Evaluating Potentially Harmful Exposures During Pregnancy and Lactation

With today's technology and constantly changing environment (physically and educationally) it is virtually impossible for any one individual to know all there is to know about all the medications and environmental toxins that can be harmful to pregnancy. Fortunately, this information is constantly being updated in a database that is available for review by your health care providers, pharmacists and consultants/geneticists.

One must keep in mind that there is a baseline incidence of spontaneous birth defects in the general population (ranging from very minor to serious) and this can be a confounding issue whenever a patient is being counseled regarding a concern about a potentially harmful exposure. Furthermore, this baseline statistic is influenced by additional variables such as the gestational age of the pregnancy at the time of exposure, the patient's ethnicity and the medical history of both patient and partner.

Every day there are numerous anxious calls to prenatal care providers with concerns about exposures during pregnancy. Questioning whether they can have a local anesthetic for a tooth extraction or get their hair colored. Many of these concerns have been addressed through the years which has led to the answers you are looking for through statistical analysis.

I would stress, before bringing such routine questions to your prenatal provider, start with asking your (dentist, herbalist, hairdresser, etc.) about the specifics of the drug or hair product and any concerns that have been raised as they are likely to be most familiar with the product and your situation. It is likely you are not the first time this concern has come up. Their comments to you may be comforting even though you must consult with your prenatal care provider regardless. They want to be sure you are getting the best care and not assuming anything as such decisions are so important. The reason to talk with your pregnancy provider is because the timing of exposure is among the most significant factors when assessing your risk and is not information anyone other than your prenatal care provider will be fully aware of. Your due date is based on your last menstrual period and ultrasound (when necessary) to date your pregnancy accurately.

In addition to timing of exposure during the pregnancy there are other factors not mentioned above including duration and dosage of an exposure as is the case with radiation exposure.

Once your provider has gathered the necessary information, he/she will often refer to the Physician's Desk Reference or a book such as "Drugs During Pregnancy and Lactation" . If the information is not readily available or is inconclusive, your provider will consult with the pharmacist/radiologist etc. who may have access to a larger data base or arrange a visit with a consultant/geneticist who will gather additional information/history from you and address the exposure in more detail.

This article clearly cannot offer advice or recommendations about any specific exposures and is not intended to diagnose, cure, prevent or treat any medical concern on this topic. Hopefully it has helped one understand the process used and the limitations confronting your medical provider when trying to get you the answers you want relating to potentially harmful exposures during your pregnancy.