What are the considerations regarding pregnancy?

From the Guidelines

Pregnancy considerations should prioritize preconception care, including folic acid supplementation, management of chronic conditions, and lifestyle modifications to minimize risks and ensure the best possible outcomes for both mother and fetus. When considering pregnancy, it is essential to discuss reproductive plans, including risks due to age, maternal or paternal conditions, and obstetric and family history 1. Women of reproductive age should take a daily supplement of 400 to 800 mcg of folic acid, starting before conception, to reduce the risk of neural tube defects 1. Additionally, health concerns in men, such as diabetes mellitus, erectile dysfunction, and testicular conditions, may affect fertility, and lifestyle factors like tobacco smoking and sexually transmitted infections can directly impact pregnancy outcomes 1.

Key considerations for pregnancy include:

• Preconception care to reduce maternal and fetal morbidity and mortality
• Folic acid supplementation to prevent neural tube defects
• Management of chronic conditions, such as diabetes and hypertension
• Lifestyle modifications, including avoiding alcohol and tobacco use
• Nutritional screening and supplementation, particularly for women who have undergone bariatric surgery 1
• Immunization status evaluation to prevent infections like hepatitis B and rubella 1

It is crucial to address these considerations to minimize risks and ensure the best possible outcomes for both mother and fetus. Women who wish to prevent pregnancy should be offered contraceptive methods approved by the U.S. Food and Drug Administration, and routine counseling about emergency contraception should also be available when needed 1. Furthermore, pregnant women who have undergone bariatric surgery should undergo nutritional screening during each trimester and may require more frequent review with a specialist bariatric dietitian 1. By prioritizing these considerations, healthcare providers can help ensure a healthy pregnancy and minimize potential complications.

From the FDA Drug Label

Pregnancy Teratogenic Effects Pregnancy Category A Folic acid is usually indicated in the treatment of megaloblastic anemias of pregnancy. Folic acid requirements are markedly increased during pregnancy, and deficiency will result in fetal damage (See INDICATIONS AND USAGE) Studies in pregnant women have not shown that folic acid increases the risk of fetal abnormalities if administered during pregnancy. If the drug is used during pregnancy, the possibility of fetal harm appears remote. Because studies cannot rule out the possibility of harm, however, folic acid should be used during pregnancy only if clearly needed

The main considerations regarding pregnancy are:

• Folic acid is usually indicated in the treatment of megaloblastic anemias of pregnancy
• Folic acid requirements are markedly increased during pregnancy, and deficiency will result in fetal damage
• Folic acid should be used during pregnancy only if clearly needed, as studies cannot rule out the possibility of harm, although the possibility of fetal harm appears remote 2

From the Research

Considerations Regarding Pregnancy

• The use of folic acid supplementation is recommended for all women in the reproductive age group to prevent neural tube defects and other congenital anomalies 3
• Women should be advised to maintain a healthy folate-rich diet, but folic acid/multivitamin supplementation is needed to achieve the red blood cell folate levels associated with maximal protection against neural tube defect 3
• The safety of over-the-counter medications during pregnancy is a concern, and the benefit of the drug should outweigh the risk to the fetus 4, 5, 6
• Common over-the-counter medications used during pregnancy include acetaminophen, chlorpheniramine, kaolin and pectin preparations, and most antacids, which have a good safety record 4, 5
• Other medications, such as histamine H2-receptor blockers, pseudoephedrine, and atropine/diphenoxylate, should be used with caution 4, 5
• The use of medications for the treatment of alcohol use disorders during pregnancy is rare, but acamprosate and naltrexone may be considered based on the current evidence base 7

Folic Acid Supplementation

• Women with a low risk for a neural tube defect or other folic acid-sensitive congenital anomaly require a diet of folate-rich foods and a daily oral multivitamin supplement containing 0.4 mg folic acid for at least 2 to 3 months before conception, throughout the pregnancy, and for 4 to 6 weeks postpartum or as long as breast-feeding continues 3
• Women with a moderate risk for a neural tube defect or other folic acid-sensitive congenital anomaly require a diet of folate-rich foods and daily oral supplementation with a multivitamin containing 1.0 mg folic acid, beginning at least 3 months before conception 3
• Women with a high risk for a neural tube defect or other folic acid-sensitive congenital anomaly require a diet of folate-rich foods and a daily oral supplement with 4.0 mg folic acid for at least 3 months before conception and until 12 weeks' gestational age 3

Over-the-Counter Medications

• Acetaminophen is generally considered safe during any trimester 5
• Cold medications are also commonly used and are considered safe for short-term use outside of the first trimester 5
• Histamine H2 blockers and proton pump inhibitors have not demonstrated significant fetal effects 5
• Nonsteroidal anti-inflammatory drugs are generally not recommended in pregnancy, especially during organogenesis and in the third trimester 5