Pregnancy: Suggested questions
The medicine
- When did the medicine start and has it been stopped? Don’t just ask what trimester the medicine was taken in because it doesn’t tell you about the duration of exposure. Was it started before pregnancy or during it? If it is to continue, how long will the medicine be taken for?
- Indication, and is it working? If treatment is to continue, you have to know the indication in case you need to recommend a safer alternative. You also need to balance the risk to the mother and the risk to the embryo/fetus. If the medicine is very effective and for a serious medical condition, then this may make you more inclined to continue with the treatment depending upon the risk to the embryo/fetus.
- Medicines in previous pregnancies? Has the woman taken the drug in question during a previous pregnancy, and was it effective? What other medication has the woman taken during previous pregnancies for any similar condition? Taking the same medicine in a previous pregnancy doesn’t guarantee safety but is evidence of efficacy.
The mother and embryo/fetus
- Is the woman planning a pregnancy or actually pregnant now? Are you being asked for advice about
prospective or retrospective exposure? You have scope to recommend a safer
treatment from the beginning if the woman is not yet pregnant.
- How many weeks pregnant is she now? This will define the period of expected
fetal exposure to the medicine, which is often crucial in determining
safety.
- Obstetric history? Has the woman had any previous pregnancies and what were the
outcomes? Is there a family history of malformations or history of
recurrent miscarriage?
Going forward
- Can you consider alternative approaches to
limit the exposure to this medicine?
- Is treatment essential? Can it be delayed until after delivery, or a
safer period in the pregnancy?
- Would non-drug
alternatives be appropriate? They may carry less risk.
- Are there medicines with better evidence of safety that can be used? Have any different
medicines been tried, or could they be considered?
- Have you planned for after delivery? Plan early, if applicable. Will the newborn need to be monitored (for e.g. sedation, withdrawal effects) and who will do this? If mum intends to breastfeed, will the medicine be safe in this situation? If not, what should be done? (See breastfeeding tutorial)
The 'questions to ask' from every tutorial on this site have been brought together into a Quick Question Guide that you may want to download for future reference.