What to Avoid During Pregnancy
During pregnancy, women should avoid certain medications (ACE inhibitors, angiotensin receptor blockers, statins, thalidomide, isotretinoin, mycophenolate mofetil), alcohol, illicit drugs, smoking, and unsafe sleeping practices to protect maternal and fetal health. 1, 2, 3
Medications to Avoid
Absolutely Contraindicated Medications
- Teratogenic medications:
- Thalidomide and its analogues: Known human teratogens that cause severe birth defects or embryo-fetal death 1, 3
- Isotretinoin: Requires strict pregnancy prevention (iPLEDGE program) due to high risk of birth defects 2
- Mycophenolate mofetil (MMF): Associated with 49% miscarriage rate and 23% structural anomaly rate 1
- Ozanimod: Should be avoided due to potential adverse effects 1
Cardiovascular Medications
- ACE inhibitors and angiotensin receptor blockers: Can cause fetal renal dysplasia, oligohydramnios, pulmonary hypoplasia, and intrauterine growth restriction 1
- Should be stopped prior to pregnancy or as soon as possible in first trimester
- Statins: Generally should be avoided, though risk appears low 1
- Exception: May be considered in high-risk patients with familial hypercholesterolemia after shared decision-making
- Atenolol: Not recommended during pregnancy 1
Other Medications
- Live vaccines: Should not be given to newborns whose mothers received anti-TNF medications (infliximab, adalimumab) after 20 weeks gestation 1
Substances to Avoid
- Alcohol: Increases risk of SIDS and should be avoided during pregnancy and after birth 1
- Women with alcohol-related liver disease should delay conception until abstinence is achieved 1
- Illicit drugs: Increases risk of SIDS and should be avoided during pregnancy and after birth 1
- Tobacco: Smoking during pregnancy increases risk of complications 4
Imaging and Procedures to Avoid
- CT scans and radioisotope studies: Should be avoided when possible 1
- Gadolinium: Should not be administered during the first trimester of pregnancy 1
Safe Alternatives
Safer Medication Options
- For hypertension: Methyldopa, nifedipine, labetalol, diltiazem, and clonidine are safer alternatives 1
- For IBD treatment: Most IBD medications are safe during pregnancy 1
Safe Imaging Options
- Ultrasound: First-line imaging modality during pregnancy 1
- MRI without contrast: Can be used when medically necessary 1
Sleep Safety During Pregnancy and After Birth
Avoid bed-sharing with infants, especially in these situations 1:
- When the infant is younger than 3 months
- If either parent smokes or the mother smoked during pregnancy
- If either parent is excessively tired
- If either parent has used medications or substances that impair alertness
- On soft surfaces like waterbeds, old mattresses, sofas, or armchairs
- With soft bedding, pillows, or heavy blankets
Keep soft objects and loose bedding out of infant's sleeping environment to reduce SIDS risk 1
Avoid overheating infants - dress them appropriately with no more than one layer more than an adult would wear 1
Special Considerations
For Women with Chronic Conditions
- Diabetes: Blood pressure target of 110-135/85 mmHg is recommended 1
- Liver disease: Ursodeoxycholic acid can be continued during pregnancy for primary biliary cholangitis 1
- IBD: Vaginal birth should be avoided in patients with active perianal Crohn's disease, perianal abscess, or active rectal disease 1
For Cancer Treatment
- Chemotherapy: Should be avoided during first trimester; can be administered during second and third trimesters with slightly increased risk of complications 1
- Radiotherapy: Should be administered post-partum 1
Remember that any medication use during pregnancy should be discussed with healthcare providers to weigh risks and benefits. The first trimester is generally the period of highest risk for medication-induced birth defects.