The FDA said the results of a recent study showed that children exposed to valproate products in the womb had lower IQ at the age of six than children who were exposed to other antiepileptics.

Drugs containing valproate are used to prevent migraine headaches, treat epileptic seizures and manic episodes associated with bipolar disorder.

Abbott Laboratories' Depacon, Depakote, Depakote CP, Depakote ER and Depakene, and Noven Therapeutics LLC's Stavzor and their generics contain valproate. (http://r.reuters.com/nej87t)

Drugs containing valproate already carry a boxed warning for birth defects.

"Valproate medications should never be used in pregnant women for the prevention of migraine headaches because we have even more data now that shows the risks to the children outweigh any treatment benefits for this use," FDA's Director of the Division of Neurology Products, Russell Katz said.

This is the second time the FDA has warned on drugs containing valproate. In a June 2011 press release, the regulator had issued interim results of a study showing reduced cognitive functions in three-year-old children exposed to valproate.

(Reporting By Pallavi Ail in Bangalore; Editing by Roshni Menon)

Sonny Santiago, 23, was a rapper who died in a car crash in February. Commissioners at Pine Grove Cemetery in Lynn this week unanimously rejected his family's request to inscribe his gravestone with a song verse that included profanity.

The commission became aware of the language when the company inscribing the 3-foot tall memorial submitted drawings to commissioners.

Pine Grove Cemetery regulations posted online state that "the cemetery office must approve all inscription work on monuments."

"We've never had a problem like this before," commission Chairman Arthur Dulong told The Daily Item of Lynn (http://bit.ly/10kALVH ).

City officials contacted the family about the inscription and they agreed to have the gravestone inscribed with a different, profanity-free verse from a song Santiago wrote, said Santiago's sister-in-law, Angela Ventola.

"Everything got changed," she said. "Those words are not going on."

The commission's dispute with Santiago's family is not over. The family added a 3-foot by 8-foot decoration made from mulch and rocks on his gravesite shaped like the number "1." Uno was his performance name.

The family has been asked to remove the decoration because it does not conform to cemetery rules.

Santiago's mother, Ana DeJesus, said the family will comply with the request but she's not happy about it.

"I feel like we paid for the spot," she said. "We want to be with him. It's not fair."

___

Information from: The (Lynn, Mass.) Daily Item, http://itemlive.com

But as this year's elections nears, former President Michelle Bachelet, who was detained and tortured under the regime of Gen. Augusto Pinochet, is reaching out to the now-legal Communist Party and other left-leaning groups in her bid to return to the nation's top post.

It's a politically pragmatic move in a country plagued by mounting social demands and frequent protests.

But it's also part of Bachelet's goal, assuming she regains the presidency, to oversee an overhaul of the education and tax systems, which would be the country's most wide-ranging reform in four decades.

Chile, the world's top producer of copper, is respected for its fast-growing economy, strong institutions and low unemployment. But it also has the worst inequality rate among the 34 countries of the Organization for Economic Co-operation and Development.

As a presidential candidate, Bachelet needs the backing of the Communists and liberal social groups in the face of mounting demands and protests clamoring for a wider distribution of Chile's copper wealth, the preservation of the environment and free education.

Chile currently has two major electoral blocs, the center-left Concertacion coalition Bachelet leads and a center-right grouping that has said it will not back her proposals. Belonging to the country's Socialist Party, Bachelet says a change in the constitution is needed to break with the two-coalition system in place since the military dictatorship and allow one side or another to collect enough votes for significant change.

Enormously popular in the last year of her 2006-2010 presidency, Bachelet is now the front-runner in the Nov. 17 vote. A survey by the pollster Centro de Estudios Publicos found that 54 percent of respondents who had made up their minds on a candidate said they would vote for Bachelet, far ahead of any other name. If that number holds, it would help her avoid a runoff election mandated if no candidate wins a majority of votes.

The CEP poll, conducted between November and December of last year, interviewed 1,484 people and had a margin of error of three percentage points.

Bachelet recently announced her plans to run for president after spending 2 1/2 years in New York as the first executive director of UN Women, the United Nations' new agency for women and gender issues.

"Given the characteristics of Michelle Bachelet, the question is not whether she'll win in the first or second round but whether she'll win the whole thing, and the answer is yes," said Bernardo Navarrete, a University of Santiago political scientist.

Bachelet hasn't directly mentioned courting the Communist Party but has echoed their demands for education and constitutional reform.

"Chile needs a founding document born in democracy, a constitution aligned with the present conditions of Chile, that guarantees the economic and social rights to all Chileans," Bachelet said while announcing her pre-candidacy last month.

The other leading political group in Chile is the center-right Coalition for Change, which has been unable to capitalize on the country's economic success under the bloc's standard-bearer President Sebastian Pinera. Pinera enjoyed only a 31 percent approval rating in the late-2012 poll, and 29 percent approval for his handling of the economy.

On top of that, the coalition was dealt a tough blow this week when its presidential candidate Laurence Golborne, a charismatic businessman seen by the Pinera government as its best hope, was forced out of the race by a financial scandal.

The coalition chose Economy Minister Pablo Longueira as his replacement. A veteran politician who was close to Pinochet, Longueira has criticized Bachelet for reaching out to the Communist Party and has indicated he would oppose any efforts to return to a more state-funded education system.

Bachelet's military father worked for Socialist President Salvador Allende and, like his wife and daughter Michelle, was detained and tortured after the Sept. 11, 1973, coup that ended Allende's rule. Bachelet's father eventually died of a heart attack in custody.

Pinochet pushed for the privatization of state enterprises and ended central control and funding of the nation's school system. Reversing those laws became a rallying cry during student marches over the past two years that have halted Chile and pushed education reform to the top of the national agenda.

Student leaders have focused their demands on restoring free, quality public education and have said they can bring about that change through votes, after previously pouring most of their energies into street protests.

Among the top Communist Party leaders Bachelet must woo is well-known student activist Camila Vallejo, who inspired millions during the education protests. Vallejo is running for Congress, part of a push by her party to win 10 legislative seats.

Without the backing of leftists such as Vallejo, Bachelet "would be unable to crystalize reform processes because she would lack enough votes," said Marcelo Mella, a political analyst at the University of Santiago.

But since Chile's return to democracy in 1990, the Communist Party has resisted joining the Concertacion coalition and instead banded with other more leftist groups. Vallejo has said she won't give Bachelet her vote or support without knowing more about her political agenda. The goal, Vallejo has said, is electing more non-Concertacion lawmakers who would support raising corporate taxes and undoing Pinochet-era education, health and pension reforms.

"What we need at this moment is a Congress that is mostly in the opposition and that has enough lawmakers to allow us to make changes," Vallejo told the University of Chile radio station in an interview.

"That's what we need in such a crucial moment. Even candidate Michelle Bachelet says it."

The online game maker's stock fell more than 10 percent in extended trading Wednesday after the first-quarter results came out.

Zynga, which makes "FarmVille" and other games, said Wednesday that it earned $4.1 million, which was breakeven per share. A year earlier, it lost $85.4 million, or 12 cents per share. Adjusted earnings were 1 cent per share in the latest quarter, compared with expectations for a loss of 3 cents.

Revenue fell 18 percent to $263.6 million, from $321 million.

Analysts, on average, had expected revenue of $264.5 million, according to FactSet.

As demand for its Facebook games fades, Zynga has cut jobs, closed game studios and shut down games to reduce expenses and focus only on popular titles. The quarter's expenses fell 34 percent to $268.5 million, from $406.6 million.

The number of people who play Zynga games at least once a month fell 13 percent to 253 million, from 292 million a year earlier. The number of daily players dropped 21 percent to 52 million, from 65 million.

CEO Mark Pincus said in a statement that 2013 will "continue to be a transition year." Zynga, whose games are played mainly on Facebook's website, is working on shifting to mobile games and to its own site off of Facebook.

For the current quarter, Zynga is forecasting an adjusted loss of 3 cents to 4 cents per share on revenue of $225 million to $235 million. Analysts were expecting a loss of 1 cent per share on revenue of $258.1 million.

Shares of San Francisco-based Zynga fell 34 cents, or 10.1 percent, to $3.01 in after-hours trading. The stock had closed up 17 cents, or 5.3 percent, at $3.35 before the results came out.

WASHINGTON (AP) -- It's not a "Star Trek" tricorder, but by hooking a variety of gadgets onto a smartphone you could almost get a complete physical without the paper gown or even a visit to the doctor's office.

Blood pressure? Just plug the arm cuff into the phone for a quick reading.

Heart OK? Put your fingers in the right spot, and the squiggly rhythm of an EKG appears on the phone's screen.

Plug in a few more devices and you could have photos of your eardrum (Look, no infection!) and the back of your eye, listen to your heartbeat, chart your lung function, even get a sonogram.

If this sounds like a little too much DIY medical care, well, the idea isn't to self-diagnose with Dr. iPhone. But companies are rapidly developing miniature medical devices that tap the power of the ubiquitous smartphone in hopes of changing how people monitor their own health.

"We wanted to make sure they have all the right tools available in their pocket" is how Joseph Flaherty of AgaMatrix describes his company's tiny glucose monitor. Diabetics can plug the iBGStar into the bottom of an iPhone and check blood sugar on the go without carrying an extra device.

This mobile medicine also might help doctors care for patients in new ways. In March, prominent San Diego cardiologist Eric Topol tweeted "no emergency landing req'd" when he used his smartphone EKG to diagnose a distressing but not immediately dangerous irregular heartbeat in a fellow airplane passenger at 30,000 feet.

And the University of California, San Francisco, hopes to enroll a staggering 1 million people in its Health eHeart Study to see whether using mobile technology, including smartphone tracking of people's heart rate and blood pressure, could help treat and prevent cardiovascular disease.

The question: Do smartphone devices really work well enough for the average patient and primary care doctor to dive in, or are early adopters just going for the cool factor? Many of the tools cost $100 to $200, there's little public sales information yet and it's not clear how insurers will handle the fledgling trend.

"Technology sometimes evolves faster than we're ready for it," cautioned Dr. Glen Stream of the American Academy of Family Physicians. "We're recognizing more and more that not all care needs to be delivered face to face," but only if people measure the right things and have a relationship with a doctor to help make good use of the findings, he stressed.

Addressing a recent TEDMED conference in Washington, Dr. Susan Desmond-Hellmann, UCSF's chancellor, put the challenge this way: "How does mobile monitoring become something more than a toy or something interesting? How does it connect to how I'm cared for by my caregiver?"

About 300 doctors, health policy wonks and others attending that high-tech meeting received what was dubbed a "smartphone physical" from medical students using 10 of the latest devices. The Food and Drug Administration has approved a number of the gadgets for sale; others are experimental prototypes gathered for the demonstration by Nurture by Steelcase and the doctor website Medgadget.

"It's going to be our generation that adopts most of these," noted Shiv Gaglani, a Johns Hopkins medical student who helped organize the project.

The FDA cites industry estimates that 500 million smartphone users worldwide will use some type of health app by 2015. Today's apps mostly are educational tools, digital health diaries or reminders and fitness sensors. The new trend is toward more sophisticated medical apps, some that work with plug-in devices, that provide information a doctor might find useful.

Some of the devices sell by prescription or on drugstore shelves, while others like the diabetes monitor and blood pressure cuff have entered a new venue for medicine the Apple store.

Simplicity is part of the idea. Take the AliveCor Heart Monitor. Snap it on like a smartphone case, place fingers on the sensors no sticky wires on the chest and you've got an EKG recording in 30 seconds. The FDA approved sale of the $199 device in December for doctors to use in exams or to prescribe for patients to use on themselves.

It doesn't measure as much as a full-scale EKG, and patients must email the recording to a doctor for analysis. But heart patients frequently experience palpitations that have ended by the time they reach a cardiologist and emailing an on-the-spot EKG reading might help the doctor figure out what happened, said AliveCor co-founder Dr. Dave Albert.

"This is a brand-new technology. We're trying to understand how people will use it," said Albert, whose company also is seeking FDA permission to sell the device over the counter.

Welch Allyn's iExaminer taps the smartphone's camera to photograph deep inside the eye the orange view of the retina filling the phone's screen.

Similarly, CellScope Inc. is developing an otoscope that magnifier doctors use to peer into the ear that can snap a photo of the eardrum. It's not for sale yet, but might parents one day email that kind of picture to the pediatrician before deciding whether Johnny needs an office visit?

"It was great to see it on the phone, rather than the pinpoints we get to see" through a traditional scope, said Dr. Bertina Yen, a Los Angeles internist-turned-health IT specialist. She turned the tables during her smartphone physical, taking over some of the equipment to try it out herself.

And University of Washington researchers are testing a way to measure lung function in people with asthma or emphysema as they blow onto the phone and it captures the sound. Usually patients blow into special machines at the doctor's office, while a use-anywhere version might help someone spot early signs of worsening before they see a doctor.

Insurers are studying what smartphone technology to pay for. For example, health care giant Kaiser Permanente is about to begin a project in Georgia to sell the iBGStar alongside other diabetes monitors in its on-site pharmacies. The project will determine whether patients like the smartphone monitor, if it improves care and if so, whether the readings should beam into patients' electronic health records, in Georgia and in other Kaiser regions.

But ultimately these devices may have a bigger role in developing countries, where full-size medical equipment is in short supply but smartphones are becoming common. Even in rural parts of the U.S. it can take hours to drive to a specialist, while a primary care physician might quickly email that specialist a photo of, say, a diseased retina first to see whether the trip's really necessary.

"These tools make diagnosis at a distance much easier," said Dr. Nicholas Genes, an emergency medicine professor at New York's Mount Sinai School of Medicine, who helped with TEDMED's smartphone physical.

LOS ANGELES (Reuters) - After enduring a roller-coaster season described by Hall of Famer Earvin 'Magic' Johnson as "one of the worst" in franchise history, Los Angeles Lakers fans are scratching their heads over what may happen next.

Widely tipped as National Basketball Association (NBA) championship contenders after assembling a star-studded lineup for their 2012-13 campaign, the injury-hit Lakers were swept out of the playoffs in the opening round by the San Antonio Spurs.

It was the first time in 46 years they had been knocked out of the post-season in four games, a humiliating exit for a team many had predicted would challenge the record 72 games won by the Chicago Bulls during their landmark 1995-96 regular season.

Despite boasting a potent starting five including All-Stars Kobe Bryant, Pau Gasol, Dwight Howard and Steve Nash, Los Angeles limped to an underwhelming 45-37 record as their ageing lineup succumbed to a spate of injuries.

Though they ended the regular season on a 28-12 run to book their place in the playoffs as the seventh-seeded team, that achievement came at a price with the inspirational Bryant ruled out of the post-season due to an Achilles tendon injury.

The Lakers were totally outplayed by the second-seeded Spurs in their first-round series, routed 103-82 in Game Four after center Howard was ejected following a second technical foul early in the third quarter.

"Dwight Howard that was a big No, No. Your teammates and the fans were counting on you," Johnson tweeted, before adding: "Dwight, I've been swept before but I never let my team down by getting kicked out of the game."

Johnson, who with fellow Hall of Famer Kareem Abdul-Jabbar spearheaded the Lakers in the fabled "Showtime" era from 1979-1989, was not finished.

"I'm sooooooooooo happy the season is over. With the talent on this team this could go down as one of the worst seasons in Lakers' history!"

Johnson, along with many others, had expected much of the men in purple-and-gold after the off-season acquisitions of Howard and Nash beefed up a roster already bristling with quality and experience in Bryant and Gasol.

However Nash ended up missing 24 games because of a fracture in his left leg while Howard never appeared to recover fully from back surgery in mid 2012 while battling a shoulder injury and perceived tension between himself and team leader Bryant.

Forwards Gasol and Metta World Peace, along with backup guards Steve Blake and Jodie Meeks, were sidelined because of assorted ailments during a tumultuous season as the team failed to gel until the pressure was on to make the playoffs.

SHIFTED ROLES

Head coach Mike D'Antoni was widely criticized for an apparent inability to adjust his offense-minded style to fit a mainly old and slow roster, gifted Spaniard Gasol suffering the most as he was repeatedly shifted between multiple roles.

"It was a bit of a roller-coaster, obviously," D'Antoni said of his first season in charge of the Lakers.

"A lot of disappointment at the end. Due to a lot of circumstances, we started off slow and got us in a hole.

"The last 40 games, we played well. Disappointed we couldn't do anything in the playoffs - a lot of it due to injuries. We had ourselves set up to make a run, but we didn't do it."

The biggest question mark facing the Lakers ahead of next season is whether they can retain both big men, Howard and Gasol, as the team's luxury taxes will soar from $30 million to $85 million if they again have a $100-million payroll.

Howard, 27, will test free agency and is noncommittal about his plans. He can either re-sign with Los Angeles for five years and $118 million or opt for a four-year, $88-million deal with another team.

Gasol, 32, has been a frequent subject of trade rumors and, with a guarantee on his contract of $19.3 million for next season, said earlier this week that he understood the "business side" of the Lakers.

"There's a possibility I could be gone," he told reporters. There's a possibility I could stay. I'm prepared either way.

"I understand the challenges the franchise is facing and the decision they have to make in order to keep the team in the direction they want looking at the present and the future."

Bryant, a five-time NBA champion, fervently hopes the Lakers can go into next season with both Howard and Gasol.

"I want him here," Bryant said of Gasol. "He gives us the best chance to win titles. You bring Dwight back, then we're off and running. You saw how well they played together (at the end of the season). That puzzle finally got solved."

Bryant, who averaged 27.3 points and 6.0 assists during the regular season before he tore his Achilles tendon on April 12, felt the Lakers never had the chance to gel because of their alarming injury rate.

"It was crazy," he said.

"It was a constant process for us, but we finally figured it out. It will be great to bring the group back because we know what to do, and we know how lethal we can be."

(Editing by Greg Stutchbury)

Echoing results across Europe, British voters appeared to punish the ruling government, fed up with economic doldrums and austerity measures. Britain's nationalist party appeared to be the recipient of a sizeable protest vote against the political elite and the EU, analysts said.

According to returns Friday from 34 contests across England, the right-wing United Kingdom Independence Party, or UKIP, won 139 county council seats, while the mainstream opposition Labour Party gained 291.

The Liberal Democrats junior partners in Britain's coalition government were down 124 county council seats, while Cameron's ruling Conservatives lost 335 seats in Thursday's vote.

UKIP leader Nigel Farage whose party Cameron once referred to as a bunch of "fruitcakes, loonies and closet racists" said the results will send a "shock wave" through the British political establishment.

"This is a real sea-change in British politics," Farage told the BBC.

Cameron's popularity has taken a beating as the government sticks to a strict policy of austerity to cut Britain's debts, slashing public sector jobs and welfare payments.

As results streamed in highlighting UKIP's strong showing in the election, Cameron said respect must be shown for those who chose to support the party.

"We are going to work really hard to win them back," he added.

The prime minister now finds himself in the difficult position of trying to shore up right-wing backing ahead of the next general election in 2015, while trying to maintain his own affinity for more left-wing causes.

The results are a mixture of typical midterm protest and "rage against the machine," said Tony Travers, director of the government department at the London School of Economics and Political Science.

"It is a traditional midterm protest vote and it's found its lightning conductor through UKIP," Travers said. "However, there is a more generalized protest that isn't just against this government in its midterm, but is also a protest against mainstream elite politics."

He suggested UKIP's appeal and the local election results bear echoes of the Tea Party movement in the U.S., complete with cries of "we need to get our country back."

"This is a vote against 'they're all the same.'"

While Friday's results will jeopardize the Conservative Party's success in the 2015 general election, Travers was skeptical the local elections would steer Cameron further to the right.

"Cameron is quite awkwardly trapped," Travers said. "The number of options available to him to shift towards UKIP are limited if he's to keep faith with his own commitment to modernizing the Conservative Party," Travers said.

Still, the results in the short term could lend momentum to voices within Cameron's party urging the prime minister to introduce legislation needed to enshrine his pledge for a referendum on European Union membership by 2017.

That promise of a referendum was seen by many as a political play to shore up support for the Conservatives amid growing signs of discontent within the party and voters flocking for the exits.

The heart of UKIP's success lies not only in harnessing anti-immigration sentiment and appealing to socially conservative views on gay marriage, but exploiting Britons frustrations with a stagnating economy.

John Curtice, a politics professor at the University of Strathclyde, said the challenges facing Cameron's Conservatives in clawing back voters were underscored by the response to the prime minister's pledge to change Britain's relationship with the EU.

"It went absolutely nowhere," Curtice said. "What they have to do now above all is restore the public's faith in the competence of the government in particular its economics. That will help to bring these folks back."

But while many called the local elections indicative of a protest vote, UKIP leader Farage dismissed any suggestion the UKIP surge would be a short-lived phenomenon.

"The next big vote is a European election this time next year in which we will be positioned as the only party saying we should divorce ourselves from a political union and have a simple free trade alternative," he told the BBC

Voting took place in 34 council contests across England, plus the Isle of Anglesey in Wales.

___

Online:

Cassandra Vinograd can be reached at http://twitter.com/CassVinograd

Even as some of the renegade rivers are showing signs of cresting, the recovery won't be fast or easy. The National Weather Service expects many of the waterways to remain high into next month, straining levees during the river's expectedly slow descent.

Floodwaters were rising to record levels along the Illinois River in central Illinois. In Missouri, six small levees north of St. Louis were overtopped by the surging Mississippi River, though mostly farmland was affected.

The biggest troubles were in Illinois, on the Illinois River that Peoria officials said Tuesday finally had crested, but not without destruction. In Peoria Heights, population 6,700, roads and buildings were flooded and riverfront structures were inundated. Firefighters feared that if fuel from businesses and vehicles starts to leak, it could spark a fire in areas that could be reached only by boat.

"That's our nightmare: A building burns, and we can't get to it," Peoria Heights Fire Chief Greg Walters said. "These are combustible buildings, and we have no access to them simply because of the flooding."

About 20 to 30 homes and businesses near the river have been evacuated, he said.

Among those still in their homes was Mark Reatherford. The 52-year-old unemployed baker has lived for decades in the same split-level home with a gorgeous view: a small park between him and the Illinois River. But by Tuesday afternoon, as a chilly rain fell, the river had rolled over the park and made it to Reatherford's home, creating a 3-foot-deep mess in the basement. Reatherford had cleared out the basement furniture and was hopeful the main floor would stay dry.

Now, he's considering moving.

"You can't get a better view than what we've got here," he said. But "I'm getting too old to deal with this."

In a nearby neighborhood, retired Caterpillar crane operator Roland Gudat spent much of Tuesday afternoon on his porch swing, looking out with marvel toward the Illinois River that had swallowed up homes down the street but sparing his home of 46 years, except for the hundreds of gallons of water he has pumped out of his basement as seepage from the saturated ground.

Gudat, 73, remarked that he'd never seen the river so high. That goes for the gawkers who have annoyed him so much that he and neighbors placed saw horses in their driveways to prevent them from turning around, forcing them to back their way back down the road.

"I told them this isn't a damn cul de sac," he said. "If they knock those saw horses over, I'm gonna turn their keys off and call the cops."

In downtown Peoria, tens of thousands of white and yellow sandbags stacked 3 feet high lined blocks of the city's scenic riverfront, holding back floodwaters that already had surrounded the visitors' center and the 114-year-old former train depot that lately has housed restaurants. Across the street, smaller sandbag walls blocked off riverside pedestrian access to Caterpillar's headquarters and the city's museum.

In nearby Chillicothe, more than 400 homes have been affected by the flood, said Vicky Turner, director of the Peoria County Emergency Management Agency. Many homes have been evacuated, but others whose owners have had their buildings raised over the years because of flooding have chosen to stay put, Turner said.

"They row back and forth ... up to the main road," she said.

Yet elsewhere, there were snippets of good news. Lucas Schultz, the 12-year-old Smithton, Ill., boy who was rescued Sunday from the raging Big River near Leadwood, Mo., and revived by his rescuer was at home Tuesday and doing fine.

The Mississippi still hasn't crested in Dutchtown, Mo., a 100-resident town 110 miles south of St. Louis that in recent days, with help from dozens of Missouri National Guard members, waged a feverish sandbagging effort that as of Tuesday had worked.

In Indiana, floodgates were installed to try and keep the flooding Wabash River from the state's oldest town, Vincennes. Some strategic spots were also being reinforced with sandbags. The weather service projected a crest on Saturday about 12 feet above flood stage, the highest reading in nearly 70 years at Vincennes, founded in 1732.

In Saginaw County, Mich., water topped the dyke at Misteguay Creek in Spaulding Township. Businesses and homes were flooded along the Tittabawassee River, a Saginaw River tributary. Part of Shiawassee National Wildlife Refuge also was under water.

___

Associated Press writer Don Babwin in Chicago contributed to this story.

Need some pain relief? In the fine print is the warning that painkillers like Advil aren't for the third trimester. Left unsaid is whether to worry if you took them earlier.

An awful cold? Don't panic if you used decongestant pills, but doctors advise a nasal spray in early pregnancy.

And don't abandon antidepressants or epilepsy medicines without talking to your doctor first. Some brands are safer during pregnancy than others and worsening depression or seizures aren't good for a mom-to-be or her baby.

"To come off of those medications is often a dangerous thing for the pregnancy itself," warns Dr. Sandra Kweder of the Food and Drug Administration. "They need information on what to expect, how to make those trade-offs."

A new study shows how difficult that information is to come by.

Women often turn to the Internet with pregnancy questions. But researchers examined 25 pregnancy-related websites and found no two lists of purportedly safe drugs were identical. Twenty-two products called safe on one site were deemed risky on another.

Worse, specialists couldn't find evidence to back up safety claims for 40 percent of the drugs listed, said Cheryl Broussard of the Centers for Disease Control and Prevention, who led the recent study.

"The reality is that for most of the medications, it's not that they're safe or not that's the concern. The concern is that we just don't know," she said.

Broussard experienced some of that confusion during her own two pregnancies when different doctors handed over different lists of what was safe to use.

It's a growing dilemma. The CDC says medication use during the first trimester especially vulnerable for birth defects because fetal organs are forming has jumped 60 percent in the last three decades. Plus, women increasingly are postponing pregnancy until their 30s, even 40s, more time to develop a chronic health condition before they're expecting.

The CDC is beginning a Treating for Two program to explore how to get better information, and the FDA plans to revamp prescription drug labels with more details on what's known now. But people want an easy answer use it or don't and for many drugs, they won't get one anytime soon.

"Women agonize over it," said Dr. Christina Chambers of the University of California, San Diego. She helps direct California's pregnancy risk information hotline that advises thousands of worried callers every year.

Some drugs pose particular birth-defect risks. For example, the FDA requires versions of the acne drug isotretinoin, first marketed as Accutane, to be sold under special tight controls. Similarly, last year FDA said women who want to use a new weight-loss drug, Qsymia, need testing first to be sure they're not pregnant.

Other medications are considered safe choices. Obstetricians say pregnant women need a flu shot, for example. A recent massive study in Denmark offered reassurance that taking the anti-nausea drug Zofran for morning sickness won't hurt the baby.

But many drug labels bear little if any details about pregnancy. Drugmakers shy from studying pregnant women, so it can take years for safety information to accumulate. Moreover, the CDC says 1 in 33 babies has some type of birth defect regardless of medication use. It can be hard to tell if a drug adds to that baseline risk.

Consider antidepressants, used by about 5 percent of pregnant women. Certain brands are suspected of a small risk of heart defects. Studies suggest a version called SSRIs may increase risk of a serious lung problem at birth from 1 in 3,000 pregnancies to 3 in 3,000 pregnancies, Chambers said. Also, some babies go through withdrawal symptoms in the first days of life that can range from jitteriness to occasional seizures.

Women have to weigh those findings with the clear risks of stopping treatment, she said.

"The time to be thinking about all this is when you're not pregnant," when your doctor can consider how to balance mom's and baby's health and might switch brands, Chambers said.

That's what heart attack survivor Kelli Tussey of Columbus, Ohio, did. The 34-year-old takes a variety of heart medications, including a cholesterol-lowering statin drug that the government advises against during pregnancy.

So when Tussey wanted a second child, she turned to doctors at Ohio State University who specialize in treating pregnant heart patients. They stopped the statin and switched her to a safer blood thinner.

"They said my heart could take it," Tussey said. Now four months pregnant, "it seems everything's fine."

Sometimes it's a question of timing. That painkiller ibuprofen, sold as Advil and other brands, isn't for the third trimester but isn't a big concern earlier on, said Dr. Siobhan Dolan, an adviser to the March of Dimes.

And women should watch out for over-the-counter drugs with multiple ingredients, like decongestants added to allergy medicines, Dolan said. While any potential risk from decongestant pills seems small, "the question is, 'Do you really need it?'" she asked, advising a nasal spray instead.

Ask your doctor about the safest choices, Dolan said. Also, check the Organization of Teratology Information Specialists, or OTIS www.otispregnancy.org for consumer-friendly drug fact sheets or hotlines to speak with a specialist.

Stay tuned: The FDA has proposed big changes to drug labels that now just say if animal or human data suggest a risk. Kweder said adding details would help informed decision-making: How certain are those studies? What's the risk of skipping treatment? Is the risk only during a certain trimester?

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Online:

www.otispregnancy.org

http://www.cdc.gov/pregnancy/meds/index.html