Medication Safety in Pregnancy: A Comprehensive Review of Risks and Management Approaches

Abstract

Medication use during pregnancy presents complex clinical challenges because of the necessity to balance maternal benefit against fetal risk. Physiological changes in pregnancy influence pharmacokinetics and pharmacodynamics, while the potential for teratogenicity, fetotoxicity, and perinatal complications warrants careful risk-assessment and management. This review outlines the underlying risk mechanisms, stages of gestation relevant to drug exposure, common maternal conditions requiring therapy, principles of prescribing in pregnancy, major classes of concern (infectious disease agents, cardiovascular drugs, psycho-therapeutics, analgesics, anti-epileptics), and management strategies including pre-conception counselling, monitoring, deprescribing, and use of safety registries. Emerging approaches such as post-marketing surveillance, pregnancy registries, physiologically-based pharmacokinetic modelling, and pharmacogenomic frameworks are also reviewed. The aim is to provide a comprehensive, structured overview to guide clinicians in safe medication management for pregnant women, highlighting current evidence gaps and future directions.