Calls to a teratogen information service regarding potential exposures in pregnancy and breastfeeding

The study presented here found that analgesics, vaccinations, cold medications (decongestants, cough medications, and antihistamine), and herbals, homeopathic and dietary medications were of most frequent concerns for callers to the MotherToBaby Utah service. The majority of inquiries were from the potentially-exposed individual, who were currently pregnant rather than from those who were breastfeeding. Most of the inquiries were related to exposures during the first trimester of pregnancy.

With regards to the high proportion of calls relating to medications obtained in the non-prescription setting, including herbal/other natural health products/supplements there have been few studies that have explored the use of herbals, homeopathic and dietary medications during pregnancy and breastfeeding. Herbal products are regulated by the Food and Drug Administration (FDA) as foods. Manufacturers are not required to do the pre- and post-marketing surveillance to determine if there is an increase in the risk of birth defects, other negative pregnancy outcomes, or side-effects in breastfed babies. Due to limited information online and from health care providers, many called the MotherToBe service seeking advice about these exposures during pregnancy and breastfeeding. With limited data on dose/amount of the exposure, a true risk assessment was not possible. Until the regulations regarding herbals and other natural products change, and more evidence based studies are undertaken, there are no known safe exposures for these products during pregnancy and breastfeeding.

Holden et al. [9], interestingly found no difference in the rates of herbals and other natural product use between pregnant and non-pregnant users. Indicating that use by pregnant women in the United States is common, with over a third of the population using one or more therapies. Of more concern, only half disclosed the use of these types of substances to their providers. It appears that use is increasingly commonplace and as outlined by a recent study [10] in Australia. Pregnant women want more personal control over their bodies and are more concerned about their own personal experience when taking a herbal medicine during pregnancy rather than clinical evidence of efficacy. Many pregnant women are turning also to Chinese medicine, but similar to conventional pharmaceuticals, Chinese medicines are not free of risk, and have the potential to cause adverse pregnancy outcomes and fetal development [11]. There is limited clinical data concerning the safety of maternal exposure to Chinese medicines and basic research and mechanistic studies of the potential teratogenicity of Chinese medicines are lacking [11]. Unfortunately, the MotherToBaby Utah service does not categorize out Chinese medicines as a separate classification, however, this is to be considered in the future as the use of these products increases.

A comparative study was undertaken by Patil et al. [12], this was also a retrospective descriptive study of pregnancy and breastfeeding related inquiries to the University of North Carolina Health Care System Drug Information Center (January 2001 to December 2010). Their review of 433 calls found that inquiries were most often made during the antepartum period (34 %), followed by the postpartum (28 %) and preconception (22 %) periods. This is in contrast to the majority (88.6 %) of inquiries to MotherToBaby Utah which were made during a current pregnancy. The study undertaken by Patil et al. [12], determined the most frequent indications for inquiries to their service were related to psychiatry and infectious disease-related medication use in pregnancy.

One reason for the difference in inquires between MotherToBaby Utah could be that the North Carolina Health Care System Drug Information Centre would mostly respond to questions from health care providers and not the public. Most teratogen information services (TIS) take a larger percent of calls from the public and exposure questions would therefore differ. Future projects would include data from all TIS’ in the United States to determine regional medication usage of medications by pregnant and breastfeeding women. There is other literature describing TIS call experiences, but not from USA teratogen information services. The only other relatively recent large analysis of an equivalent service came out of Australia which showed there was a demand for such a service especially in rural areas [13].

Medication use is common and prevalence of use during pregnancy is increasing [14]. This study provides counseling focal points for health care providers in pregnant and breastfeeding populations. The vast majority of maternal medications have an undetermined risk for birth defects or other adverse fetal outcomes because they have not been adequately studied in human pregnancy [15]. Many of the common exposures do not require a prescription and are readily accessible, and make up the greatest concern of those calling MotherToBaby Utah. There is a need for increased efforts in educating the public, especially women who are currently or thinking of becoming pregnant, of risks as well as the relative safety of common exposures. Although this study helps expand current knowledge of common exposures in pregnancy and breastfeeding in the USA, larger studies are needed. Prenatal care should encompass up-to-date and appropriate education regarding these common exposures in pregnant and breastfeeding women.


Overall, few studies have been published regarding medication use during pregnancy and breastfeeding. As callers to the MotherToBaby Utah service may call more than one time, prevalence could not be determined in these data. Updates to the database would need to be completed in order to determine prevalence. In addition, although it is rare that a health care provider and the mother would both call regarding the same exposure concern, it could happened. Both inquires would then be reported in the database. The current system does not account for the number of times this might happen. It is reasonable to view this as educating two separate individuals, the health care provider and the mother. Educating providers on common exposures in pregnant and breastfeeding women may reduce the need for mothers and other concerned individuals to contact the service.

In the MotherToBaby Utah system, vitamins are entered separately and would be entered by the name of the vitamin e.g., vitamin B6 is entered as Pyridoxine and vitamin B9 would be entered under folic acid. When searching the database, vitamins would not be included in the results of the database under Herbs/Dietary Supplements.

With regards to pregnant women taking OTCs, it is possible that women using OTC medications are not seeking professional advice and therefore could be more likely to call MotherToBaby Utah. Unfortunately, this study was not designed to collect data to support this statement. Most of the callers get the MotherToBaby contact information from their health care provider or are told by the health care provider to call the service. It is possible that woman using OTC medications are more likely to call the service.

Another limitation of the study is that termination of pregnancies were not considered in these statistics and it is unknown whether exposures could have led to terminations either accidentally or intentionally. A 1989 study found that calls to a teratogen information service reduced the number of abortions [16]. A recent change for the MotherToBaby Utah service was to ask any caller who brings-up abortion if they are still considering abortion after the counselling. The abortion discussion is rare among the calls received and would take some time to have enough data to be statically significant.