Medication Strategies During Pregnancy

When you're pregnant, you want to do everything you can to protect your baby. If you have a cold, a headache, or heartburn, is it safe to take an over-the-counter (OTC) remedy?

No one can say for sure that a medication is safe to use while you're pregnant. But, avoiding medicines you need may not be a good idea, either. It may be wiser to treat an illness than ignore it.

Doctor knows best

When you find out you're pregnant, it's important to talk with your doctor or midwife about whether to stop or continue medications you're taking. You and your health care provider should discuss the risks and benefits of the medications and decide what's best for you and your baby.

Planning ahead is even better. If you're planning to get pregnant, talk with your health care provider about medications that are safe during pregnancy and which you should avoid.

Read labels

Medications sold in the United States are regulated by the FDA, which ranks them on how safe they are during pregnancy. Warnings for pregnant women may be on the packaging. But some products haven't been thoroughly evaluated for risks during pregnancy because it would be unethical to do so. Even without a warning, risks may exist. This is also true for herbal products and dietary supplements, which aren't regulated by the FDA.

If your health care provider says it's OK to take an OTC medication, follow his or her instructions about how much to take and how often.

OTC drugs to avoid

Many pregnant women take medication, including OTC remedies. Ask your health care provider about the following, which are usually off-limits:

  • Aspirin. Low doses of this nonsteroidal anti-inflammatory drug (NSAID) have not been associated with a higher risk of harm to the baby. Studies have examined whether aspirin prevents preeclampsia, and it has been used for treatment of antiphospholipid antibody syndrome. However, pregnant women should avoid taking aspirin close to delivery. 

  • Ibuprofen, ketoprofen, indomethacin, and naproxen. These NSAIDs usually aren't recommended in the third trimester. They've been linked with a higher risk of some fetal heart problems. They may cause problems with conception and may raise the risk for miscarriage. However, indomethacin is sometimes used prior to 32 weeks to treat preterm labor.

  • Guaifenesin. There is not enough scientific evidence to prove that guaifenesin use during pregnancy increases the risk of adverse birth outcomes. However, liquid forms of guaifenesin may contain alcohol, so if consumed in sufficient quantities, it may lead to fetal alcohol syndrome.  

  • Nizatidine. This medicine for heartburn and gastroesophageal reflux disease has been linked to problems with pregnancies in animals. More studies relating to pregnant women are needed.

  • Nicotine patches or lozenges. Like cigarettes, smoking cessation drugs (nicotine therapy drugs) contain nicotine. While the medication may be safer than smoking, the risks of the medicine are not fully known. Women who smoke should first try quitting without the medicine. 

Don't assume you need to suffer through symptoms because you're expecting a baby. Ask your health care provider about ways to get relief.

What about maintenance medications?

Pregnancy poses special challenges if you have a chronic condition such as asthma, diabetes, epilepsy, or high blood pressure. Managing medications may be one of them. It's smart to see your health care provider before conceiving so you can plan ahead.

In some cases, sticking with your current treatment regimen may be the best idea. For example, controlling your blood glucose levels if you have diabetes may reduce your risk of miscarriage. And, keeping asthma or high blood pressure in check during pregnancy can help prevent problems with the baby. Other drug therapies may need to be fine-tuned. Perhaps a lower dose of the medication or another drug is an option. Women with epilepsy who take seizure control medications should talk with their health care provider. Having seizures and certain drugs taken during this time may sometimes carry a risk of harm to the developing fetus. 

Whatever you do, don't stop taking medicine on your own. Discuss your medication and your pregnancy with your obstetrician first. Your doctor will help you weigh any risks and benefits. If medication helps you stay healthy, it may be the best choice for you and your baby.