Principles of medication use in pregnancy

Dr Bernadette Jenner sets out a practical framework for prescribing in pregnancy rather than a list of "safe" and "unsafe" drugs, covering the benefit, risk, alternatives and no-treatment decision, timing of exposure, lowest effective dose, and use of resources such as the UK Teratology Information Service. Using examples including warfarin in metallic heart valves, biologics and a composite case of a woman with epilepsy and hypertension, she covers preconception counselling, pharmacokinetic changes (such as falling lamotrigine levels), VTE and pre-eclampsia prophylaxis, GLP-1 receptor agonist exposure, and postpartum medication planning. She also draws on the MBRRACE-UK reports to show how withholding indicated treatment from pregnant and breastfeeding women has contributed to harm, and argues for including pregnant women in clinical research.