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