Читать книгу Infants and Children in Context - Tara L. Kuther - Страница 151

More than 90% of pregnant women take prescription or OTC medications (Servey & Chang, 2014). Prescription drugs that can act as teratogens include antibiotics, certain hormones, antidepressants, anticonvulsants, and some acne drugs (Webster et al., 2018). In several cases, physicians have unwittingly prescribed drugs to ease pregnant women’s discomfort that caused harm to the fetus. For example, in the late 1950s and early 1960s, many pregnant women were prescribed thalidomide to prevent morning sickness. However, it was found that taking thalidomide 4 to 6 weeks after conception (in some cases, even just one dose) caused deformities of the child’s arms and legs and, less frequently, damage to the ears, heart, kidneys, and genitals (Fraga et al., 2016). Isotretinoin, a form of vitamin A used to treat acne, is a potent teratogen associated with miscarriage as well as severe face, heart, and central nervous system abnormalities, as well as intellectual disability (Henry et al., 2016; Wilson, 2016). The teratogenic effect of isotretinoin is so severe that the U.S. Food and Drug Administration (2010) requires that women prescribed isotretinoin take physician-administered pregnancy tests for 2 months prior to beginning treatment and agree to use two methods of birth control and complete a monthly pregnancy test each month while taking it.

Nonprescription drugs, such as diet pills and cold medicine, can also cause harm, but research on OTC drugs lags far behind research on prescription drugs, and we know little about the teratogenic effect of many OTC drugs (Hussain & Ashmead, 2017). Frequently, findings regarding the teratogenic effects of drugs are mixed, with some studies suggesting potential harm and others suggesting no ill effects of a given drug. For example, although high doses of the common painkiller aspirin may be associated with an increased risk of miscarriage and poor fetal growth (Li, Liu, & Odouli, 2003), low doses are often prescribed to pregnant women to prevent and treat high blood pressure and preeclampsia (dangerously high blood pressure late in pregnancy that can cause organ damage) (Roberge, Bujold, & Nicolaides, 2017). Likewise, the most common OTC drug consumed during pregnancy, caffeine, found in coffee, tea, cola drinks, and chocolate, appears to be safe in low doses (200 milligrams or about one cup per day; March of Dimes, 2015). Heavy caffeine consumption, however, is associated with an increased risk for miscarriage and low birthweight (Chen et al., 2014, 2016).