When you're pregnant, treating a simple ailment can seem complicated. While you may be tempted to reach for the remedies you used before pregnancy, you're probably concerned about their safety. The truth is, many medications are safe to take when you're expecting, but there are some that can hurt your baby.
In general, it's best to avoid any unnecessary medications early in your pregnancy. During the first trimester, fetal organs develop rapidly, making them extremely vulnerable to the potential risks of drugs.
But that doesn't mean you have to suffer. If you truly can't get by without medication, your doctor can tell you which over-the-counter and prescription drugs are safe to take at your stage of pregnancy. Your healthcare provider can also suggest drug-free options to ease your symptoms.
A cold compress and rest can help alleviate headaches and muscle pain during pregnancy, but if you need additional relief, your doctor may recommend acetaminophen (the active ingredient in Tylenol). When this drug is used as directed, it's a safe option. However, it's best to avoid aspirin and nonsteroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen (the painkiller in Advil and Motrin) and naproxen (the active ingredient in Aleve). Some studies suggest that taking these medications near conception or in early pregnancy may increase the risk of miscarriage and birth defects.
Few women get through nine months without cold or allergy symptoms. The safest way to go is to try nondrug remedies: Rest, drink lots of fluids -- especially warm ones -- and use a saline nasal spray to help relieve stuffiness. The good news is that while a cold can make you miserable, it poses no special risks during pregnancy. The flu, however, can be more serious in pregnant women, and sometimes results in pneumonia. Since flu shots are safe for both you and baby, it's wise to get one during flu season if you're in your second or third trimester.
If cold or allergy symptoms interfere with your ability to eat or sleep, your healthcare provider may recommend medication, especially if you're past the first trimester. Many doctors believe the antihistamine chlorpheniramine (found in Chlor-Trimeton) is the safest option, as it has been used for many years by pregnant women and isn't known to cause birth defects. Unfortunately, little is known about newer drugs like loratadine (found in Claritin), so it's wise to avoid them.
If you need a decongestant, your doctor may suggest a nasal spray that contains oxymetazoline, (such as Afrin or Dristan Long Lasting), because only a small amount of the drug is absorbed into your system.
To relieve a cough, doctors often recommend a suppressant called dextromethorphan (found in Robitussin and Vicks Formula 44). However, you should avoid cough products that contain iodine, which can cause potentially life-threatening thyroid problems in the fetus, as well as those that contain high levels of alcohol.
Heartburn, constipation, and hemorrhoids are among the most common complaints of pregnancy. Luckily, there are several drug-free solutions you can use to prevent these problems. To head off heartburn, avoid eating large meals, especially in the evening, and opt for smaller, more frequent ones instead. You should also steer clear of rich, fried, or spicy foods, which often trigger stomach irritation. Sleeping on an incline can also prevent the contents of your stomach from splashing into your esophagus, causing heartburn.
If symptoms persist, your doctor may recommend a safe antacid, such as calcium carbonate (Tums). But if further relief is needed, your doctor may suggest sucralfate, commonly known as Carafate, a drug that coats and protects the stomach lining.
To prevent constipation and the hemorrhoids that often follow, drink plenty of water and eat fiber-rich foods. Exercise, with your doctor's approval, can also help to keep constipation at bay. If problems persist, your doctor may suggest a bulk-fiber laxative, such as Metamucil or Fiberall. However, you should avoid stimulant laxatives, like castor oil, which can trigger labor. When treating hemorrhoids, use products that contain glycerin or witch hazel, but avoid hydrocortisone, which hasn't proven to be entirely safe and can be absorbed into your system.
If your doctor prescribes a medication for you during your pregnancy, rest assured that the drug probably poses far fewer risks than the effects of an untreated illness or infection. In fact, antibiotics such as penicillin are frequently prescribed during pregnancy to treat a variety of bacterial infections. While most of these drugs are considered safe for mother and baby, there are some exceptions. The antibiotic erythromycin estolate can affect a pregnant woman's liver function, while a newer group of drugs called fluoquinolones may harm your baby's developing bones and cartilage. Tetracycline, another commonly used antibiotic, is not recommended after the fourth month of pregnancy because it may stain your baby's primary and permanent teeth.
Fortunately many moms-to-be can now safely cope with chronic health problems by using medication. High blood pressure can be treated with methyldopa or a number of other medications. But it's best to avoid a group of drugs called ACE inhibitors, commonly used to treat high blood pressure. These drugs can damage fetal kidneys after the first trimester. While most asthma medications are considered safe, (including inhaled steroids and bronchodilator sprays containing terbutaline sulfate or albuterol), less is known about sprays containing salmeterol, so consult your doctor before use.
Recent studies also show that the most commonly prescribed depression medications (such as serotonin reuptake inhibitors, including fluoxetine [Prozac]) are not associated with an increased risk of birth defects or pregnancy complications. Babies exposed to these drugs late in pregnancy may be more jittery than usual for the first few days after birth, but appear to develop normally thereafter.
While it's wise to avoid unnecessary medications during pregnancy, you don't have to suffer to protect your baby. As long as you follow your doctor's advice, you can get the relief you need without undue risks to anyone.
Dr. Schwarz, obstetrical consultant to the March of Dimes, is past president of the American College of Obstetricians and Gynecologists; vice chairman for clinical services, department of obstetrics and gynecology, Maimonides Medical Center; Emeritus Distinguished Service Professor of Obstetrics and Gynecology, SUNY Downstate Medical Center, both in Brooklyn.
Originally published in American Baby magazine, April 2004.
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