Clinical Registry

Pregnancy Drug Safety

Complete A-Z index of medications and their safety profiles across all trimesters. Sourced from FDA, ACOG, and peer-reviewed clinical guidelines.

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Evidence-based safety ratings, alternatives, and trimester guidance.

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Full Registry (A-Z)

Clonazepam

Benzodiazepine / Antiepileptic

Benzodiazepine used for seizure disorders, panic disorder, and anxiety. Crosses the placenta readily. Risk of cleft lip/palate with first-trimester use is debated — pooled data does not confirm a significant increase. Neonatal abstinence syndrome (NAS) with chronic use: hypotonia, hypothermia, poor feeding, respiratory depression. Neonatal "floppy infant syndrome" with high doses near delivery. Use the lowest effective dose; avoid abrupt discontinuation.

Clotrimazole

Antifungal (Topical Azole)

First-line treatment for vulvovaginal candidiasis (VVC) in all trimesters. Topical application results in negligible systemic absorption, making it safe for the fetus. Available as creams and vaginal suppositories without prescription. A 7-day course is recommended in pregnancy (vs. 1–3 days for non-pregnant women) for higher cure rates.

Codeine

Opioid Analgesic

Avoid. Codeine is a prodrug converted by CYP2D6 to morphine. Ultra-rapid metabolizers produce excessive morphine, posing risk of neonatal opioid toxicity. In 2017, the FDA contraindicated codeine (and tramadol) for breastfeeding mothers due to neonatal deaths from morphine toxicity in infants of ultra-rapid metabolizers. In pregnancy, opioids carry risk of Neonatal Opioid Withdrawal Syndrome (NOWS), fetal growth restriction, and preterm birth with chronic use. For acute pain in pregnancy, acetaminophen is preferred. Short-term use of codeine near term poses additional risk of neonatal respiratory depression.

Dexamethasone

Corticosteroid (Antenatal)

Synthetic corticosteroid that crosses the placenta without inactivation. Alternative to betamethasone for fetal lung maturation in preterm delivery (24–34 weeks), particularly in low-resource settings where betamethasone may be unavailable. Also used for autoimmune conditions, fetal complete heart block (with anti-SSA antibodies), and Bell palsy. Betamethasone is preferred for fetal lung maturation in settings where both are available. For maternal indications (e.g., septic shock, cerebral edema), use is acceptable when life-saving.

Diazepam

Benzodiazepine

Long-acting benzodiazepine. Crosses the placenta extensively; accumulates in fetal tissues. Used in obstetric emergencies for eclamptic seizures (where magnesium sulfate has failed) and acute anxiety. Chronic use is associated with neonatal abstinence syndrome. Floppy infant syndrome documented with high doses at delivery. Not recommended for routine anxiety management in pregnancy — magnesium sulfate is preferred for eclampsia.

Dinoprostone

Prostaglandin E2 (Cervical Ripening)

Prostaglandin E2 used for cervical ripening prior to labor induction (intracervical gel or vaginal insert/Cervidil). Effective and safe for this indication in the third trimester. Must not be used in women with prior uterine surgery (classical cesarean scar) due to uterine rupture risk. Remove vaginal insert before initiating oxytocin. Prostaglandins are contraindicated as tocolytics (opposite mechanism).

Diphenhydramine

Antihistamine (1st Generation)

First-generation sedating antihistamine used for allergic conditions, sleep, and NVP. More sedating than second-generation agents. No established teratogenicity in humans but limited near-term use recommended. When used very close to delivery, associated with neonatal CNS depression, jitteriness, and respiratory issues. Prefer second-generation antihistamines (cetirizine, loratadine) for routine use.

Dolutegravir

Antiretroviral (INSTI)

Integrase strand transfer inhibitor (INSTI) now recommended as the preferred ART anchor drug in pregnancy by WHO (2021) and most national guidelines including Uganda ARV guidelines. Earlier concern about neural tube defects from a Botswana surveillance study (Tsepamo) was based on periconceptional exposure data that has since been revised — the signal did not persist in larger, updated analyses. DTG-based regimens achieve faster viral suppression than EFV-based regimens. Use TLD (tenofovir + lamivudine + dolutegravir) as preferred regimen.

Doxycycline

Antibiotic (Tetracycline)

Avoid in pregnancy, particularly after organogenesis begins. Tetracyclines bind calcium in developing calcified tissues. After the fourth month, they are incorporated into fetal bone and primary tooth enamel causing yellow-brown discoloration and enamel hypoplasia. May cause hepatotoxicity in the mother at high IV doses. Short courses in early T1 (before fetal tooth development) are unlikely to cause dental effects but alternatives should still be sought.

Doxylamine

Antihistamine / Antiemetic

Combined with pyridoxine (Vitamin B6) as Diclegis (delayed-release) or Bonjesta — the only FDA-approved medication specifically for nausea and vomiting of pregnancy (NVP). Extensive post-marketing surveillance from its earlier formulation (Bendectin) across millions of exposures showed no teratogenicity. Withdrawn from the US market in 1983 due to litigation despite no scientific evidence of harm; re-approved in 2013 after full FDA review.

Enoxaparin

Anticoagulant (LMWH)

Standard of care for VTE prevention and treatment in pregnancy. Does not cross the placenta due to its large molecular weight. No teratogenicity. Requires dose adjustment in pregnancy (weight-based; anti-Xa monitoring in some cases). Renal function monitoring recommended. Switch to unfractionated heparin (UFH) at 36–37 weeks to allow neuraxial anesthesia planning.

Ergometrine / Methylergonovine

Uterotonic (Ergot Alkaloid)

Uterotonic ergot alkaloid used for prevention and treatment of PPH after delivery of the placenta. Effective but has significant contraindications: causes vasoconstriction and is contraindicated in hypertension, preeclampsia, and cardiovascular disease — which are common comorbidities in obstetric PPH scenarios. Oxytocin and misoprostol are preferred first-line agents; ergometrine is reserved for refractory cases or used in combination (Syntometrine = oxytocin + ergometrine). Must not be used before delivery of the baby — severe uterine tetany and fetal hypoxia.

Erythromycin

Antibiotic (Macrolide)

Safe macrolide antibiotic used in pregnancy. Specifically indicated for PPROM to prolong pregnancy latency (ORACLE trial), and for chlamydial infections when azithromycin is not available. The estolate salt is contraindicated in pregnancy due to maternal hepatotoxicity; use erythromycin base or ethylsuccinate.

Escitalopram

Antidepressant (SSRI)

Commonly used SSRI with a favorable pregnancy safety profile. Large cohort studies and registry data do not show a significant increase in major congenital malformations. Has less data than sertraline or fluoxetine but growing evidence is reassuring. Monitor for Poor Neonatal Adaptation (PNA) with late-pregnancy use.

Famotidine

H2-Receptor Antagonist (Antacid)

Commonly used for gastroesophageal reflux (GERD), a frequent complaint in pregnancy. H2 blockers including famotidine are considered safe across all trimesters. Cross placenta but no evidence of teratogenicity in large cohort studies. Preferred over proton pump inhibitors as first-line for mild-moderate GERD due to longer safety track record in pregnancy.

Fluconazole

Antifungal (Azole)

Oral fluconazole has a significant gestational-age-dependent risk profile. A single low dose (150 mg) for vaginal candidiasis is commonly used but increasingly scrutinized: a large 2016 Danish cohort (n=3,315) found a doubling of spontaneous abortion risk, and a 2020 NEJM study identified a significant association between single-dose and high-dose fluconazole use in T1 and cardiac septal defects. High-dose prolonged fluconazole (400–800 mg/day) is a known teratogen causing a distinctive skeletal malformation syndrome. Use topical azoles (clotrimazole, miconazole) as first-line for vaginal candidiasis.

Fluoxetine

Antidepressant (SSRI)

Well-studied SSRI in pregnancy. No consistent increase in major structural malformations. Its very long half-life (fluoxetine + active metabolite norfluoxetine: 1–6 days) means prolonged fetal exposure relative to shorter-acting SSRIs, and may slightly increase the duration and intensity of neonatal adaptation syndrome.

Fluoxetine-Safety-Postpartum

Antidepressant (SSRI)

For completeness: fluoxetine is also used postpartum for postnatal depression. The main breastfeeding consideration is its long half-life (fluoxetine + norfluoxetine) leading to measurable infant serum concentrations. While not contraindicated, sertraline or paroxetine are preferred for breastfeeding mothers. Separate slug to capture postnatal searches.

Folic Acid

Vitamin / Nutritional Supplement

Essential periconceptional supplement. Folic acid (synthetic oxidized form of folate) reduces the risk of neural tube defects (NTDs) such as spina bifida and anencephaly by 50–70% when taken before conception and through the first trimester. Standard dose: 400–800 mcg/day for low-risk women; 4–5 mg/day for high-risk (prior NTD pregnancy, antiepileptic drug use, obesity, diabetes). Insufficient folate is a major preventable cause of birth defects.

Furosemide

Loop Diuretic

Loop diuretic used for pulmonary edema, heart failure, and severe hypertension in pregnancy. Not used for routine edema management. Reduces maternal plasma volume, which can compromise uteroplacental perfusion and cause fetal electrolyte disturbances. Reserved for specific maternal indications (pulmonary edema, peripartum cardiomyopathy). Animal studies at high doses showed fetal renal malformations — not replicated at therapeutic human doses.

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