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Drug ratings in pregnancy (US Food and Drug Administration)

Drug ratings in pregnancy (US Food and Drug Administration)
Category Interpretation
A Controlled human studies show no risk
Controlled studies in pregnant women fail to demonstrate a risk to the fetus in the first trimester with no evidence of risk in later trimesters. The possibility of fetal harm appears remote.
B No evidence of risk in studies
Either animal reproduction studies have not demonstrated a fetal risk but there are no controlled studies in pregnant women or animal reproduction studies have shown an adverse effect (other than a decrease in fertility) that was not confirmed in controlled studies in women in the first trimester and there is no evidence of a risk in later trimesters.
C Risk cannot be ruled out
Either studies in animals have revealed adverse effects on the fetus (teratogenic or embryocidal effects or other) and there are no controlled studies in women or studies in women and animals are not available. Drugs should be given only if the potential benefits justify the potential risk to the fetus.
D Positive evidence of risk
There is positive evidence of human fetal risk, but the benefits from use in pregnant women may be acceptable despite the risk (eg, if the drug is needed in a life-threatening situation or for a serious disease for which safer drugs cannot be used or are ineffective).
X Contraindicated in pregnancy
Studies in animals or human beings have demonstrated fetal abnormalities or there is evidence of fetal risk based on human experience or both, and the risk of the use of the drug in pregnant women clearly outweighs any possible benefit. The drug is contraindicated in women who are or may become pregnant.
In 2015, the US Food and Drug Administration (FDA) began overseeing the phase-out of pregnancy risk categories (A, B, C, D, and X) from prescription drug labeling and began requiring information from available human and animal studies of (1) known or potential maternal or fetal adverse reactions and (2) dose adjustments needed during pregnancy and the postpartum period. Additional information is available at the FDA website: Pregnancy and Lactation Labeling Final Rule.
Reproduced with permission from: Lexicomp Online. Copyright © 1978-2022 Lexicomp, Inc. All Rights Reserved.
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