Medications and supplements in pregnancy

It is not possible to give a single answer to this question and, before starting or stopping the use of any medicine, it would always be better to talk to the gynecologist who is following you during pregnancy. When deciding whether or not to use a drug it is in fact necessary that you and your doctor carefully consider the risks and benefits of the drug.

Benefits : what benefits can the drug have for me and my baby (fetus)?

Risks : how can the drug hurt me or my baby (fetus)?

During pregnancy there may be times when you can choose whether or not to follow a drug therapy, some of the drugs that you and your doctor choose during pregnancy could be different from the ones you would choose if you were not pregnant; for example period came 3 days early, for a common cold, you might decide to live with a runny nose, rather than taking the drugs you usually used before getting pregnant. In other cases, taking a drug is not a choice, but a necessity : some women simply have to take drugs during pregnancy. Sometimes the future mother has to take medicines for a few days or weeks to treat an urinary tract or upper respiratory tract infection. Other women, on the other hand, need to take care of themselves every day to keep chronic health problems under control, such as

asthma ,

diabetes ,

depression ,

epilepsy .

Currently, tests on drugs are rarely carried out on pregnant women for fear of hurting the child: if the situation does not change, and ethically is not conceivable to date, the only way that allows doctors and researchers to understand the effect of Drugs on pregnant women and children are the exposure records, research involving a group of pregnant women being treated with a certain drug. Women enroll in the study during pregnancy and are followed for some time after giving birth. The researchers compare the children of women who have followed therapy during pregnancy with the children of healthy women. This type of research compares large groups of pregnant women and children to find out what the effects of the drug are. For more information and before addressing specific topics, we report the reference site managed by the AIFA on drugs and pregnancy , as well as a valuable American database focused on breastfeeding, pregnancy and drugs.

Over-the-counter medications

All over- the-counter medications also have an information leaflet and a section is dedicated to the use of the drug during pregnancy: in OTCs the woman is usually advised to seek advice from a doctor before taking the drug.

During pregnancy research

If you are planning to become pregnant, you can increase the chance of giving birth to a healthy baby by taking some preventive measures: first book a check-up visit with your gynecologist to prescribe preconceptional exams and during the visit tell him all the drugs, vitamins and herbal products that you usually use. It is essential to continue to treat your health problems even during pregnancy and your doctor will tell you if you will need to change medication. In some cases it will be necessary to change medication, while in others the therapy may be interrupted before conception. Every woman is a special case, so we advise you to talk to your gynecologist instead of changing the therapy on your own. Find out about the vitamins that all women planning a pregnancy should take, for example folic acid (a B group vitamin) to prevent brain and spinal malformations of the fetus. You should start taking these vitamins before getting pregnant or, at the latest, when you find out you are.

During the visit it would also be good to discuss three important topics with the doctor:

caffeine,

alcohol ,

smoke.

Medication use during pregnancy is a sensitive issue that needs to be addressed together with your doctor. Therapy is necessary for some health problems. Not using a necessary medication can harm you and your child: for example, urinary tract infections, if left untreated, can turn into kidney infections . Kidney infections can cause premature labor and the baby may have low birth weight. An antibiotic is required to treat urinary tract infections. Ask your doctor if the benefits of a particular drug outweigh the risks for you and your baby.

Vitamins and natural products during pregnancy

The specific multivitamin supplements to be taken during pregnancy are safe and can be really useful. Pregnant or pregnant women should take a multivitamin supplement or a supplement that contains at least 400 micrograms (µg) of folic acid every day. You should start taking these vitamins before getting pregnant or, at the latest, when you find out you are. Folic acid decreases the risk of fetal neural tube malformations, such as spina bifida: in these diseases the vertebral column or fetal brain does not develop normally. Iron can contribute to the prevention of anemia (insufficiency of red blood cells in the blood). It is important to take the vitamins in the dose prescribed by the doctor, because even  too many vitamins can hurt the child ; for example it has been demonstrated a connection between the excess of vitamin A and some serious fetal malformations.

However, the effects of dietary supplements taken during pregnancy are still largely unknown. The illustrative sheets of some herbal products boast the usefulness of the product, if taken during pregnancy, however in most cases there are no in-depth research able to prove that these claims are true or that the product may hurt you or your child . Before using any herbal product or dietary supplement, ask your doctor for advice. These products may contain substances that are potentially dangerous for you or your child. Unlike drugs, the safety and therapeutic efficacy of herbal remedies and natural remedies are not approved by the Ministry, so most of these products are not checked for the potential danger to the pregnant woman or the fetus, nor to for safety during pregnancy. Even products that may seem safe, such as echinacea, should currently be weighed in light of the real needs of the pregnant woman, of the scientific evidence of efficacy and safety (the fact that dangers are not documented does not mean that they do not exist, in other words the absence of evidence is not the same as proof of absence ).

And the vaccines?

The vaccines protect the body from dangerous diseases; some are not safe during pregnancy, while in other cases the decision to administer them depends on the woman’s situation.

The gynecologist will evaluate different aspects before administering it:

Is there a high probability of exposure to the disease?

Could the infection pose a risk to the mother or fetus?

When is the vaccine safe?

For example it is recommended to consider vaccination against hepatitis B when women are at risk of contracting it during pregnancy, just as the flu vaccine should be considered during the cold season for women who are on the second or in the third quarter; this allows to protect both the mother, reducing the risk of hospitalization by at least 50%, and the child, significantly reducing the cases of illness and otitis in the first two months of life. In the first trimester of pregnancy, on the other hand, an ad personam evaluation is performed , that is relative to each pregnant woman, weighing the risks and benefits of the two possibilities. In other cases it is instead very important to resort to vaccination for specific diseases before starting the pregnancy search, think for example of chicken pox and rubella , two potentially dangerous diseases during the 9 months.

Giving birth without pain with an epidural

Giving birth without pain, or at least with a contained pain : it is the aspiration of every woman who approaches the moment of birth, an aspiration that is actually achievable through epidural analgesia , considered the most effective method of limiting the pain of childbirth .

The epidural in Italy and abroad, the data

In Italy, however, the so-called “painless birth” is still relatively widespread . There are complete and updated data for the whole country, but according to a recent survey by the SIAARTI, Italian Society of Anesthesia, Analgesia resuscitation and intensive therapy, the percentage of women in the past two or three years have made an epidural during a vaginal delivery fluctuates between 10% of Marche and Trentino and 35% of Lazio (where, however, 77% of parts with epidurals take place in Rome), passing through 12% of Sicily, 18% of Tuscany, 20% of Umbria, 26% of Liguria, Veneto and Lombardy and 27.7% of Emilia Romagna (data communicated to nostrofiglio.it by professorEdoardoCalderini , director of the department of Anesthesia and intensive care at the Mangiagalli Clinic in Milan and regional councilor of Siaarti for Lombardy). Data significantly lower than those recorded in other countries: according to Siaarti, epidural analgesia would concern 67% of vaginal parts in the United States, 65% in Japan, 56% in Spain, about 60% in France .

One of the main obstacles to a wider dissemination of the epidural is organizational. “Providing women with this form of H24 analgesia seven days a week is a very demanding activity for a structure because it requires a certain number of anesthesiologists, and this generally happens only at larger birth points,” explains Calderini. “On the other hand, it must be said that some regions like Lombardy have made a great effort in this direction in recent years, and that since last year the epidural is included in the essential levels of assistance . Although it is still not guaranteed anywhere, I expect that within a few years the situation will improve more and more ”.

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