Medications taken by the father before and during the future mother's pregnancy: what risks for the unborn child?

The Reference Center for Teratogenic Agents (CRAT) is a public structure independent of the pharmaceutical industry. It is financed by Assistance Publique – Hôpitaux de Paris and the National Medicines Safety Agency (ANSM). Its mission: to inform health professionals about the teratogenic effects of certain medications, vaccines and addictions, during pregnancy – whether exposure is maternal and/or paternal – and breastfeeding. Its website is open to the public.

For clarification, a teratogenic effect refers to the ability of a substance to cause malformations or anomalies in the development of a fetus during pregnancy.

Drug consumption among future fathers, a growing concern

The taking of medication by the future father has become a growing concern: it represented 10% of the questions asked to CRAT experts in 2023, compared to 3% in 2013.

The risks associated with treatments in men include sexual disturbances (erection, ejaculation and libido problems) and impaired fertility. An impact on offspring may exist, in particular due to the potential passage of substances via the vaginal route, with risks of toxicity at the gene level (genotoxicity). Certain molecules can be mutagenic, i.e. induce genetic mutations. They can possibly be clastogenic, when they increase the risk of chromosomal breaks and DNA damage. Teratogenicity, as well as intrauterine growth retardation, or prematurity, are also monitored, as are neurodevelopmental disorders in children.

A third of men exposed to a drug 6 months before conception

An American study noted that between 2011 and 2020, a third of fathers received treatment in the three to six months before conceiving a child: 8.6% received psychotropic drugs, 7.2% received antibiotics, 6 .8% to analgesics and 5.6% to antihypertensives.

Many therapeutic classes have been examined in detail by CRAT experts, and overall, the taking of medications by the father before or during pregnancy does not seem to pose any particularly worrying problems.

• Regarding the antidepressants Selective serotonin reuptake inhibitors, which are widely used, such as sertraline (Zoloft) or paroxetine (Deroxat), they do not present a risk of toxicity for genes. In more than 1,000 pregnancies where the father was treated with these molecules, no malformation or neurodevelopmental disorder was observed in the offspring. Consequently, their prolonged use is not considered problematic by the CRAT. If you experience sexual problems under treatment, talk to your doctor.
• Regarding the antidiabeticsin particular GLP-1 analogues, in common use such as semaglutide (Ozempic), liraglutide (Saxenda, Victoza) or even dulaglutide (Trulicity), no alert has been reported at this stage. These drugs are not genotoxic and would not cause damage to fertility.
• For the calcium channel blockersprescribed against high blood pressure, heart rhythm disorders, etc., sperm abnormalities have been observed in vitro and in animals, but these effects are reversible. Experts recommend asking the question of their responsibility if fertility problems appear in men undergoing treatment, but do not consider the situation worrying.
• As for isotretinoin (Roaccutane), well known for its teratogenic effects when taken by the mother to treat acne, it does not seem to pose a problem in humans.
• As for sodium valproate, prescribed in epilepsy (Dépakine, etc.) or bipolar disorders, it can alter the number and mobility of sperm, but these effects are reversible when treatment is stopped. The reassuring experts rely on studies of more than 1,000 children born to treated fathers. Therefore, a man can conceive under treatment without special supervision. However, in the event of fertility problems, it is recommended to discuss it with your doctor.