Parasympatholytic
PREGNANCY RECOMMENDATION: Limited Human Data—No Relevant Animal Data
BREASTFEEDING RECOMMENDATION: No Human Data—Probably Compatible
PREGNANCY SUMMARY
The limited pregnancy experience showing teratogenicity requires confirmation. In general, however, anticholinergics appear to be low risk in pregnancy. (See Atropine.)
FETAL RISK SUMMARY
Belladonna is an anticholinergic agent. The Collaborative Perinatal Project monitored 50,282 mother–child pairs, 554 of whom used belladonna in the 1st trimester (1, pp. 346–353). Belladonna was found to be associated with malformations in general and with minor malformations. Specifically, increased risks (standardized relative risk >1.5) were observed for respiratory tract anomalies, hypospadias, and eye and ear malformations. The association between belladonna and eye and ear malformations was statistically significant. Interpretation of these data is difficult, however, because the authors of the study emphasized that even though some agents had elevated risks and significant associations did occur, a cause-and-effect relationship could not be inferred. For use anytime during pregnancy, 1355 exposures were recorded (1, p. 439). No association was found in this group.
A 1994 case report described the use of belladonna alkaloid (4 times daily for 5 days) in two women with hyperemesis and excessive salivation (2). A phenothiazine (specific agent not mentioned) antiemetic also was given. One woman gave birth to a normal female infant at term, whereas the other gave birth to twins at 30 weeks. All three infants had normal examinations (2).
BREASTFEEDING SUMMARY
No reports describing the use of belladonna during lactation have been located. In general, however, agents in this class are probably compatible with breastfeeding. (See Atropine.)
References
1.Heinonen OP, Slone D, Shapiro S. Birth Defects and Drugs in Pregnancy. Littleton, MA: Publishing Sciences Group, 1977.
2.Freeman JJ, Altieri RH, Baptiste HJ, Kuo T, Crittenden S, Fogarty K, Moultrie M, Coney E, Kanegis K. Evaluation and management of sialorrhea of pregnancy with concomitant hyperemesis. J Natl Med Assoc 1994;86:704–8.