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But four large cohort studies that followed women through pregnancy and followed the children until they were 9 years old don't show higher risk. "Two recent published studies show a slight risk for heart defects with Paxil, a selective serotonin reuptake inhibitor, or SSRI. Confusion Over Paxilīlack-box warnings on prescription labels indicate the highest level of risk determined by the FDA.īut the recent black-box labeling of the antidepressant Paxil causes confusion for pregnant women, says Martinez. "It's interesting to me that by comparison, Accutane's risk is much higher than thalidomide's - which carries a 20% risk - and its harm to the child is far worse," she says. Furthermore, of the 65% of babies born without structural malformations, 50% are profoundly intellectually disabled. Martinez tells WebMD that if a woman takes the drug during pregnancy, there is a 30% to 35% risk for major birth defects, including complete absence of the thymus gland serious, often lethal, heart defects absence of the inner and outer ears and severe, possibly lethal, hydrocephalus - a buildup of excess fluid in the brain. Someone gets an outbreak of pimples and wants Accutane," she says. "It's an amazing drug approved for severe nodular or cystic acne, but it's estimated that in the U.S., 90% of prescriptions are off label. Yet in terms of risk and impact, it pales in comparison to isotretinoin, best-known by the brand name Accutane, according to Lynn Martinez, Utah State Health Department coordinator of the Pregnancy Riskline in Salt Lake City. The thalidomide scare of the 1960s is legendary.

Vitamin A and its derivatives, such as isotretinoin, etretinate, retinoids.

Trimethadione (no longer available in the U.S.) and paramethadione.

Folic acid antagonists, methotrexate, aminopterin.

Angiotensin-converting enzyme (ACE) inhibitors, such as enalapril and captopril.

Androgens and testosterone derivatives, such as danazol.

According to the educational bulletin on teratology published by the American College of Obstetrics and Gynecology (ACOG), the following are among the known causes of birth defects: Drugs and Chemicals The level and length of time of exposure, as well as the stage of the pregnancy at time of exposure, can come into play. Substances that can cause birth defects are called "teratogens." Exposure to them does not automatically put your fetus at risk. So is there any way to lower the risk? The following information should help you separate the facts from the likely fiction. And most known defects are due to genetic or other unpreventable causes - not to mom's exposure to toxic chemicals, foods, drugs, or infections. According to the March of Dimes web site, the cause of about 70% of birth defects is unknown. Besides the known risks, there lurks a vast gray area in which the research is inconclusive. Unfortunately, the territory is not clearly charted. With new alarms sounded almost daily, it's a challenge to know what to do. But what about the sushi bar, nail polish, and bottled water? When you're expecting a baby, how vigilant do you need to be about possible toxins? Sure, you'll want to steer clear of smokers, the cat's litter box, and margaritas.