Medications & Pregnancy
MEDICATIONS & PREGNANCY
Although some medications are considered safe to take during pregnancy, the effects of other medications on your unborn baby are unknown. According to the CDC, about two-thirds of women in the U.S. take one or more prescription medications during pregnancy. Yet most medications have not been adequately studied for their safety during pregnancy. One report notes that more that 90% of the medications approved by the FDA from 1980 to 2000 had insufficient data to determine safety in pregnancy. Therefore, it is very important to pay special attention to medications you take while you are pregnant, especially during the first trimester, which is a crucial time of development for your baby.
An estimated 50% of U.S. pregnancies are unplanned. Therefore, all women of childbearing age should discuss the risks of any medications you take with your doctor, including over-the-counter medications.
If you were taking prescription medications before you became pregnant, be sure to ask your doctor about the safety of continuing these medications as soon as you find out that you are pregnant. Your doctor will weigh the benefit to you and the risk to your baby when making his or her recommendations. With some medications, the risk of not taking them may be more serious than the risk associated with taking them.
If you are prescribed any new medication, please inform your doctor that you are pregnant. Be sure to discuss the risks and benefits of the newly prescribed medication with your doctor before taking the medication.
EFFECTS OF MEDICATIONS DURING PREGNANCY
We know little about the effects of taking most medications during pregnancy. This is because pregnant women are often not included in studies to determine safety of new medications before they come on the market. Less than 10% of medications approved by the U.S. Food and Drug Administration (FDA) since 1980 have enough information to determine their risk for birth defects.
Because of studies conducted after medications come on the market, we do know that taking certain medications during pregnancy can cause serious birth defects. Examples are thalidomide (also known as Thalamid®) and isotretinoin (also known as Accutane®). Such medications should be avoided by all women who are or might become pregnant. For women who are taking these medications, it is important to discuss effective contraception methods with their doctor. While some medications are known to be harmful when taken during pregnancy, we don’t know the safety or risk of most medications. The effects depend on many factors, such as:
How much medication is taken (sometimes called the dose).
- When during the pregnancy the medication is taken.
- Other health conditions a woman might have.
- Other medications a woman takes.
- The important thing to remember is to talk to your doctor. Be sure to tell your doctor about all medications and herbal or dietary supplements you’re taking or planning to take, so you can make sure you’re taking only what is necessary.
LISTS OF SAFE MEDICATIONS DURING PREGNANCY
Many internet websites post lists of medications that are safe to take during pregnancy. But for many of the medications listed, there is not enough known to determine their safety or risk for use during pregnancy.2 Don’t make decisions about medication use during pregnancy based on lists you find online. Instead use the lists as a starting point to talk with your doctor. Don’t stop or start taking any type of medication that you need without first talking with a healthcare provider. A conversation with a healthcare provider can help ensure that you are taking only what is necessary.
Safe to take: Regular and extra-strength Tylenol (acetaminophen)
Follow the dosage on the bottle for Tylenol and you’ll be okay. Other types of pain relievers—such as ibuprofen (a.k.a. Motrin or Advil) and naproxen (a.k.a. Aleve)—can trigger a decrease in amniotic fluid levels in third trimester (which means less cushioning for baby and more pressure on its lifeline, the umbilical cord), says Dr. Park. Advil may also make a certain vessel in the baby’s heart close prematurely and cause developmental issues in later stages of pregnancy.
Safe to take: Metamucil, Colace, Citracel, Milk of Magnesia, Dulcolax
If you’re feeling a little plugged up, blame it on a surge in the hormone progesterone that slows down your smooth muscle cells so your bowel movements aren’t as regular. (Or blame it on your growing uterus for pushing on your intestines!). Dr. Park gives the green light for taking stool softeners and laxatives, but also try upping your fiber intake by eating more fruits and veggies and drinking plenty of fluids.
FOR INDIGESTION AND HEARTBURN
Safe to take: Tums, Maalox, Mylanta, Pepcid
Progesterone is at it again, causing heartburn by affecting your smooth muscle cells and relaxing the sphincter between your stomach and esophagus so acid comes up. (And your growing uterus is also pushing on your stomach to add to the heartburn.) Before you take a prescription med such as Prilosec, try over-the-counter remedies first because they’re the least strong. Also eat smaller, more frequent meals and stop noshing two to three hours before you hit the sack.
Safe to take: Penicillin
If you have an infection such as strep throat or an UTI that calls for antibiotics, penicillin is the way to go. “There have never been any birth defects associated with the penicillin family, or any other issues linked to mom or baby,” says Dr. Park. However, the tetracycline and doxycycline families of antibiotics have been found to cause discoloration in babies’ teeth after the fourth month of pregnancy, because these meds affect the calcification—or the hardening—of their pearly whites. “It’s purely a cosmetic thing, but best to avoid those types of antibiotics,” says Dr. Park.
Safe to take: Monistat, Gynelotrimin
Yeast infections are common during pregnancy, and while the condition won’t harm the baby the last thing you want to do is suffer through the itchy discomfort. “There is some absorption of vaginal creams into the body and blood stream, but doses are low and no studies show that it affects baby or mom negatively,” says Dr. Park. “We don’t prescribe the oral pill diflucan or fluconzaole because observational studies show that moms who have had to take extended doses for chronic fungal infections have had babies with birth defects.” However, it’s safe to take this oral yeast infection med when breastfeeding if you get the fungal infection known as thrush from your baby.
FOR THE COMMON COLD
Safe to take: Benadryl, Sudafed, Afrin nasal spray, Claratin, Robitussin DM, Vicks Formula 44, Halls cough drops
“Pretty much all of the over-the-counter meds for common cold are thought to be safe,” says Dr. Park. One thing to keep in mind is that there are a lot of combination meds, such as Tylenol Cold, that treat multiple symptoms, such as a runny nose and cough and fever. But if the only cold symptoms you have are a headache and stuffy nose, why would you take a medication that also treats a cough? “Rather than taking meds you don’t actually need, target only the symptoms you want to treat by buying drugs for each of your specific concerns,” says Dr. Park.
Look for the ingredient dextromethorphan, or DM, for a cough suppressant; guaifenesin to loosen up mucus; and pseudoephedrine and phenylephrine, or PE, as a decongestant for a stuffy nose.
Please consult with your healthcare provider before taking any medication while pregnant.
FOR THE FLU
Safe to take: Tamiflu
Your immune system isn’t as strong when you’re pregnant, so the flu can hit you a whole lot harder—and even lead to death in extreme cases. That’s why it’s so important to get the flu vaccine (ask for the inactivated flu vaccine so you don’t get the live virus). However, if you’ve been exposed to and/or tested positive for the flu, doctors say it’s important to take Tamiflu to lessen the symptoms and duration. “Tamiflu is thought to be safe for pregnant women, and the risks of skipping it are far greater than taking the meds,” says Dr. Park. “That’s because the baby’s temperature is always going to be a degree higher than yours, so if you have a high fever it may cause birth defects during early development stages and pre-term labour during later stages of pregnancy.”
RISK FACTOR CLASSIFICATIONS
Each medication has a risk factor classification associated with potential risk factors during pregnancy. These ratings, along with an evaluation of the risks and benefits of using a particular medication in your situation, will help you and your health care provider determine what steps to take. Pregnancy medication classifications include the following:
Category A: Controlled studies show no risk or find no evidence of harm.
Category B: Animal studies show no risks, but there are no controlled studies on pregnant women.
Category C: Animal studies have shown risk to the foetus, there are no controlled studies in women, or studies in women and animals are not available.
Category D: There is positive evidence of potential fatal risk, but the benefits from use in pregnant women may be acceptable despite the risk (i.e. life threatening condition to mother).
Category X: Studies in animals or human beings have demonstrated fatal abnormalities, or there is evidence of fatal risk. The drug is contraindicated in women who are or may become pregnant.
Category C is the confusing category. A medication gets this classification if there is insufficient data on its use during pregnancy. It could be safe or probably safe, or it could be potentially harmful.
ALTERNATIVES TO MEDICATION
Your doctor has the best in mind for both you and your developing baby. She might look to change the course of treatment by incorporating other methodologies such as acupuncture, herbal medications, or behavioural techniques. Of course, this depends on what medical conditions you are dealing with.
You or your health care provider can explore the Natural Medicines Database to find out information about herbs and their use during pregnancy.
IS IT SAFE TO TAKE CLARITIN OR OTHER ALLERGY MEDICATIONS DURING PREGNANCY?
Allergy medications are sometimes recommended during pregnancy. Before you take any medication during pregnancy, however, it’s important to weigh the severity of your symptoms against the possible risks to your baby.
For example, loratadine (Claritin, Alavert) is considered a category B drug — which means that animal studies haven’t shown any risks to unborn babies whose mothers take the drug. Other allergy medications in this category include cetirizine (Zyrtec) and budesonide nasal spray (Rhinocort). Although there are no guarantees about safety during pregnancy, drugs in this class are often the best option when medication is needed during pregnancy.
If you’re struggling with allergy symptoms, it might help to:
Avoid triggers. Limit your exposure to anything that triggers your allergy symptoms.
Try saline nasal spray. Over-the-counter saline nasal spray can help ease symptoms. Use the spray as needed.
Rinse your nasal cavity with a neti pot. Once or twice a day, fill the neti pot with an over-the-counter saline nasal solution. Then tilt your head over the sink, place the spout of the neti pot in your upper nostril and pour in the saline solution. As you pour, the saline solution will flow through your nasal cavity and out your lower nostril. Repeat on the other side.
Or use water that’s distilled, sterile, previously boiled and cooled, or filtered using a filter with an absolute pore size of 1 micron or smaller. Rinse the neti pot after each use with distilled, sterile, previously boiled and cooled, or filtered water. Leave the neti pot open to air-dry.
Include physical activity in your daily routine. Exercise helps reduce nasal inflammation.
Use nasal strips at night. Over-the-counter adhesive nasal strip scan help keep your nasal passages open while you’re sleeping.
Elevating the head of the bed. Raising the head of the bed by 30 to 45 degrees might help ease symptoms.
If these tips don’t relieve your allergy symptoms, remember that allergy medications aren’t necessarily off-limits during pregnancy. Work with your health care provider to choose the safest medication for you and your baby.