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Key messages
1. Exercises reduce back and pelvic pain during pregnancy. There is weak evidence for
improvements with acupuncture and chiropractic care (N) (Level I).
2. Use of NSAIDs during pregnancy is associated with an increased risk of miscarriage (U)
(Level III‐2).
The following tick boxes represent conclusions based on clinical experience and expert
opinion.
For pain management in pregnancy non‐pharmacological treatment options should be
considered where possible before analgesic medications are used (U).
Use of medications for pain in pregnancy should be guided by published
recommendations; ongoing analgesic use requires close liaison between the obstetrician
and the medical practitioner managing the pain (U).
NSAIDs should be used with caution in the last trimester of pregnancy and should be
nd
avoided after the 32 week (U).
Table 11.1 ADEC drug categorisation according to fetal risk
A Drugs that have been taken by a large number of pregnant women and women of childbearing
age without any proven increase in the frequency of malformations or other direct or indirect
harmful effects on the fetus having been observed.
B1 Drugs that have been taken by only a limited number of pregnant women and women of
childbearing age, without an increase in the frequency of malformation or other direct or indirect
harmful effects on the human fetus having been observed.
Studies in animals have not shown evidence of an increased occurrence of fetal damage.
B2 Drugs that have been taken by only a limited number of pregnant women and women of
childbearing age, without an increase in the frequency of malformation or other direct or indirect
harmful effects on the human fetus having been observed.
Studies in animals are inadequate or may be lacking, but available data show no evidence of an
increased occurrence of fetal damage.
B3 Drugs that have been taken by only a limited number of pregnant women and women of
childbearing age, without an increase in the frequency of malformation or other direct or indirect
harmful effects on the human fetus having been observed.
Studies in animals have shown evidence of an increased occurrence of fetal damage, the
significance of which is considered uncertain in humans.
C Drugs that, owing to their pharmacological effects, have caused or may be suspected of causing,
harmful effects on the human fetus or neonate without causing malformations. These effects
may be reversible. Accompanying texts should be consulted for further details.
D Drugs that have caused, are suspected to have caused or may be expected to cause, an increased CHAPTER 11
incidence of human fetal malformations or irreversible damage. These drugs may also have
adverse pharmacological effects. Accompanying texts should be consulted for further details.
X Drugs that have such a high risk of causing permanent damage to the fetus that they should not
be used in pregnancy or when there is a possibility of pregnancy.
Notes: For drugs in the B1, B2 and B3 categories, human data are lacking or inadequate and subcategorisation is
therefore based on available animal data. The allocation of a B category does NOT imply greater safety than
the C category. Drugs in category D are not absolutely contraindicated in pregnancy (eg anticonvulsants).
Moreover, in some cases the ‘D’ category has been assigned on the basis of ‘suspicion’.
Due to legal considerations in Australia, sponsor companies have, in some cases, applied a more restrictive
category than can be justified on the basis of the available data.
In some cases there may be discrepancies between the published product information and the information
in this booklet due to the process of ongoing document revision.
Source: ADEC (1999). © Commonwealth of Australia. Reproduced with permission (see notes on verso page).
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