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Medication in Obstetrics

Minimize all medication use during pregnancy (especially in 1st TM), unless clearly indicated!

FDA pregnancy categories

A: No risk in controlled human studies

B: No risk in controlled animal studies and no risk seen in humans

C: Small risk in controlled animal studies, but not seen or not studied in humans

D: Strong evidence of risk in humans but benefit may outweigh tisk

X: High risk - never to be used in pregnant humans

Analgesics

  • Acetaminophen - B / compatible with breastfeeding
  • Ibuprofen - C 1st/2ndTM ; D 3rdTM / compatible with breastfeeding
  • Fentanyl - C / compatible with breast feeding
  • Hydromorphone (Dilaudid) - C / compatible with breast feeding
  • Morphine - C / Compatible with breast feeding
  • Oxycodone (Percoset) - B / Compatible with breast feeding
  • Hydrococone (Vicodin) - C / Compatible with breast feeding

Antibiotics

  • Ampicillin - B / Compatible with breast feeding
  • Amoxicillin - B / Compatible with breast feeding
  • Cefazolin - B / Compatible with breast feeding
  • Gentamicin - D / Compatible with breast feeding
  • Clindamycin - B / Avoid if possible in breast feeding, monitor infant
  • Cipro - C (avoid in pregnancy) / Avoid if possible in breast feeing, monitor infant
  • TMP-SMX - D / infant risk minimal in breast feeding
  • Nitrofurantoin - B in 1st and 2nd TM ; D in 3rd TM / Compatible with breast feeding
  • Ceftriaxone - B / Compatible with breast feeding
  • Zosyn - B / Compatible with breast feeding
  • Erythromycin - B / infant risk minimal in breast feeding
  • Vanco - C / infant risk cannot be ruled out in breast feeding
  • Keflex - B / Compatible with breast feeding
  • Flagyl - B / Infant risk cannot be ruled out, avoid if possible in breast feeding
  • Doxycycline - D / avoid in breast feeding

Anticoagulation

  • Lovenox - B / Compatible with breast feeding
  • Heparin - C / Compatible with breast feeding
  • Warfarin - X / Compatible with breast feeding

Antiemetics

  • Vitamin B6 - A / Compatible with breast feeding
  • Doxylamine - C / May decrease breastmilk supply
  • Prochlorperazine - C / Infant risk cannot be ruled out in breast feeding
  • Metoclopromide - B / Infant risk cannot be ruled out in breast feeding
  • Ondansetron - B / Infant risk cannot be ruled out in breast feeding
  • Promethazine HCl - C / Compatible with breast feeding

Diabetes medication

  • Metformin - B / Compatible with breast feeding
  • Sulfonylurea - B / infant risk cannot be ruled out
  • Insulin - B / Compatible with breast feeding

Hypertension or preeclampsia treatment

  • Hydralazine - C / Compatible with breast feeding
  • Labetalol - C / Compatible with breast feeding
  • Magnesium sulfate - A / Compatible with breast feeding
  • Nifedipine - C / Compatible with breast feeding

Psychiatric / substance abuse medications

  • Zolpidem - C / Caution with breastfeeding
  • Buproprion - C / Compatible with breast feeding
  • Citalopram, fluoxetine, Sertraline - C / Compatible with breast feeding
  • Trazodone - C / Compatible with breast feeding
  • Lorazepam - D / Compatible with breast feeding

https://www.aafp.org/afp/2003/0615/p2517.html

Pocket Obstetric and Gynecology by K Joseph Hurt, 2nd edition

 

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