Updated on December 4, 2015.
By J. Kyle Mathews, MD
Backaches, indigestion and nausea are just a few of the symptoms women may experience during pregnancy. Many women also have seasonal allergies that flare up during pregnancy. And then, of course, there’s the common cold and its associated ailments, like congestion, fever, coughing and aches and pains.
As an obstetrician and gynecologist, I work with women to help them have a safe pregnancy and a healthy baby. So, when it comes to treating symptoms like these, I talk to all of my pregnant patients about how they can safely find relief, including the use of over-the-counter (OTC) medicines. You don't necessarily have to suffer through your symptoms just because you're pregnant.
Here are some common questions my patients ask me about OTC medicines. If you have any doubts about whether something is safe to take, ask your healthcare provider.
First and foremost, talk to your provider before taking any OTC medicines. Your provider is in the best position to help you decide whether taking an OTC medicine is right for you.
Many OTC medications have been used for years and are known to be safe throughout all trimesters of pregnancy. However, it seems wise to avoid any unnecessary exposure during pregnancy. This can be done by finding out what meds are safe and which ones to avoid, and using them only as needed. Your provider can also suggest other remedies to treat symptoms if specific OTC medicines are not an option.
Whether it's to ease back pain from your growing belly or to treat a throbbing headache, many women will talk to their provider about using pain relievers during their pregnancies. Many of my colleagues and I generally consider OTC medicines containing the active ingredient acetaminophen safe for short-term pain relief throughout pregnancy, including the first trimester. To minimize any adverse side effects, patients are advised to start with the minimum possible dose — or one pill — and to take only what’s needed for symptom relief.
Do not use aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil) or naproxen (Aleve) during pregnancy, as they can potentially cause harm in the unborn child or during delivery.
Almost all of my patients complain of indigestion at some point during their pregnancies. Antacids, which neutralize stomach acid, are generally safe to take during pregnancy and can be taken as needed to relieve heartburn. Some contain calcium, which is an extra bonus during pregnancy.
If your symptoms are persistent, talk to your provider about taking an H2 blocker, the next step up from antacids. An H2 blocker, which blocks stomach acid production, takes about 30 to 90 minutes to take effect and can provide relief for up to 24 hours. Proton-pump inhibitors (PPIs), such as Nexium, Prevacid and Prilosec, appear to be safe as well.
In addition, eating smaller meals more frequently can help prevent indigestion. To avoid nighttime heartburn, don't eat a large meal within 3 hours of going to bed.
Nausea is very common, especially during the first trimester. The initial treatment for nausea is to try eating small meals and snacking throughout the day, sticking to a bland diet and avoiding smells and food textures that cause nausea.
If you experience morning sickness, try home remedies like eating a few crackers before getting out of bed in the morning. Also, having a small snack that contains protein before you go to sleep, such as yogurt or a peanut butter sandwich, may help prevent morning sickness. Ginger, vitamin B6 and acupressure bands have also been proven to help with nausea.
If these tips don't help, talk to your provider. In some women, excess stomach acid may cause or contribute to nausea; taking an antacid or acid blocker as a preventive measure may eliminate or reduce nausea. A single tablet (25 milligrams) of the antihistamine doxyalmine (Unisom), taken at night before bed, may also help.
Constipation is common during pregnancy. It can be caused by the extra iron in prenatal vitamins, hormone changes and pressure the growing uterus places on the colon (large intestine). It can also be caused by not drinking enough fluids; this causes the stool to harden in the large intestine, making it more difficult and painful to go to the bathroom.
If you’re already drinking plenty of water, eating more fruits and vegetables, and exercising regularly, a stool softener may help. In fact, some prenatal vitamins include a stool softener, but talk to your provider before taking any stool softeners.
You should always talk to your provider before taking any OTC cold or cough medicine. Some medicines contain alcohol or other ingredients that aren't safe for your baby, such as aspirin, NSAIDs or phenylephedrine. A careful read of the label can help you identify which medications to avoid.
I often advise my patients to drink plenty of fluids and make sure they receive extra rest when they feel cold symptoms coming on. Humidifiers and saline nasal sprays also provide ways to help relieve congestion. If your cold symptoms don’t go away within 7 to 10 days or you feel you need to take an OTC medicine to feel better, talk to your provider. If you do take something, treat symptoms individually rather than taking multi-symptom treatments to avoid taking medicines you don't need. Always treat a fever with acetaminophen — it’s safer to reduce a fever than not while pregnant.
If patients suffer from severe allergies and need relief, they should always talk to their provider first, who may point to the American College of Asthma, Allergy and Immunology (ACAAI) guidelines that note that antihistamines may be useful during pregnancy to treat symptoms of hay fever and other types of allergies. ACAAI also says that chlorpheniramine and diphenhydramine have been used safely for many years during pregnancy, but be careful — they may cause drowsiness. Loratadine and cetirizine are two newer, less-sedating antihistamines that are also safe to use during this time.
Although they are minimally absorbed in the blood stream, avoid taking decongestant nasal sprays for more than 3 days as they can cause a "rebound" effect, making your symptoms worse.
Women who are pregnant or thinking about becoming pregnant should take a daily vitamin that contains at least 400 micrograms of folic acid. Folic acid reduces the chance that the baby will develop neural tube defects like spina bifida, where the spine doesn't form properly.
It's also a good idea to take extra iron and calcium during pregnancy. Look for supplements that contain 17 milligrams of iron and 200 to 300 milligrams of calcium.
Prenatal vitamins can be a good way to get the extra vitamins and minerals you need during pregnancy in a single pill, but you can also take these supplements separately, if you prefer. However, some vitamins shouldn’t be taken in large doses while pregnant. These include the fat-soluble vitamins that can be stored in fat: A, E, D and K.
It’s not unusual to have itchy skin when you’re pregnant. Topical hydrocortisone creams and ointments are safe to use during pregnancy. However, if you notice a rash or bumps that don’t go away, check in with your provider.
Vaginal yeast infections can also be treated with an OTC antifungal cream. However, if you aren’t 100% sure that you have a yeast infection or your symptoms don’t resolve with treatment, plan a visit with your ob/gyn to make sure you’re treating the right thing.
You can also treat small cuts and abrasions with a topical antibiotic cream or ointment.
Hemorrhoids can happen — or worsen — with pregnancy. OTC hemorrhoid treatments, including Anusol, Preparation H and Tucks pads, are all safe in pregnancy.
Insect repellant is recommended, especially in areas where West Nile is prevalent. The Centers for Disease Control and Prevention recommends applying insect repellant with DEET, wearing protective clothing, and avoiding times of day when insects are more active.
Sunscreen should be used routinely, as your skin may be more sensitive to the sun while pregnant.
Herbal remedies used as medicine aren’t considered drugs and as such aren’t monitored by the U. S. Food and Drug Administration (FDA). That means there’s no guarantee as to the safety, purity or quality of these supplements. As such, it’s probably safest to avoid them during pregnancy. Commercially prepared herbal teas are considered safe during pregnancy, however.
Published on July 25, 2011.
Dr. J. Kyle Mathews is a board-certified physician in obstetrics and gynecology in private practice in Plano, TX.