Pregnant Patients Deserve Better

In my view, the pharma industry is not yet doing enough to address the lack of prescribing information available for pregnant women – but right now, none of us are. Unfortunately, there are important disincentives. Some of them are economic, but there are regulatory and ethical complexities as well. Caution is often preached when it comes to pregnant women and research, but I think it is important to think about the ways that caution has been distributed – unevenly and unfairly. Of course testing medicines and prescribing them in pregnancy is an area that requires care and caution, given the risks that some of these medications might entail for women and their offspring. But much less attention has been paid to the risks of not testing or prescribing, and those risks can be significant.

The unwillingness to test medications has led to a dearth of data to guide dosing or give providers information about the safety profile of medication, and can make them reticent to use medications important for maternal or fetal health. Often providers making prescribing decisions (and women too) think that by not prescribing (or taking) medicine they are being “better safe than sorry.” But failure to treat illness can have dire consequences: in pregnancy, untreated depression is associated with fetal growth restriction and prematurity, even suicide; untreated asthma is associated with preeclampsia, premature delivery, hemorrhage and low birthweight; in women with diabetes, inadequate glucose control can result in a high chance of severe birth defects; failure to continue treatment for multiple sclerosis in pregnancy can leave women permanently unable to walk. When essential medication is avoided, the risks to women and their children can be huge.