No drug – whether it’s OTC or prescription, alcohol, nicotine, or caffeine – should be considered safe during pregnancy! Most drugs can cross the placenta and affect your unborn baby as well as you.

Considering that the major stages in an embryo’s development occur during the first few weeks of life, before most woman even know that they’re pregnant, it’s wise, if you’re even contemplating motherhood, to think twice and check with a physician before taking any medicine!

Aspirin or salicylate analgesics, such as Anacin, Alka Seltzer, and so on, especially if overused in the third trimester, may prolong pregnancy or labour and cause severe bleeding in both mother and newborn before, during, and after delivery.

Antacids, such as Maalox, Milk of Magnesia, and others, should not be taken for prolonged periods, or in high doses. They may cause muscle problems in the fetus, and sodium antacids can cause a pregnant woman to retain too much water.

Anti-cough medicines, such as terpin hydrate products, contain large amounts of alcohol, which can cause birth defects. (Be aware of how much more alcohol you’re adding to your daily intake.)

Diuretics, if used routinely, can be dangerous to mother and fetus, and may cause liver and/or blood disorders in newborns.

Anti-diarrheal containing paragoric, if used too often, may lead to drug dependency in newborns and cause withdrawal symptoms. (If taken just prior to delivery, these medications have been known to cause breathing problems in newborns.)

Prescription anti-nausea preparations containing doxylamine with pyridoxine might cause birth defects.

Topical hydrocortisone products, used for the treatment of hemorrhoids can, if used in large amounts or for prolonged periods, is absorbed through the skin and cause birth defects.

Tetracycline, especially if used in the last half of pregnancy, may cause discoloration of forming teeth in newborns as well as retard their teeth and bone growth.

Decongestants containing pseudoephedrine may cause a reduction in size and rate of bone formation in the fetus.

Laxatives, which contain large amounts of sodium or sugar may increase blood pressure and cause water retention. Saline laxatives – Epsom Salts, Citrate of Magnesia, Phospho-Soda – containing magnesium or potassium should be avoided if your kidney functions are not normal; those containing sodium should be avoided if you tend to retain water. Repeated use of mineral oil as a laxative can decrease proper absorption of foods, vitamins, and oral medications. It may also cause blood disorders in newborns. Castor oil can also be dangerous because it may cause contractions in the womb.

Quinine may cause birth defects and stimulate premature labour.

Tranquillizers and sedatives, such as Librium, Valium, Dalmane, and others, may increase chances of birth defects. These drugs can also cause dependency and withdrawal symptoms in newborns. (Used late in pregnancy or during labour, they have been known to cause breathing problems in newborns.) Phenothiazine products are also not recommended as they can cause jaundice and muscle tremors in newborns.

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Some patients might decide not to opt for weight-loss surgery following screening, others might be deemed unsuitable; such patients should ideally be picked up in primary care.

The screening process might pick up biochemical evidence of an undiagnosed cause for obesity, or individuals for whom non-invasive management is clearly a better option. Patients might lose so much weight as a ‘preoperative’ measure that surgery is no longer necessary. In others there might be a psychological or underlying psychiatric condition that calls either for a different treatment altogether or needs to be dealt with before surgery is considered. Schizophrenia, personality disorder and uncontrolled depression are absolute contraindications for surgery. Individuals whose obesity is caused simply by love of food, or patients with binge eating disorder might find the postoperative adjustment of behaviour overwhelmingly difficult.

Prior to embarking on surgery, the risk : benefit ratio is considered and patients might be deemed unsuitable for surgery because of their comorbidities, anaesthetic risk and general well-being.

Women of childbearing age should be treated with extreme caution because of the increased nutritional needs of pregnancy being hampered by the reduced capacity for absorption of nutrients. Such patients are advised not to become pregnant after surgery until their weight has stabilized and their micronutrient status has been checked; contraceptive advice is essential.

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Retin-A

Retin-A is a much underutilized topical anti-acne preparation. It unblocks the oily ducts very effectively and is excellent for removing both blackheads and whiteheads. The main problem with Retin-A is that it initially produces some peeling, redness and irritation of the skin. After the first six weeks, however, the skin settles down.

People are often afraid of using Retin-A because of the initial irritation as well as the potential sun sensitivity. Both of these side effects are overstated. If Retin-A is used correctly, under medical supervision, it is a very successful treatment with minimal problems.

Retin-A comes as a cream, a gel or a lotion. The cream is the least irritating and should be used initially. Although the gel is a weaker strength, it is actually more irritating because it has an alcohol base. Individuals with oily skin may eventually use Retin-A lotion, which is the strongest preparation, but should wait until their skin has acclimatized to the cream.

Retin-A may cause initial irritation and even flaring of acne lesions. It takes a minimum of two to three months before any improvement is seen and this continues the longer it is used. However, Retin-A ‘controls’ acne rather than ‘cures’ it and is only effective while it is being used. It is safe to use for prolonged periods.

Although Retin-A does make your skin more sensitive to the sun, this effect has been exaggerated. However, if you are going outdoors for prolonged periods, a non-creamy sunscreen should be worn. Many sunscreens are irritating when Retin-A is being used, so a low irritant sunscreen such as Clinique City Block, Ego SunSense Toddler Milk, Ego Sunsensitive, Roche Aquababy or Koala Beach SPF 15 Gel is best. Alcohol-based sunscreens can sting if used in conjunction with Retin-A.

Topical preparations

Topical antibiotics, in particular clindamycin, erythromycin and lincomycin, are also very useful for acne as they specifically attack the bacteria within the oily glands. These topical preparations are best used in conjunction with benzoyl peroxide or Retin-A and cause few problems and minimal irritation. Not all topical antibiotics are useful as many have no specific action against the offending bacteria.

Some of the old-fashioned anti-acne preparations contain sulphur and salicylic acid. They are still useful but are not as effective as those mentioned above. Topical cortisone preparations are best avoided as they can aggravate acne.

A new preparation, called Ketsugo, seems promising for the treatment of acne. This product is derived from shark oil, and has been developed by Japanese scientists. Although not yet fully evaluated, it appears to reduce oil production and is effective in cases of mild acne.

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