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Drugs Affecting Foetus and Nursing Infants

A teratogen is a drug or chemical that induces alterations in the formation of cells, tissues and organs and thus creating physical defects in a developing embryo or foetus.

Drug induced changes can occur only during organogenesis; however, drug induced toxicologic changes affect the foetus after completion of tissue or organ formation because these drugs induce degenerative changes in formed tissue or organs.

To be safe, drugs that are known to be innocuous to the embryo or foetus should be used in the dental management of pregnant women. Drugs with unknown teratogenic potential should be prescribed only after consultation with the patients gynaecologist. Drugs with known teratogenic effects should not be used during dental procedure.

Classification Definition
A No risk demonstrated to the foetus in any trimester.
B No adverse effects.
C Only given after the risk to the foetus are considered.
D Definite foetal risk; may be given in spite of risks if needed in the life threatening situations.
X Absolute Foetal abnormalities; not to be used at any time during pregnancy.

Dental treatment during Pregnancy

Oral health is important during pregnancy and should not be neglected. The rise in hormone levels during pregnancy causes the gums to swell, bleed and trap food causing increased gum irritation. Preventive dental work is essential to avoid oral infections such as gum disease, which has been linked to pre-term birth.

Foetal organ development occurs during the first trimester; it is best to avoid all potential risks at this time if possible. During pregnancy, avoid elective dental treatment, such as routine dental X-rays and whitening of teeth and bonding, especially during the first trimester. However, if dental pain is experienced, emergency treatment and minimal emergency X-rays should be completed immediately with consultation between dentist and obstetrician. If non-emergency dental work is needed during the third trimester, it is usually postponed until after the birth. This is to avoid the risk of premature labour.

Dental Care During Pregnancy

  • Ask the patient if they are pregnant.
  • Ask the names and dosages of all medications they are taking – including medications and prenatal vitamins prescribed by their doctor as well as any specific medical advice given. Alter the dental treatment plan based on this information.
  • Encouraging your patients to undergo regular periodontal (gum) examinations is very important because pregnancy causes hormonal changes.
  • Advice rinsing mouth with water or a mouth rinse if patient is suffering from morning sickness and have bouts of frequent vomiting. Also prescribe toothpaste with a bland taste.
  • Advice healthy, balanced and nutritious diet devoid of sugary snacks. Additionally, some studies have shown that the bacteria responsible for tooth decay are passed from the mother to the child.
  • Baby's first teeth begin to develop about three months into pregnancy. Healthy diets containing dairy products, cheese and yogurt are a good source of these essential minerals and are good for baby's developing teeth, gums and bones.

Safe drugs in Pregnancy

Some Medications Considered Safe for Use During Pregnancy

Condition  Medication
Asthma Budesonide inhaled or nasal spray
Bladder infection (UTI)  Nitrofurantoin - Avoid in patients with possible G6PD deficiency
Cough  Dextromethrophan
Constipation  Docusate,  Milk of magnesia, Polyethyelene glycol
Diabetes Insulin, Glyburide, Metformin
Diarrhea  Loperamide
Gastroesophageal reflux disease (GERD)  Ranitidine,  Cimetidine
Hayfever, sneezing, runny nose, itchy watery eyes  Chlorpheniramine, Diphenhydramine
Headache or fever Acetaminophen, Paracetamol
Hemorrhoids  Tucks, Preparation H, Anusol
High blood pressure  Methyldopa
Hyperprolactinemia  Bromocriptine , Carbergoline
Hypothyroidism  Thyroid hormone, Levothyroxine
Infection  Acyclovir , Azthitromycin, Cepaholosporins (examples: Cephalexin, Cefazolin, Cefaclor, Clindamycin), Erythromycin, Penicillins (example: Amoxicillin,  Clavulanate, Methicillin, Carbenicillin), Metronidazole.
Insomnia  Doxylamine
Motion sickness Dimenhydrinate
Nasal congestion  Pseudoephedrine- avoid in first trimester.
Nasal congestion, sneezing, runny nose, itchy watery eyes Triprolidine, Pseudoephedrine- avoid in first trimester.
Nasal congestion, sneezing, runny nose, itchy watery eyes, fever and headache Acetaminophen, Chlorpheniramine, Pseudoephedrine- avoid in first trimester.
Nausea  Ginger Pyridoxine 25 mg PO TID with Doxylamine Succinate 25 mg 1/2 tablet TID, Metoclopramide
Preeclampsia  Magnesium sulfate
Vaginal yeast infection  Clotrimazole cream

Safe drugs for Lactating Mothers

Medications Commonly Prescribed for Maternal Ailments During Breast-Feeding

Condition Recommended agents Alternative agents Use with caution
Allergic rhinitis Beclomethasone,  Fluticasone, Cromolyn (Nasalcrom) Cetirizine, Loratadine, Sedating antihistamines, Decongestants
Cardiovascular Hydrochlorothiazide, Metoprolol, Tartrate, Propranolol, Labetalol Nifedipine, Verapamil, Hydralazine, Captopril, Enalapril Atenolol, Nadolol, Sotalol, Diltiazem
Depression Sertraline, Paroxetine Nortriptyline, Desipramine Fluoxetine
Diabetes Insulin, Glyburide, Glipizide, Tolbutamide Acarbose Metformin, Thiazolinediones
Epilepsy Phenytoin, Carbamazepine Ethosuximide, Valproic sodium Phenobarbital
Pain Ibuprofen, Morphine, Acetaminophen Naproxen, Meperidine
Asthma Cromolyn, Nedocromil Fluticasone, Beclomethasone
Contraception Barrier methods Progestin-only agents Oestrogen-containing contraceptives
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Indian Dental Association
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