Medication decisions in pregnancy: New approach

Most women use medication during pregnancy. Yet, selecting appropriate drugs and doses is challenging. In an article in The Lancet, physicians and researchers introduce a shared decision-making approach combining ethical principles and a pregnant woman's values with existing evidence.

They use the example of sertraline, a commonly prescribed antidepressant in pregnancy, to illustrate the advocated decision-making process.

Although pregnant  often need medication for various conditions like morning sickness to high BP, data on drug safety and efficacy in pregnancy remains limited. Historically seen as vulnerable research subjects, pregnant women have been widely excluded from drug development and testing.

The thalidomide scandal of the 1950s–60s, which caused severe birth defects in thousands of children, exposed the potential risks of administering medications to pregnant women without adequate evidence, prompting a highly cautious approach to prescribing drugs during pregnancy.

However, withholding medication from a pregnant woman may indirectly harm both her and her child by compromising the mother's health and well-being. Additionally, pregnant women may not receive balanced information about a medication's risks and benefits or be fully involved in treatment decisions, they just depend on the doctors' knowledge and prescriptions, potentially leading to suboptimal decision-making and avoidable harm.

In several countries, the illiterate patients won't be in a condition to  understand fully the conditions and  consequences to decide for themselves or taking part in the decision making process along with the medical fraternity about taking the drugs. 

The medical community urgently needs ethical and actionable models to help balance the benefits and risks of medications for individual pregnant patients and fetuses, says lead author of this article.