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Using Over-the-Counter Medications During Pregnancy

Baby Talk

Over-the-counter (OTC) medications are ones that can be bought without a prescription. They are all the preparations and remedies that fill the shelves in your local pharmacy.

Here's the rule to remember about the medications you can buy over the counter (OTC): Just because these medications are readily available and safe for you to use, it does not mean they are safe for your baby. Some of the remedies we all take without a second thought need to be okayed by your doctor before you can take them during your pregnancy—aspirin, cold remedies, yeast infection medications, preparations for digestive problems, and sleep aids, for example. Your doctor or a good pharmacist can weigh the risks and benefits and decide what is best for both you and the baby.


If you pop a few pain pills every time you feel a tension headache coming on or feel the twinge of a stiff muscle, you might have to break this habit very quickly now that you're pregnant.

Full-strength aspirin is not good for pregnant women-especially in the last three months. It might increase bleeding tendencies in the mother and in the fetus (which is especially dangerous for babies born prematurely). When taken late in pregnancy, aspirin might delay the onset of labor, reduce the strength and frequency of contractions, and increase the length of labor. Aspirin can also increase the risk of hemorrhage at delivery and cause bleeding problems in the newborn. That's an awful lot of damage for such a "safe" medication.

In addition to aspirin, there is a long list of over-the-counter medications for the treatment of pain that you should avoid because they contain both aspirin and caffeine . Popular ones include:

Hey Mom!

Sometimes a doctor might okay the use of aspirin by a pregnant patient. If an expectant mother suffers from severe rheumatoid arthritis, for example, and can't bear the pain, the doctor might decide that the risk of taking aspirin is worth the benefits it gives the mother. This is the kind of call your doctor can help you make.

Hey Mom!

Before you open a bottle of pills, try a few other remedies first. A neck massage and a nap are sometimes good for headaches. Body aches often ease with a massage and a warm bath. The pain of varicose veins can be relieved by putting your feet up and by wearing support hose. And many body discomforts in general can be zapped with the relaxation exercises.

Another type of pain reliever to be avoided during pregnancy is the nonsteroidal antiinflammatory drug (called NSAID). It includes ibuprofen (found in Motrin, Advil, Motrin IB, and Nuprin) and naproxen (found in Anaprox and Naprosyn). These drugs are relatively new on the pain-relief scene and not too much is known about their effect on pregnancy. It is thought that if used late in a pregnancy, NSAIDs can cause problems similar to the ones caused by aspirin. Unless your doctor says differently, it's best to avoid these pain relievers in the last three months of pregnancy.

Acetaminophen (the pain-relieving ingredient in products like Tylenol and Datril) is the best choice for pain relief during pregnancy—but use it with caution. A new study suggests that pregnant women in their second and third trimesters might want to limit their use of Tylenol. In a study of more than 9,000 pregnant women, researchers found that frequent use of the painkiller acetaminophen—also known as paracetamol—after the 20th week of pregnancy might increase the risk of the babies wheezing as young children. Women who took acetaminophen daily or most days doubled the risk of their children beginning to wheeze when they were 3½ years old. Heavy use of aspirin was also associated with a higher risk of wheeze, but only in children under six months old. The researchers recommend that if painkillers are needed, expectant mothers should still take acetaminophen rather than aspirin, but they should not use it every day.

Sniffles and Sneezes

A bad head and chest cold, a seasonal allergy attack, or the flu during pregnancy can make you miserable—but be careful about taking over-the-counter remedies. Some cough syrups, antihistamines, and decongestants can be bad for the fetus (especially early in the pregnancy).

Many cold medicines contain alcohol. Alcohol is very bad for the developing baby. Some medications contain as much alcohol as a four-ounce glass of wine. They also might contain aspirin, which is bad for the baby, for the reasons explained earlier.

When you're so stuffed up you can't breathe, a good nasal spray is a gift from heaven. But when you're pregnant, even a nasal spray can be a problem. Many contain oxymetazoline. This compound clears the sinuses by tightening the small blood vessels of the nasal passages. Unfortunately, it also has the potential to tighten the arteries leading to the uterus. If this happens, the flow of blood and oxygen to the fetus is reduced. Although the risk is small, it is best to stay away from these remedies. Watch out for oxymetazoline in nasal sprays such as all Afrin products, Coricidin Decongestant Nasal Mist, Dristan Long Lasting Nasal Spray, Duration 12 Hour Nasal Spray, Neo-Synephrine 12 Hour Nasal Spray, and Vicks Sinex Long-Acting Decongestant.

Over-the-counter cold and allergy medications in the same class as oxymetazoline often contain other compounds that do not tighten arteries. All of these are considered safe during pregnancy, when used in the proper dose under a physician's supervision. They include Alka-Seltzer Plus Cold Medicine, Allerest Allergy Tablets and Sinus Pain Formula, A.R.M. Allergy Relief Medicine Caplets, Contac, Doricidin, Dimetapp, Robitussin-CF, Triaminic, Actifed, Sudafed, Benadryl Decongestant, Maximum Strength Dristan, Sinus Excedrin Analgesic, Sinutab, Tylenol Cold Medicine, Tylenol Allergy Sinus Medication, Vicks Formula 44D Decongestant, and Vicks NyQuil Nighttime Cold Medicine.

Some allergies are controlled by a series of injections of allergens (substances to which a person is allergic) to build up resistance. You should not start allergy shots during your pregnancy; there's no telling what kind of reaction you'll have initially. But if you have been getting allergy shots before your pregnancy, it is probably safe to continue them during the pregnancy under certain conditions:

As a bonus, some allergists believe that allergy injections during pregnancy can give the baby resistance to that particular allergen later in life. Talk to your prenatal doctor and your allergist about what is best for you.

Are you prone to the flu? Do you worry about getting the flu during your pregnancy? If so, ask your doctor about getting a flu vaccine (some do not advise it in the first trimester). The Centers for Disease Control recommends getting a flu shot if you'll be in your third trimester during the flu season (mid-November to mid-March). Because the vaccine can make you achy and feverish, however, you must talk to your doctor before getting the shot.

If you get the flu during your pregnancy, you'll feel miserable just like everybody else who gets the flu—maybe a little more so because it's still not a good idea to load yourself up with symptom-relief medications. Tylenol is good for fever and body aches, but stay away from all the other stuff sold specifically for flu symptoms. Many of them contain alcohol and other ingredients that are bad for the baby.

There are many natural remedies for cold, flu, and allergy symptoms that you can try before you reach for the medicine bottle. If you're all stuffed up and/or have a sore throat, use a humidifier to add moisture to the air. Sleep with two pillows so your head is slightly raised and the excess mucus can drain down your throat. Drink hot broth to help open clogged sinuses. Rest—the simplest solution might be the most effective. Eat well; your body needs all the energy it can get to fight off a cold naturally.

Relief from Morning Sickness

When you've grazed on bland snacks for weeks and have had it with sucking on lemons and pushing on acupressure points to stop your morning sickness, all with no relief, your doctor might suggest that you try medication to calm your stomach. This is definitely a case where allowing you to dehydrate from frequent vomiting is a great deal worse than the cure. Your doctor might suggest the following remedies:

If these medications still don't calm the vomiting of morning sickness, your physician might choose to use a stronger remedy. You must not ignore extreme morning sickness, because it causes complications such as weight loss and mineral and body fluid loss.

Digestive Problems

All pregnant women quickly find out that a tiny little fetus can cause an awful lot of upset in the digestive tract. Everything from heartburn to constipation can be blamed on the body changes of pregnancy. If these troubles persist, your doctor might approve the use of certain medications that will bring relief. But not all medications for digestive problems are safe for your baby, so be sure to ask before you buy.

Antacids: Heartburn and indigestion are badges of expectant motherhood; few can escape them during pregnancy. If you can live with the occasional discomfort, it's best to stay away from medications altogether. But if you're suffering week after week, talk to your doctor. He will recommend an antacid that's best for you—not all are safe.

Popular antacids such Maalox, Mylicon, Milk of Magnesia, Gelusil, Di-Gel, Tums, and Rolaids are all safe to take during pregnancy. (Some have the added bonus of containing compounds that will relieve excess gas.) Others, however, should be avoided: Alka-Seltzer, for example, is not recommended because it contains aspirin. Alka-Mint and Alka-Seltzer Advanced formula, however, are generally safe to use because they do not contain aspirin. Pepto-Bismol is on the "avoid" list; it contains an element closely related to aspirin and should not be used during pregnancy.

Newer antacids like Pepsid, Zantac, and Tagamet have not been thoroughly tested for safety during pregnancy, but there does not seem to be a problem with their use and there have been no reports of fetal harm. Ask your doctor before you use one of these antacids.

Constipation: If you're pregnant, you might be constipated also-for some women the two just go together. If you haven't had a bowel movement for days and you're in pain, ask your doctor about using a stool softener or laxative. These medications will soften your stools so they pass easily and relieve the pressure on your bowel. Using a stool softener or laxative is good in an emergency, but don't get into the laxative habit. If you're not careful you can "train" your bowels to need the laxative in order to work normally. After you get relief, keep your bowels in shape naturally—drink lots of water, eat high-fiber foods, such as fruits and vegetables, and exercise.

Diarrhea: When you have diarrhea, you want relief. Diarrhea ties you to your house; it tires you out, and it flushes fluids and nutrients out of your body. Relief is easily found in over-the-counter medications, such as Kaopectate or Imodium A-D. Both are safe to take when you're expecting.

Sleep Aids

In the first three months of pregnancy, a woman can sleep anywhere, anytime. How ironic that later in pregnancy, she sometimes can't sleep at all! When you're losing sleep because you are anxious about having a baby, or your legs ache, or the baby kicks and keeps you up, or because of 100 possible pregnancy-related reasons, you might be tempted to take a sleeping pill. You should think again and then talk to your doctor.

Most over-the-counter (OTC) sleeping pills contain antihistamines, which, in addition to clearing your sinuses, depress your central nervous system. This includes Excedrin P.M., Sominex, Sleep-Eze, and Unisom. Only Unisom contains a type of antihistamine that is considered relatively safe to use during pregnancy. When used infrequently and in the right dose, Unisom should not affect your baby.

Whether pregnant or not, sleeping pills should not be used more than a few nights in a row. A side effect of antihistamines is a mental slowdown that can make it difficult to concentrate, focus, or drive a car the morning after. These OTC drugs are usually effective for only mild, temporary forms of insomnia. Because they work quickly but don't last very long, these products work only to help you fall asleep. They can't help with frequent nighttime awakenings. If you are plagued by insomnia during your pregnancy, talk to your doctor before you try to medicate yourself to sleep.

Excerpted from The Complete Idiot's Guide to Pregnancy and Childbirth © 2004 by Michele Isaac Gliksman, M.D. and Theresa Foy DiGeronimo. All rights reserved including the right of reproduction in whole or in part in any form. Used by arrangement with Alpha Books, a member of Penguin Group (USA) Inc.

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