Medications and Pregnancy

Pregnant women often come in to see the dermatologist as flares of acne or various rashes are very common during pregnancy. As dermatologists, we must pay close attention to what medications we prescribe for obvious reasons. Typically, we advocate avoiding all medications during the first trimester in which most major development of the fetus occurs.  In certain extreme cases, exceptions may be made but only in the setting of working in close conjunction with the patient’s obstetrician. After the first trimester, certain medications may be used; the safest categories are labeled as A or B.

Pregnancy categories are designated by the US FDA as follows:

• A: Well controlled studies in humans show no risk to the fetus.
• B: Well controlled studies in humans show no risk to the fetus although animal studies may have demonstrated some risk in animal models OR  no adverse risk is demonstrated in animal models and there are no well controlled human studies.
• C: Animal studies demonstrate potential risk in animal models but there is no human data; the drug may be considered for use if the benefits outweigh the risks.
• D: There are known adverse risks to the human fetus but the medication may be considered for use if the benefits of the medication outweigh the risks.
• X: There are severe adverse risks to the human fetus and the risks far outweigh the benefits so the drug should not be used.

As can be imagined, it is nearly impossible to perform studies of medications in pregnant women, so category A status is very unlikely to be obtained. Generally, the safest medication class in pregnancy is category B and most dermatologists will stick with this class of medications, although exceptions may have to be made.

One interesting point to note is that benzoyl peroxide and salicylic acid which are readily available in many over the counter products are actually category C!  Work with your dermatologist and obstetrician to find the best treatment for you, which in some cases may be no treatment at all.

NB: The content of this blog post is intended to be purely informative and educational. It should not be considered medical advice in any form and does not replace or replicate the doctor-patient relationship. Please see your dermatologist and obstetrician for any skin issues related to pregnancy.