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Editorial |

Drugs in Pregnancy:  Associations, Causation, and Misperceptions

Gideon Koren, MD; Irena Nulman, MD
Arch Pediatr Adolesc Med. 2010;164(5):494-495. doi:10.1001/archpediatrics.2010.64.
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Since the thalidomide era, there are concerns regarding potential adverse effects of drug and chemical exposure on the developing fetus in pregnancy, causing physicians and expectant mothers high levels of anxiety toward drugs, even in life-threatening conditions.1 Two articles in this issue of the Archives deal with potential intrauterine effects of xenobiotics and their complex interactions with maternal health and lifestyle. The 2 articles focus on compounds that are at the eye of the storm of current concerns. Oberlander et al2 focus on depression and antidepressants, involving an estimated 10% to 15% of pregnant women, while Stone and colleagues3 deal with potential adverse effects of recreational drugs, used by a substantial proportion of women of reproductive age. While it does not appear that the selective serotonin and epinephrine reuptake inhibitors cause consistent patterns of birth defects,4 there remain concerns regarding the ability of these receptor-specific agents to adversely affect fetal brain development. In general, existing studies have failed to show long-term effects on neurodevelopment, but their interpretation is challenged by the fact that depression and anxiety by themselves are known to adversely affect the child. In a similar manner, while a large number of children are exposed in utero to recreational drugs, on balance, epidemiological studies have failed to show consistent adverse fetal effects of cocaine, methamphetamine, and cannabis.5

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