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 Centre for Addictionand Mental Health |
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Myths and factsFrom: Exposure to Psychotropic Medications and Other Substances during Pregnancy and Lactation: A Handbook for Health Care Providers On this page:
A lot of misinformation exists concerning drug use during pregnancy and breastfeeding. Much of this information is passed on to the general public through the media, well-meaning family and friends, and even health care practitioners. Why does this misleading information exist? Prior to the 1950s, it was thought that a pregnant woman developed a “placental barrier” through which nothing that would hurt the fetus could pass. As a result, during that era, there was little concern over what a woman may be exposed to during pregnancy. Then the thalidomide tragedy occurred and the common belief, as often happens, swung to the other extreme. Today, it is widely believed that most substances can harm the fetus or baby, and that women should not be exposed to any medication or other substance while pregnant or breastfeeding. Common sense should tell us, however, that the truth lies somewhere in between. Here are some common myths about exposure during pregnancy and breastfeeding, and some facts to dispel those myths. Depression and other mental illnesses during pregnancyMyth: Pregnancy has a protective effect against mental illness. While pregnant, a woman is shielded from depression and another mental illnesses. Fact: Pregnancy has no protective effect whatsoever. Some women who already have a mental illness are at a higher risk for relapse if they stop taking their medication. Medication use in general during pregnancy and breastfeedingMyth: It’s important to always use the medication that has the most safety data available. Fact: While this sounds like good information, if the drug with the most safety data is not effective for a particular woman or if she is taking a different drug when she becomes pregnant, this would not be the best advice. Myth: It is dangerous to take medications while breastfeeding. Fact: Many drugs can be taken while breastfeeding without harm to the infant. The American Academy of Pediatrics considers excretion of less than 10 per cent of a drug into the breast milk to be compatible with breastfeeding. Antidepressant, antipsychotic and benzodiazepine use during pregnancyMyth: These drugs should be used during pregnancy only in the most severe cases. Fact: In general, if a woman is being treated successfully with pharmacotherapy for mental illness before she becomes pregnant, her treatment should continue throughout pregnancy as well. Untreated depression and other mental illnesses—regardless of the severity—can harm both the mother and her fetus or baby. Antiepileptic and lithium use during pregnancyMyth: Since these drugs have been found to cause birth defects, they should be avoided during pregnancy. Fact: Because these drugs are used to treat serious illnesses (e.g., epilepsy and bipolar disorder), the benefits and risks associated with their use, and with cessation of their use, must always be weighed before making any changes. For example, the risk that a baby will have a birth defect is minimal; often the risk of the mother relapsing or experiencing untreated illness is more serious. Alcohol use during pregnancy and breastfeedingMyth: A woman who has had a few drinks prior to finding out that she is pregnant will have a baby with fetal alcohol spectrum disorder. Fact: There is no evidence to support this claim. In the “all-or-nothing period”—between six and 12 days after fertilization but before implantation (i.e., before the woman knows she is pregnant)—either injuries to the conceptus (whether or not they were caused by exposure to alcohol) will result in the woman having a spontaneous abortion, or the woman will continue to have a normal, healthy pregnancy. Myth: If a woman who has been drinking during her pregnancy decides to stop drinking, it will be too late to prevent damage to her baby. Fact: It’s never too late for a pregnant woman to stop drinking because the less alcohol she consumes, the lower the risk of adverse effects on her baby. Myth: A woman should never take a drink when she is breastfeeding her baby. Fact: If a woman plans to have a few drinks, she can minimize the amount of alcohol secreted into her breast milk by estimating how long it will take until the alcohol is excreted from her body. (See Figure 4 [PDF] for an algorithm designed specifically for making this calculation.) Smoking during pregnancyMyth: To prevent any harmful effects that could put the fetus or child at risk, a woman must completely quit smoking during pregnancy. Fact: Smoking is extremely addictive and some women find it tremendously difficult to quit. However, by reducing the number of cigarettes smoked each day, adverse effects can be minimized. Therefore, women should be encouraged and supported to cut down on the quantity smoked. Myth: A woman who smokes in her third trimester will lower the birth weight of her baby and will therefore have an easier labour. Fact: While smoking in the third trimester may lower a baby’s birth weight to some extent, the amount is probably not enough to significantly ease labour. Further, low birth weight can result in potentially significant complications for the baby. Cocaine use versus alcohol or tobacco use during pregnancyMyth: “Crack babies” grow into severely damaged children whose needs drain the health care and social service systems. Fact: While exposure to cocaine may affect the fetus, studies suggest that neonates exposed to cocaine in utero may experience less severe effects than neonates born to mothers who used alcohol regularly or excessively, or who smoked half a pack of cigarettes a day during pregnancy. In fact, alcohol consumption during pregnancy is the leading preventable cause of neurodevelopmental deficits in Canada. Opioid use during pregnancyMyth: Opioids shouldn’t be used in pregnancy. If a woman finds out she’s pregnant, she should stop using opioids immediately. Fact: A woman shouldn’t necessarily stop taking opioids when she discovers she is pregnant. In fact, withdrawal effects from opioid cessation can trigger uterine contractions that, in the first trimester, can lead to spontaneous abortion (or, in the third trimester, can lead to premature labour).
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Psychotropic medications and other substances: Properties, effects and recommendations |
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Last updated: Apr 17, 2008 4:20 PM Published: Dec 02, 2008 12:19 PM ID#P35807 |