On Thursday, March 24 we held a web chat about pregnancy and medications. What is safe and what is not safe to take when you're pregnant.

Our panelists were Dr. Adam Borgida at Hartford Hospital, who often lectures on this topic, and Sharon Lavigne from UConn Health Center’s Pregnancy Risk Line.

Hartford Courant Health Reporter Bill Weir moderated the chat.

 Pregnancy & Medications: What Is and Isn't Safe(03/24/2011) 
11:53
Rinker Buck: 
Hello and welcome to today’s webchat: “Pregnancy & Medications: What Is and Isn't Safe.” We'll be beginning our chat at 12 noon

Our panelists, Sharon Lavigne, coordinator of CT Pregnancy Exposure Information Service at the University of Connecticut, and Adam Borgida, doctor of maternal fetal medicine at Hartford Hospital, will be taking your questins.
Thursday March 24, 2011 11:53 Rinker Buck
12:00
William Weir: 
Hello and welcome to today¿s webchat: ¿Pregnancy & Medications: What Is and Isn't Safe.¿ We are now taking readers' questions.

Today, we're joined by our panelists, Sharon Lavigne, coordinator of CT Pregnancy Exposure Information Service at the University of Connecticut, and Adam Borgida, doctor of maternal fetal medicine at Hartford Hospital, will be taking your questions.

Welcome, Sharon and Adam. Thanks for joining us.
Thursday March 24, 2011 12:00 William Weir
12:00
Dr. Adam Borgida: 
Thank you. Hi Sharon.
Thursday March 24, 2011 12:00 Dr. Adam Borgida
12:00
Sharon Voyer Lavigne: 
Glad ot be here and hello to Adam
Thursday March 24, 2011 12:00 Sharon Voyer Lavigne
12:00
William Weir: 
Let¿s start with a broad question: How much of a concern are medication-related complications for pregnany women, and what¿s the best way for them to get information about it?
Thursday March 24, 2011 12:00 William Weir
12:02
Sharon Voyer Lavigne: 
Of course I would recommend that patients ask their health care providers prior to pregnancy about any medications they need to take. They can call us directly as well to get the most current reproductive data- 800-325-5391.
Thursday March 24, 2011 12:02 Sharon Voyer Lavigne
12:02
Dr. Adam Borgida: 
Sharon could best answer the way to get information. It's felt that only 2 to 3 % of birth defects are related to medication exposure in pregnancy. Most birth defects are called multifactorial which means a variety of factors cause them.
Thursday March 24, 2011 12:02 Dr. Adam Borgida
12:02
Sharon Voyer Lavigne: 
Most of the time we are giving folks reassuing information.
Thursday March 24, 2011 12:02 Sharon Voyer Lavigne
12:03
[Comment From KatherineKatherine: ] 
I have PCOS and have been taking metformin to help me get pregnant along with clomid. We just found out that we are pregnant. Should I stop taking the metformin? What types of effects might it have? I go in for my first appointment on Monday
Thursday March 24, 2011 12:03 Katherine
12:03
Dr. Adam Borgida: 
I agree. Most medications are not known to be very harmful, but dose and timing of them are important.
Thursday March 24, 2011 12:03 Dr. Adam Borgida
12:04
Dr. Adam Borgida: 
Metformin is useful in PCOS and can help women ovulate and conceive. It is felt to be safe in the first trimester and recent studies have used it throughout pregnancy to manage Diabetes. I would not stop the medication until you speak with your Obstetrician. You may not need it if you don't have high sugars, but it is often continued for the first trimester. Some studies indicate it may help prevent miscarriage.
Thursday March 24, 2011 12:04 Dr. Adam Borgida
12:04
Sharon Voyer Lavigne: 
What great news for you Katherine. For more info go to www.OTISpregnancy.org under Resources and then Fact sheets.
Thursday March 24, 2011 12:04 Sharon Voyer Lavigne
12:04
[Comment From AngelaAngela: ] 
I was taking Nortriptalyne (not sure on spelling) and Treximet for my migraines and was told to get off of it before getting pregnant. Is this a high risk? What can I take for migraines that is safe for pregnancy?
Thursday March 24, 2011 12:04 Angela
12:05
Sharon Voyer Lavigne: 
Angela- TCA are not expected to cause any significant increase risk of birth defects.
Thursday March 24, 2011 12:05 Sharon Voyer Lavigne
12:05
Sharon Voyer Lavigne: 
Treximet- is a combo drug in the triptan family. DO any of the related medications work for you?
Thursday March 24, 2011 12:05 Sharon Voyer Lavigne
12:06
Dr. Adam Borgida: 
I'm not familiar with Treximet but the riskline probably has information. Often migraine improve in pregnancy and the TCA is safe as Sharon said. Sometimes other medications can be used as well such.
Thursday March 24, 2011 12:06 Dr. Adam Borgida
12:07
Sharon Voyer Lavigne: 
The concern with triptans is theoretical. No significant association with defects has been seen, but since them ed constricts blood vessels, there may be concern for blood flow issues to the placenta and fetus. This is really not been substantiated though.
Thursday March 24, 2011 12:07 Sharon Voyer Lavigne
12:07
William Weir: 
How much of an effort have pharmaceutical companies made to make medications that are pregnancy-safe? Is there enough of a market for it to give companies incentive?
Thursday March 24, 2011 12:07 William Weir
12:09
Sharon Voyer Lavigne: 
More and more the CDC is requiring pregnancy outcome data and OTIS (Organization of Teratology Information Specialists) currently run several pregnancy registries. THis is critical information.
Thursday March 24, 2011 12:09 Sharon Voyer Lavigne
12:10
Dr. Adam Borgida: 
I think most drug companies are worried about research and marketing medications in pregnancy. Often we use medications off label meaning not for FDA approved indications but there may be research supporting their safety and efficacy. Its hard to get safety trials approved for pregnancy.
Thursday March 24, 2011 12:10 Dr. Adam Borgida
12:10
Sharon Voyer Lavigne: 
Women planning pregnancy, pregnant or breastfeeding make up a very large market for RX companies, so it is worth it for them to prove their meds safety.
Thursday March 24, 2011 12:10 Sharon Voyer Lavigne
12:11
Dr. Adam Borgida: 
There are a few new medications approved for pregnancy specific uses, but the drug companies may end up charging a great deal for these medications to make up for the cost of getting FDA approval.
Thursday March 24, 2011 12:11 Dr. Adam Borgida
12:11
[Comment From First Time MamaFirst Time Mama: ] 
Prenatal vitamins ¿ how important are they, and are all vitamins equally safe?
Thursday March 24, 2011 12:11 First Time Mama
12:12
Sharon Voyer Lavigne: 
The web site I mentioned earlier lists all current studies that we are involved in. Results are published and listed on the site as well.
Thursday March 24, 2011 12:12 Sharon Voyer Lavigne
12:12
Sharon Voyer Lavigne: 
Vitamins are not all equal. We recommend you take the RDA for pregnancy for each vitamin and mineral and avoid herbals.
Thursday March 24, 2011 12:12 Sharon Voyer Lavigne
12:13
Sharon Voyer Lavigne: 
Your MD can RX a prenatal for you to take prior to pregnancy.
Thursday March 24, 2011 12:13 Sharon Voyer Lavigne
12:13
William Weir: 
Sharon, could you tell us a little about the CT Pregnancy Exposure Information Service and how people can use it?
Thursday March 24, 2011 12:13 William Weir
12:14
Dr. Adam Borgida: 
Most prenatal vitamins are similar but you should check to see if they contain the appropriate amounts. You want about 1 mg of folate. Also, too many prenatal vitamins can be an issue. For example too much vitamin A can be a problem.
Thursday March 24, 2011 12:14 Dr. Adam Borgida
12:14
Sharon Voyer Lavigne: 
To treat mornign sickness there are several choices. The Motherisk program in Toronto runs a free NVP call line- you can find the address on the OTIS web site along with a fact sheet on this.
Thursday March 24, 2011 12:14 Sharon Voyer Lavigne
12:14
Dr. Adam Borgida: 
So one vitamin per day is enough and your Dr. can add additional folate or iron if needed
Thursday March 24, 2011 12:14 Dr. Adam Borgida
12:15
Dr. Adam Borgida: 
I agree. There are many choices for nausea and if one doesn't work, often another may.
Thursday March 24, 2011 12:15 Dr. Adam Borgida
12:17
Sharon Voyer Lavigne: 
To use the CT Pregnancy Riskline, just call us 860-523-6419 or 800-325-5391- most of what we do is over thephone. We sometimes bring women in for face to face free counseling. Calls or visits are free.
Thursday March 24, 2011 12:17 Sharon Voyer Lavigne
12:17
[Comment From Allergy SuffererAllergy Sufferer: ] 
I'm pregnant and I have notoriously bad spring allergies. What over the counter allergy meds are safe for me to take, so I survive the upcoming allergy season.
Thursday March 24, 2011 12:17 Allergy Sufferer
12:18
Sharon Voyer Lavigne: 
What do you usally use (not pregnant) for your allerigies?
Thursday March 24, 2011 12:18 Sharon Voyer Lavigne
12:18
Dr. Adam Borgida: 
Most OTC allergy medications are safe in pregnancy. They usually have the side-effects of causing drowsiness. Many containing pseudoehpredrin have been taken off the OTC market or are regulated by the pharmacies. I would avoid these, especially if you have high blood pressure.
Thursday March 24, 2011 12:18 Dr. Adam Borgida
12:18
Sharon Voyer Lavigne: 
I agree with Dr. Borgida.
Thursday March 24, 2011 12:18 Sharon Voyer Lavigne
12:19
[Comment From NursingMomNursingMom: ] 
Are there medications I should stay away from while I'm nursing? I was sent home from hospital with Vicodin for post-delivery pain, but I'm concerned that it might be bad for my babe. Should I be worried about passing him anything through breastmilk?
Thursday March 24, 2011 12:19 NursingMom
12:19
Dr. Adam Borgida: 
Most medications are passed in the breast milk in very small quantities. A small amount of your pain medication may be getting through, but it is considered a safe amount. Your Pediatrician may have additional advice.
Thursday March 24, 2011 12:19 Dr. Adam Borgida
12:20
Sharon Voyer Lavigne: 
Opiods, specifically codeine and hydroxycodone may cause too much med in the milk for the baby- SHort term use and watching the baby for too much sedation is best.
Thursday March 24, 2011 12:20 Sharon Voyer Lavigne
12:20
[Comment From Allergy SuffererAllergy Sufferer: ] 
Claritin D or Sudafed
Thursday March 24, 2011 12:20 Allergy Sufferer
12:21
Sharon Voyer Lavigne: 
Claritan should be fine, the D part used to be pseudoephdrine adn is now phenylephrine- you can read abou them all www.OTISPregnancy.org under resources and fact sheets. They are not very high risk exposures though.
Thursday March 24, 2011 12:21 Sharon Voyer Lavigne
12:22
Dr. Adam Borgida: 
I agree with Sharon, again! Sudafed is the D part of Claritin D.
Thursday March 24, 2011 12:22 Dr. Adam Borgida
12:22
William Weir: 
Sharon and Adam, in your experience, have you found that there are specific medications that women are particularly worried about?
Thursday March 24, 2011 12:22 William Weir
12:23
Sharon Voyer Lavigne: 
Of all things, Psychiatric medications.
Thursday March 24, 2011 12:23 Sharon Voyer Lavigne
12:23
Dr. Adam Borgida: 
I agree. Antidepressants are a big worry.
Thursday March 24, 2011 12:23 Dr. Adam Borgida
12:23
Sharon Voyer Lavigne: 
The problem is the benefit of using them almost always outweighs any risk.
Thursday March 24, 2011 12:23 Sharon Voyer Lavigne
12:23
Dr. Adam Borgida: 
Also anti-seizure meds
Thursday March 24, 2011 12:23 Dr. Adam Borgida
12:24
Sharon Voyer Lavigne: 
again, it is better to be seizure free in pregnancy than to skip your medications.
Thursday March 24, 2011 12:24 Sharon Voyer Lavigne
12:24
Dr. Adam Borgida: 
Also, women should never abruptly stop antidepressants.
Thursday March 24, 2011 12:24 Dr. Adam Borgida
12:24
Sharon Voyer Lavigne: 
I agree.
Thursday March 24, 2011 12:24 Sharon Voyer Lavigne
12:25
[Comment From PainMedsPainMeds: ] 
Hello. I have hydrocodone for a prior back surgery. I have a prescription to take as needed. I am trying to conceive.. Should I stop taking the pills during this time and when pregnant?
Thursday March 24, 2011 12:25 PainMeds
12:25
Dr. Adam Borgida: 
We are usually very reassuring to mothers using these medications in pregnancy and can add additional reassurance with an ultrasound to look for any possible abnormalities.
Thursday March 24, 2011 12:25 Dr. Adam Borgida
12:26
Dr. Adam Borgida: 
There isn't any evidence I'm aware of that that medication can cause birth defects. But I would try to stick to the lowest effect dose as infrequently as possible.
Thursday March 24, 2011 12:26 Dr. Adam Borgida
12:26
Sharon Voyer Lavigne: 
Managing chronic pain can be difficult and worrisome for women. Most of these meds do not increase the risk for birth defects, but amy increase risk for neonatal withdrawal for the baby. This can be managed though.
Thursday March 24, 2011 12:26 Sharon Voyer Lavigne
12:27
Dr. Adam Borgida: 
Also, bear in mind that the physiologic changes in your body may have an effect on your backk when pregnant.
Thursday March 24, 2011 12:27 Dr. Adam Borgida
12:30
Sharon Voyer Lavigne: 
Please note that when I wrote before "NVP" that this refers to morning sickness, so I did address first time mama's question.
Thursday March 24, 2011 12:30 Sharon Voyer Lavigne
12:31
Dr. Adam Borgida: 
Hey Sharon- any new information on antiseizure meds in pregnancy? There's so many new ones out there.
Thursday March 24, 2011 12:31 Dr. Adam Borgida
12:31
[Comment From PainMedsPainMeds: ] 
Thank you, I appreciate it!
Thursday March 24, 2011 12:31 PainMeds
12:31
Sharon Voyer Lavigne: 
Yes, Lamotrigine has some good reports and works well for alot of women for different reasons.
Thursday March 24, 2011 12:31 Sharon Voyer Lavigne
12:32
Sharon Voyer Lavigne: 
It is very popular and we get a ton of calls on it.
Thursday March 24, 2011 12:32 Sharon Voyer Lavigne
12:32
Dr. Adam Borgida: 
Do you get many inquiries from women on Depakote or does it seem to have fallen out of favor?
Thursday March 24, 2011 12:32 Dr. Adam Borgida
12:33
Sharon Voyer Lavigne: 
Depakote and Dilantin should be avoided still. We still get calls, but much less frequently.
Thursday March 24, 2011 12:33 Sharon Voyer Lavigne
12:33
Dr. Adam Borgida: 
Great. Thanks.
Thursday March 24, 2011 12:33 Dr. Adam Borgida
12:33
William Weir: 
Could either of you tell us a little about Depakot and Dilantin?
Thursday March 24, 2011 12:33 William Weir
12:33
Sharon Voyer Lavigne: 
Adam do you want to talk about the type of ultrasound and echos that we recommend for some exposures?
Thursday March 24, 2011 12:33 Sharon Voyer Lavigne
12:34
Dr. Adam Borgida: 
Sure, we have been moving ultrasound to the first trimester for some screening, but an ultrasound at about 18 weeks is the best time to screen for most birth defects.
Thursday March 24, 2011 12:34 Dr. Adam Borgida
12:35
Sharon Voyer Lavigne: 
Depakote and Dilantin are very traditional anticonvulsants used to treat seizures and sometimes mood disorders like bipolar disorder. They both pose high r isk for birth defects, mental retardation and autism is linked to Depakote. Spina bifida is linked to Depakote as well.
Thursday March 24, 2011 12:35 Sharon Voyer Lavigne
12:35
Dr. Adam Borgida: 
For patients at an increased risk for a baby with birth defects in the heart, we can often see evidence at that 18 week scan, but usually look again at about 22 weeks with a fetal echocardiogram.
Thursday March 24, 2011 12:35 Dr. Adam Borgida
12:36
Sharon Voyer Lavigne: 
These screenings provide a lot of good information for the patient and her MD.
Thursday March 24, 2011 12:36 Sharon Voyer Lavigne
12:36
Sharon Voyer Lavigne: 
I almost never recommend an invasive test like amniocentesis based on a prenatal exposure.
Thursday March 24, 2011 12:36 Sharon Voyer Lavigne
12:37
Dr. Adam Borgida: 
I totally agree. An amniocentesis is almost never needed for a medication exposure. Ultrasound is safer and probably gives more information.
Thursday March 24, 2011 12:37 Dr. Adam Borgida
12:38
Sharon Voyer Lavigne: 
Our service also is not in the business of recommending termination of pregnancy based on an exposure. The patient gets the reproductive data from us and then she can make an informed choice for herself.
Thursday March 24, 2011 12:38 Sharon Voyer Lavigne
12:38
William Weir: 
How often do you get new information about medications and pregnancy? For intance, are there concerns that we have now about certain drugs that we didn't 5 years ago?
Thursday March 24, 2011 12:38 William Weir
12:38
Sharon Voyer Lavigne: 
Some callers may be afraid to call and ask their questions, because they think we may give them really bad news.
Thursday March 24, 2011 12:38 Sharon Voyer Lavigne
12:40
William Weir: 
Sharon - that's interesting about people being afraid to call out of fear of what they might find out. Would you say those fears are often unfounded?
Thursday March 24, 2011 12:40 William Weir
12:40
Sharon Voyer Lavigne: 
We are in a constant state of updating. Data comes out daily from around the globe and we review it. Most drugs that we knew were bad 5 years ago, we still have concerns about. Most drugs we were not very concerned about we are still feeling pretty good about.
Thursday March 24, 2011 12:40 Sharon Voyer Lavigne
12:40
Dr. Adam Borgida: 
Sometimes it does take some time to generate enough information to know about medication use in pregnancy. For example, ACE inhbitors (to treat high blood pressure) were felt to be safe in the first trimester but were known to be harmful later. New evidence shows thay may be harmful early in pregnancy as well and we avoid them in pregnancy.
Thursday March 24, 2011 12:40 Dr. Adam Borgida
12:41
Sharon Voyer Lavigne: 
Yes, More than 90% of the time we give reassuring information.
Thursday March 24, 2011 12:41 Sharon Voyer Lavigne
12:41
Sharon Voyer Lavigne: 
The data on ACE inhibitors is not confirmed as yet, I would say. The literature has not convinced me that there is a risk for defects. The studies have some flaws and need careful review.
Thursday March 24, 2011 12:41 Sharon Voyer Lavigne
12:42
Sharon Voyer Lavigne: 
Until we know for sure, avoiding them for more well studied drugs is a good idea.
Thursday March 24, 2011 12:42 Sharon Voyer Lavigne
12:42
Dr. Adam Borgida: 
Interesting. There are so many other blood pressure medications out there, that often we can find one felt to be safer.
Thursday March 24, 2011 12:42 Dr. Adam Borgida
12:43
Sharon Voyer Lavigne: 
Agreed!
Thursday March 24, 2011 12:43 Sharon Voyer Lavigne
12:44
Dr. Adam Borgida: 
Many patients in ACE inhibitors also have diabetes and poorly controlled diabetes is probably much worse than any medication.
Thursday March 24, 2011 12:44 Dr. Adam Borgida
12:45
Sharon Voyer Lavigne: 
Very true.
Thursday March 24, 2011 12:45 Sharon Voyer Lavigne
12:45
William Weir: 
Sharon and Adam, this has been great - thanks for all the information. We'll be wrapping up in a few minutes. Any last comments from either of you?
Thursday March 24, 2011 12:45 William Weir
12:45
Sharon Voyer Lavigne: 
I just wanted to mention that the Riskline is now on Facebook- go to CT Pregnancy Exposure Information Service and see what we are up to.
Thursday March 24, 2011 12:45 Sharon Voyer Lavigne
12:46
Dr. Adam Borgida: 
I want to thank Sharon and the Riskline for all the help they provide to Physicians and Patients in CT.
Thursday March 24, 2011 12:46 Dr. Adam Borgida
12:47
William Weir: 
Thanks again!
A replay of this chat can be seen at courant.com/cthealth
Thursday March 24, 2011 12:47 William Weir
12:47
Sharon Voyer Lavigne: 
Your tax dollars at work. Let your state representive/senator know. Thanks to Adam and his practice for the great work they provide to all my patients
Thursday March 24, 2011 12:47 Sharon Voyer Lavigne
12:47
Dr. Adam Borgida: 
Thanks Sharon and Bill.
Thursday March 24, 2011 12:47 Dr. Adam Borgida
12:47
Sharon Voyer Lavigne: 
This was great- thanks for all the super questions.
Thursday March 24, 2011 12:47 Sharon Voyer Lavigne
12:48