Medications in Pregnancy and Lactation

Pregnancy and lactation can be a common time for patients to have questions about medication exposures in pregnancy. While most medications are safe, some medications do have risks to the developing fetus or can pass through the breastmilk to the infant.

Often, patients and their families will have questions regarding whether or not medications should be stopped or changed prior to pregnancy, as well as the underlying conditions that necessitate medical therapy. For patients on medications, it is generally recommended that continuing and discontinuing medications is considered in context of the underlying medical condition, the risks of that condition in pregnancy, and the risks of that condition becoming less well controlled in pregnancy.

It is important to consider the risks of the underlying medical condition, the effects of that condition on pregnancy, and if that condition becoming worse is actually more dangerous than the medication exposure.

Our MFM team can guide you through this complex discussion and help you to understand your options. For many families, a visit with MFM or our genetic counselors can help reassure you about the risks and benefits of medications during pregnancy, as well as alternatives that may be safer, and discuss the underlying medical condition that may be complicating your pregnancy and the best ways to manage this during pregnancy.

For questions about medications in lactation, and to learn more about our comprehensive in- and out-patient provider-led lactation services, visit the UR Medicine Breastfeeding & Lactation Services website.

For toxicology and for many medication exposures, there is also access to good quality information about medications, herbal products, infections, and more in both English & Spanish at MotherToBaby.

Common Questions About Over-The-Counter (OTC) Medications

One common area that women have questions about medications is around remedies for common ailments. Whether it’s the common cold, heartburn, or a headache, you might be tempted to reach for your go-to over-the-counter remedy. But before you do, it’s important to know what you should and shouldn’t take during pregnancy. Reading labels will help you to understand what’s in your medications before you take it.

When can I take OTC medicine during pregnancy?

If you’re newly pregnant (less than 12 weeks along), you may want to avoid unnecessary over-the-counter drugs as this is critical time for developing organs. The first 12 weeks of your pregnancy are a critical time for your baby in terms of organ development, and many doctors recommend avoiding all over-the-counter drugs during this time.

Most professionals agree that it’s safer to take over-the-counter medications during the second trimester. However, you should be aware that some medications could impact your baby’s nervous system, birth weight, or development during this time. Always tell your doctor what medications you take and find out if that choice is appropriate during your pregnancy.

What OTC & Commonly Prescribed Medicines are Generally Considered Safe During Pregnancy?

Pregnancy brings with it a laundry list of ailments and complaints. Luckily, many over-the-counter remedies are considered safe to use during pregnancy. This is NOT a full list, but should give you a general idea about what’s okay to take during pregnancy to relieve common complaints. Again, discuss any medications you take with your doctor, as underlying conditions, and your specific situation may be different.

Allergies

• Antihistamines that include Chlorpheniramine, Loratadine, and Diphenhydramine (Chlor-Trimeton, Alavert, Claritin, Benadryl) 

Cold and Cough

• Over-the-counter medicines containing Guaifenesin, an expectorant (Robitussin, Mucinex, Hytuss, Neldecon Senior EX)
• Cough suppressants containing Dextromethorphan (Robitussin, Vicks 44 Cough Relief)
• Cough drops and Vicks VapoRub are also safe when used as recommended

Medications you should avoid include anything with alcohol, pseudoephedrine, and phenylephrine.

Constipation, Diarrhea, and Hemorrhoids

• Constipation medications containing Polycarbophil (Fiber-Lax, Equalactin) Psyllium (Metamucil, Perdiem, and Konsyl-D)
• Laxatives and stool softeners (Colace, milk of magnesia, Maltsupex)
• Anti-diarrhea medications containing Loperamide (Imodium, Maalox Anti-Diarrheal, Pepto Diarrhea Control)
• Hemorrhoid creams (Tucks, Preparation H, witch hazel pads)
• Fiber medications

Heartburn, Upset Stomach, Gas/Bloating

• Antacids (Tums, Mylanta, Rolaids, and Maalox)
• Simethicone for gas pain (Gas-X, Mylanta Gas, Mylicon, and Maalox Anti-Gas)
• Anti-acid medications like omeprazole (Prilosec) or pantoprazole (Protonix)

Insomnia

• Diphenhydramine (Benadryl, Nytol)
• Doxylamine succinate (Unisom Nighttime Sleep-Aid)

Itching/Rash

• Hydrocortisone (Cortaid, Lanacort)
• Caladryl/calamine lotion

Pain Relief, Headaches, and Fever

• Acetaminophen (Tylenol, Anacin Aspirin-Free)

Yeast Infections

• Tioconazole (Monistat 1, and Vagistat 1), Clotrimazole (Gyne-Lotrimin 3, Lotrimin AF), Miconazole (Monistat 3, Desenex)

Some antifungal products shouldn’t be used during pregnancy. Check with your doctor and carefully check labels.

Influenza

• Oseltamivir (Tamiflu)

What OTC medicines should be avoided during pregnancy?

Pregnant women should avoid the following medications: ibuprofen (Motrin, Advil), aspirin, and naproxen (Aleve).

When choosing medications, avoid all-in-one medications such as cold medicine that treats nasal congestion, fever, and aches and pains with one dose. Instead, treat specific symptoms (i.e. nasal congestion) to decrease the exposures, and treat only the symptoms you have. This also decreases the chance of choosing a medication that might have ingredients that aren’t safe for you or your baby.

When should I talk to my doctor?

Although many medications are thought to be safe during pregnancy, it’s important to discuss any medications you’re taking with your doctor. That’s especially true if you have a high-risk pregnancy. If you experience any unusual symptoms while taking an over-the-counter medication, contact your doctor immediately. You should also contact your doctor if you think you have the flu/COVID-19, have been exposed to Flu or COVID-19, or experience dizziness, vaginal bleeding, severe vomiting, high fever, reduced fetal movement, difficulty breathing, or chest pain. Patients that get the flu or COVID-19 are at increased the risk of pregnancy complications for both the pregnant patient and baby, including severe infection, preterm delivery, and/or the need for breathing support and hospitalization.