Seventh visit: December 27, 2017 (Obstetrics, total of 20 packets, 5 days' supply)
1.
Levofloxacin Tablets
2.
Meizhu Tablets
3.
Acetaminophen 200 mg + Ethoxybenzamide 167 mg
Due to persistent coughing, I requested medication from the obstetrician.
On December 30, I consulted another obstetrician who advised that as long as I do not have a fever, I should avoid taking any medications during this stage.
I took a total of 6 packets of medication until December 30.
I am very concerned because the first three months of pregnancy are critical for fetal organ development, and I have taken so many medications during this time.
When I asked the obstetrician about the potential effects of the medications on the fetus, he did not provide much explanation, which has left me feeling very anxious and worried.
I sincerely hope you can provide some insights for my reference.
I look forward to your guidance.
Thank you!
P.S.
I apologize for the lengthy content and appreciate your patience in reading it all!

Xiao Ni, 30~39 year old female. Ask Date: 2018/01/02

Dr. Cao Guotao reply Obstetrics and Gynecology

Hello, the effects of the medication should be after December 25th.
The medications you are taking are mostly classified as Category A, with a few being Category B and C.
Theoretically, the impact should be minimal.
If you still have concerns, you may consult your regular obstetrician-gynecologist.
Wishing you good health.

Reply Date: 2018/01/02

More Info

Medication safety during early pregnancy is a critical concern for many expectant mothers, especially when they have been taking medications prior to or during the early stages of pregnancy. Your situation, where you have been taking various medications for a prolonged period while unknowingly pregnant, raises valid concerns about potential effects on fetal development.

Firstly, it is essential to understand that the first trimester of pregnancy is a crucial period for fetal development. During this time, the foundations for all major organs are established, making it a sensitive period for teratogenic effects from medications. The FDA categorizes medications into five categories (A, B, C, D, and X) based on their safety during pregnancy. Category A is the safest, while Category X indicates that the drug is contraindicated in pregnancy due to evidence of fetal harm.

From the medications you listed, here’s a brief overview of their safety profiles:
1. Diclofenac Sodium: This is a non-steroidal anti-inflammatory drug (NSAID) that is generally advised against during pregnancy, especially in the third trimester, due to potential risks of fetal cardiovascular issues. Its use in the first trimester should be approached with caution.

2. Dexchlorpheniramine and Cetirizine Dihydrochloride: These are antihistamines. While Cetirizine is generally considered safer during pregnancy (Category B), Dexchlorpheniramine has limited data but is often used cautiously.

3. Cefadroxil: This antibiotic is considered safe during pregnancy (Category B) and is often prescribed for bacterial infections.

4. Amoxicillin: Another antibiotic that is generally considered safe during pregnancy (Category B). It is commonly used to treat infections in pregnant women.

5. Acetaminophen: This is typically considered safe for use during pregnancy (Category B), but it should be used at the lowest effective dose for the shortest duration necessary.

6. Fucou Capsules: The safety of this medication during pregnancy is not well-documented, and it is essential to consult with a healthcare provider regarding its use.

7. Lactam-acetaminofe: Without specific details, it is challenging to assess its safety, but acetaminophen is generally safe.

8. Kompimin (Rotec): The safety profile of this medication is unclear without more information.

Given that you have taken several medications during the early weeks of your pregnancy, it is understandable to feel anxious about potential impacts on your baby. However, many of the medications you mentioned, such as Amoxicillin and Acetaminophen, are considered safe for use during pregnancy.
It is crucial to have an open dialogue with your healthcare providers, including both your obstetrician and any specialists involved in your care. They can provide personalized advice based on your medical history and the specific medications you have taken. If you have concerns about potential teratogenic effects, they may recommend additional monitoring or testing to ensure the health of your pregnancy.

In conclusion, while it is essential to be cautious with medication use during pregnancy, many commonly prescribed medications are considered safe. Always consult with your healthcare provider before taking any new medications or continuing with those prescribed, especially during the critical early stages of pregnancy. Your health and the health of your baby are paramount, and your healthcare team is there to support you through this journey.

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