Medication is rarely tested in pregnant women, so evidence to support clinical decisions is often lacking. Without robust data, clinical decisions are often based on fear of potentially harming the unborn child. This affects not only pregnant women, but any woman who could potentially become pregnant – in other words, all women of childbearing age.
Women living with chronic diseases are particularly affected, as they may require ongoing medication to manage their health. But the lack of research or regulatory clarity means healthcare professionals do not have enough evidence on the use of medication before and during pregnancy. This leads to clinical decisions being based largely on precaution and anecdotal evidence.
There is a tendency to view treatment as potentially harmful to the fetus, but risk is relative: leaving a disease untreated may cause harm to the woman, the unborn child or to both of them. This dilemma may lead healthcare professionals to give conflicting information, leaving women feeling that they must choose between managing their disease and having a child.
Despite the lack of evidence, almost half of pregnant women will take at least one medication over the course of their pregnancy. Recent years have seen some progress in research around medical treatment in pregnancy, and it is now time for clinical practice to follow.
All stakeholders must work together to shift mindsets, revise ethical and regulatory frameworks and create innovative partnerships to collect evidence to guide clinical care that will align with women’s fertility goals.