Most women are aware that during pregnancy they
need to avoid as many non-essential medicines as possible. Yet these same women
are just as likely to suffer from minor conditions as anyone else, as well as
being more likely to suffer pregnancy-related symptoms such as constipation or
heartburn. So, should you have to smile and bear those headaches, coughs and
colds? Or are there over-the-counter medicines that are actually safe to use in
The problem caused by medicines taken by the
mother is that they can cross the placenta and enter the baby’s bloodstream.
This is because the medicine particles are small enough to cross the placental
barrier along with the nutrients needed for the baby’s development. The effect
any medicine has on the developing baby depends on the medicine itself and the
trimester of pregnancy the medicine is taken in.
How does a
medicine affect the developing baby?
The trimester of pregnancy is often very
important. Some medicines can be dangerous to take in the first three months
but safe in the second or third, or vice versa.
first trimester is the period of greatest risk for the baby. This is
because during this stage the baby’s organs are developing. Medicines
taken during this time have the potential to affect this development,
which could result in malformations or birth defects. If a defect is very
severe this could cause a miscarriage.
the second trimester medicines can interfere with the development of the
baby’s nervous system or with the growth of the baby, resulting in a low
birth weight. However, generally, experts believe that the second
trimester is the safest period to take medicines.
taken in the final three months of pregnancy can cause complications such
as breathing difficulties for the baby after birth. This is because the
medicine remains in the baby’s body after birth and the newborn baby may
not be able to cope with the medicine in its bloodstream the way the
Medicines taken by the mother can also indirectly
affect the baby by interfering with the environment within the womb. Some
medicines can cause contractions of the womb, decreasing the blood supply to
the baby, while others may cause early, delayed or even prolonged labor, all of
which pose a threat to the baby.
How do we know
which medicines are safe?
The answer is that often we don’t. Pharmaceutical
companies rarely perform clinical trials or actual studies of their medicines
on pregnant women. As a result, few medicines are actually licensed for use
during pregnancy. Most information we get about safety in pregnancy often comes
from practical experience with the medicine over time. Often, when a medicine
has been in wide use for many years without causing adverse effects on
pregnancies, we can conclude that it is not harmful. Information will also come
from women who have been accidentally exposed to a medicine during pregnancy
and from animal studies.
So, some medicines are known to be safe while
others are known to be definitely harmful. But in a large number of cases there
isn’t the firm evidence to conclude safety or risk. This applies to all
medicines, be they prescription only or over-the-counter.
Taking any medicine during pregnancy is all about weighing up the pros and cons. The decision should, ideally, be made by your doctor, who will be able to weigh up the benefits of a particular medicine to the mother against the risks of that same medicine to the baby. If the benefits outweigh the risks, then the medicine may be given to the mother. If the risks to the baby are too great, then alternative treatment options need to be sought. The final decision about taking a medicine should be made in conjunction with you.
Is there anything
I can take to treat minor illnesses?
The best way to minimize any risks for your baby
is to avoid all non-essential medicines, especially in the first trimester.
However, what follows is a general overview of what you can and can’t take
safely to treat common minor illnesses. Remember: always consult your
doctor or pharmacist before taking any medicine during pregnancy.
increasing exercise and dietary measures such as drinking more fluids and
eating more fiber first. If these are not effective, there are over-the-counter
laxatives that can be taken in pregnancy.
agents should be tried first if dietary changes haven’t worked.
or the stimulant laxatives, bisacodyl can also be used if necessary.
are generally safe, though sodium bicarbonate is absorbed into the
bloodstream and so antacids containing this ingredient should be avoided
in pregnancy, since your sodium intake should not be too high.
such as Gaviscon that contain alginates are safe, and can be especially
useful for heartburn caused by the pressure of the baby on the stomach.
They form a raft on the stomach contents and prevent them passing back up
the food pipe.
Pain such as headache
non-drug methods first. A head massage can help relieve headache, while
backache can be eased by gentle stretching to relieve tight muscles, or a
soak in a warm bath.
is generally regarded as safe for short-term use in all three trimesters.
It is widely used in all stages of pregnancy for pain relief and reducing
and non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen are
not recommended during pregnancy, as there are safer alternatives
available. They should particularly be avoided in the last trimester, because
they can delay labor, increase the length of labor and cause complications
in the newborn baby. Painkilling doses of aspirin can also increase the
risk of bleeding in the mother and baby if taken in the third trimester.
Evidence suggests these medicines should also be avoided in the first
trimester and by women attempting to conceive, as they may increase the
risk of miscarriage or malformations.
and dihydrocodeine can affect the baby’s breathing if taken in the last
trimester, or during labor in large amounts. Heavy use may also cause a
withdrawal syndrome in the newborn infant. However, small doses for a
short period of time to treat specific pain can be taken in the first and
second trimesters, but only on the advice of a doctor. Be aware that some
over-the-counter painkillers contain codeine or dihydrocodeine. Consult
your doctor or pharmacist before taking any medicines during pregnancy.
Hay fever and allergies
hay fever, first try as much as possible to reduce your exposure to the allergens
that trigger it.
this isn’t possible, you can safely use saline or sodium cromoglicate
nasal spray or eye drops in all three trimesters.
short-term use of nasal sprays containing corticosteroids such as beclomethasone,
budesonide or fluticasone is unlikely to cause any harm. With long-term
use sufficient steroid could be absorbed to impair the growth of the baby,
so these should only be used after discussing any risks with your doctor
containing antihistamines, such as brompheniramine, meclozine,
diphenhydramine, promethazine and doxylamine should be avoided, as there
is insufficient information about their safety. However, your doctor may
recommend the non-sedating antihistamines loratadine or cetirizine if the
measures mentioned above fail. These have not been shown to cause harm
when used in pregnancy. Chlorphenamine can also be used, but not in the
latter half of your last trimester, because it could cause problems such
as irritability or tremor in the baby after birth. Consult your doctor or
pharmacist before taking any medicines during pregnancy.
nasal sprays and eye drops should be avoided.
decongestants, such as pseudoephedrine, phenylephrine, xylometazoline,
oxymetazoline should also be avoided as there is insufficient evidence of
their safety. Steam inhalations should provide some relief from nasal
Coughs and colds
cough mixtures such as simple linctus, honey and lemon syrups, or sucking
lozenges containing honey or glycerol to coat the throat, are the safest
option to reduce coughing.
and cold remedies often contain a combination of several ingredients,
including painkillers, antihistamines and decongestants (see above), so it
is important to make sure that each ingredient is safe before taking them.
Consult your doctor or pharmacist before taking any medicines during
cough expectorant guaifenesin to help loosen a chesty cough can be used,
though drinking lots of water is just as effective for this. You could
also try using steam inhalations to help liquify mucus and make it easier
to cough up. Cough medicines containing iodine as an expectorant should be
avoided, as the iodine can impair the functioning of the baby’s thyroid
cough suppressant dextromethorphan has been in widespread use for many
years and is generally considered safe to use during pregnancy, providing
it is only taken for short periods of time and using the smallest dose
possible. However, it is probably best to avoid it in the first trimester.
Cough suppressants containing codeine should be avoided in the third
trimester. Consult your doctor or pharmacist before taking any medicines
bouts of diarrhea won’t do your baby any harm, but diarrhea lasting longer
than a few days can cause dehydration. This can be avoided by taking
rehydration salts are safe to use in pregnancy.
mixture can also be used to increase the bulk of the stools.
to stop diarrhea should be avoided, as there is insufficient information
available to decide if it is safe or not.
is not a great deal of information available about the safety of oral
antifungal medicines, such as fluconazole, so you should not take these.
doctor may prescribe you antifungal cream or pessaries, such as
clotrimazole. But these products should only be used after discussion of
the risks and benefits with your doctor.
you are prescribed a vaginal preparation, take care with vaginal
applicators to avoid damaging the cervix, or avoid using them altogether.
Eczema, dermatitis and
or soothing products such as calamine lotion should be your first port of
call as these are completely safe.
creams such as hydrocortisone can be used during pregnancy, but avoid
using them on large areas of skin, for long periods of time, or under
dressings, as significant amounts may be absorbed into the bloodstream.
This is the only over-the-counter medicine that
is really important to take, both before and during pregnancy. One 400
microgram tablet should be taken every day by women planning a pregnancy and
for the first 12 weeks of pregnancy. This is to help the development of the
baby’s spinal cord and nervous system and prevent neural tube defects such as
spina bifida. Taking folic acid daily also helps prevent birth defects such as
cleft lip and cleft palate.
A higher daily dose (5mg) of folic acid is
recommended if you or your partner has spina bifida, if you have had a previous
child born with neural tube defects, or if you are taking medicines for
epilepsy. Discuss this with your doctor.
For medicines not covered here ask the advice of
either your pharmacist or doctor. The best way to minimize risk is to minimize
your intake of all unnecessary medicines. Remember that herbal remedies are not
necessarily safe in pregnancy. If in doubt ask!
you pregnant and taking any medicines?
you told your doctor or pharmacist that you are pregnant?
you are pregnant, are you taking your folic acid tablets?
avoid all medicines during pregnancy if possible.
consult your doctor or pharmacist if you are pregnant and starting a new
some over-the-counter medicines and medicines from the drug stores can be
harmful to your baby.
remedies are not necessarily safe alternatives. Ask your doctor or
pharmacist for advice about taking these while pregnant too.
you experience any unusual effects after taking your medicine, inform your
doctor or pharmacist immediately.
doctor needs to weigh up the risks versus the benefits of giving a
medicine during pregnancy.
is different – one woman may take a harmful medicine and have a healthy
baby and another woman may take a so-called safe medicine and end up
having a child with a birth defect.
defects can occur naturally, even if you do not take any medicines, and no
one can really explain why they occur.