Updated on February 29, 2024.
Pregnancy can bring a range of new experiences. If you are among the roughly 90 percent of pregnant people who take either prescription or over the counter (OTC) medication during pregnancy, you may wonder which medications you can take, and which ones should be avoided.
While many medicines are considered safe to use during pregnancy, research on this issue is still pretty limited. Some studies point to certain medicines that should be avoided during pregnancy, while results for other types of medicines are less clear-cut.
For example, research has been accumulating about prenatal exposure to acetaminophen (Tylenol) and a possible link to later neurodevelopmental differences, particularly ADHD. Acetaminophen is one of the most frequently used OTC medications during pregnancy to relieve aches, pains, and fever. A review and analysis of the results of 22 studies, which included a total of over 367,000 people, found that prenatal exposure to acetaminophen was associated with 32 percent increased risk of ADHD in offspring. The review was published in the journal Paediatric Perinatal Epidemiology in 2023.
That said, the researchers also concluded that higher quality research is needed to confirm these results. Only 14 percent of the studies analyzed in the 2023 review were considered high quality, while 23 percent were considered low quality and 5 percent were very low quality.
Because studies on the issue have not shown a conclusive cause and effect relationship, the topic remains open to discussion. In another study, researchers collected data on acetaminophen exposure throughout pregnancy in 436 people, and then did cognitive testing (which included executive functioning tests) at age four years among their children. Results showed no significant relationship between acetaminophen exposure at any time during pregnancy and childhood cognitive development at age four years. The study was published in the journal Pediatric Research in 2023.
Treating a fever during pregnancy
As a natural part of pregnancy, many people experience a slight rise in body temperature that is not necessarily considered a fever and may not need treatment. It is important to know, though, that a true fever during pregnancy may need to be treated to prevent possible complications. Particularly during the first trimester, having a high fever over 103 degrees Fahrenheit may increase the risk of miscarriage and fetal brain or spinal cord issues.
Nonsteroidal anti-inflammatory medications (NSAIDs) are often used to treat fever, and include aspirin, ibuprofen (Motrin, Advil), and naproxen (Aleve). The US FDA has recommended against the use of all NSAIDs at 20 weeks of pregnancy or later due to potential risks to the fetus, unless specifically recommended by an HCP.
While Tylenol is not considered an NSAID, it’s best to check with your healthcare provider (HCP) if you develop a temperature of 100.0 degrees Fahrenheit or above during pregnancy, to see whether you need treatment and which OTC medicines are safe for you to use.
Managing other conditions during pregnancy
Likewise, it’s best to consult your HCP before taking OTC medicines for other concerns while pregnant, such as:
Constipation
The pressure on your bowels from the growing fetus along with hormonal changes can make constipation a typical experience of pregnancy, especially during the last trimester. If you are experiencing pregnancy-related constipation, talk with your HCP. For some people, adding more water (8 to 12 cups are recommended per day) and increasing fiber in their diet may help. Foods high in fiber include fruits and vegetables, particularly apples, citrus fruit, beans, peas, whole grains, and lentils.
Also ask your HCP about what exercises are right for you during pregnancy, because staying active may help with constipation. Iron supplements taken during pregnancy to treat anemia or as part of prenatal vitamins may also cause constipation. Always check with your HCP before making changes to your vitamins or supplements. And, if you’re still experiencing constipation after making lifestyle changes, your HCP may prescribe a laxative or fiber supplement.
Diarrhea
Hormonal changes and increased sensitivity to certain foods may cause diarrhea during pregnancy, which often clears up within a few days without the need for medication. Closer to your due date, diarrhea may become more frequent. During this time, it’s important to stay hydrated by drinking plenty of water. Fruit juice and broth can help replenish lost electrolytes. Diarrhea can also be a sign of an infection that may need treatment with antibiotics. For these reasons, it’s important talk with your HCP before taking an OTC medication to treat diarrhea during pregnancy.
Heartburn
When food and digestive fluids back up into the esophagus, it’s called acid reflux, heartburn, or indigestion. It frequently occurs during pregnancy, as a result of hormonal changes that relax the opening between the stomach and esophagus as well as pressure of the growing fetus on the stomach.
First line treatment for heartburn is lifestyle changes: try eating more frequent, small meals and avoiding foods that can worsen your symptoms, such as fried or spicy foods and high acid foods like citrus. It may also help to avoid lying on your back after eating, and to raise the head of your bed.
If symptoms continue, OTC antacids that contain calcium or magnesium (such as Tums or Mylanta) may be considered safe. High doses of antacids that contain aluminum (such as Maalox or Gaviscon), may potentially harm nerve cells. Always read labels for ingredients and daily dosages, and ask your HCP if you have any questions.
Allergies
If you have allergies, consider everyday changes that may decrease allergy symptoms before taking medication. Avoid or decrease exposure to known triggers such as dust mites or pollen, use a HEPA filter air purifier, consider nasal saline spray or using a neti pot to irrigate nasal passages (make sure you use sterile water, not tap water). Although several options may be available to you, check with your HCP before taking OTC allergy medication.
Older OTC antihistamines chlorpheniramine (Chlor-Trimeton), dexchlorpheniramine (Polaramine) and hydroxyzine (Atarax) are considered safe during pregnancy while the newer OTC antihistamines cetirizine (Zyrtec) and loratadine (Claritin) “may be safe.” And decongestants containing pseudoephedrine like Sudafed and Dimetapp should not be used during the first three months of pregnancy, according to the American College of Obstetricians and Gynecologists (ACOG).
Cough
While cough medicines like dextromethorphan (Robitussin, Vicks) and guaifenesin (Mucinex) have been around for decades, not much research has been done about their safety during pregnancy. Guaifenesin should be avoided in the first trimester due to a small amount of research linking it to possible neural tube issues in the fetus, while dextromethorphan is generally considered “acceptable” to take during pregnancy. However, some dextromethorphan-containing products also have alcohol in them (such as Vicks Nyquil) and should be avoided during pregnancy.
Bottom line
Use caution with OTC medications during pregnancy, and always check with your HCP first.
