The thalidomide tragedy in the early 1960s demonstrated the extent of the damage that drugs can do to the fetus. The episode led to the introduction of licensing arrangements controlling manufacture, sale, supply and marketing of drugs1 and it is now rare for a licence application for a new drug to include a recommendation for its use in pregnancy. The British National Formulary warns that "no drug is safe beyond all doubt in early pregnancy". Pregnant women nonetheless may need drug treatment. In this article we consider what precautions the prescriber should take to ensure that the risk to the fetus is minimised while not denying women of child-bearing age effective therapy.
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