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Medications and Pregnancy
What is safe to use?
Along with the joy and excitement of being pregnant come discomforts and complaints. Pregnant women use over-the-counter (OTC) medication one and a half times more than prescription drugs. One reason for this may be that OTC drugs are easy to buy. Another reason is that many people don’t regard products they buy without a prescription as medications. Similarly some people assume that because a herbal remedy is 'natural' it is not a medication. These are false beliefs. Both OTC drugs and herbal remedies are medications and many of them are not safe in pregnancy.
Although some medical complaints may warrant using OTC drugs to relieve the discomforts of pregnancy, caution must be taken when using any medication while pregnant. When a pregnant woman takes any medication, whether prescription or OTC, she usually exposes her fetus to that drug. Although a mother may have no side effects, the medication may not be safe for the fetus. Some of these medications can be teratogenic, meaning that the drug can cause malformations and defects in the fetus.
Pharmacists are an essential resource for information about medications if you are pregnant. They can recommend an OTC medication to help your symptoms and that is also safe for the fetus. They also have useful information about when it is wise to see your doctor. They can also recommend various non-drug measures to deal safely with the problem. The following are some of the more common symptoms you may experience during pregnancy and some suggestions for treating them using both non-drug measures and OTC medications.
Morning Sickness
Many women experience “morning sickness.” Even though it may be a normal part of being pregnant, the symptoms can be a nuisance.
Non-Drug Measures
- Eat smaller meals with carbohydrates e.g. pasta, bread and crackers.
- Separate the liquids and solids in your meal rather than eating them together.
- Avoid eating fatty foods and try to eat before the usual time of nausea.
- Encourage your partner or a friend to cook meals. Nausea can come from the smell of some foods.
- Try using Sea Bands™, wrist bands that use pressure points to decrease the nausea.
OTC Drugs
Pregnant women should not treat themselves with any over-the-counter medication for nausea as these drugs may not be safe to use during pregnancy. If the non-drug suggestions do not work, talk to your doctor for advice. Sometimes 50 mg of Vitamin B6 taken at bedtime helps the nausea. Also there is a prescription drug, DiclectinΤΜ, that is safe to take in pregnancy.
Heartburn and Gas
Pregnant women go through a lot of changes including hormone changes and an expanding uterus. These can result in irritation from stomach acid with heartburn and gas.
Non-Drug Measures
- Do not smoke or drink - pregnant women should not do this whether they experience heartburn or not.
- Try smaller and more frequent meals rather than three regular meals a day.
- Stay upright after meals, avoid slouching or bending after meals.
- Avoid peppermint, chocolate, caffeine or fatty foods.
- Wear loose clothing.
- Avoid eating before bedtime.
- Consider elevating the head of your bed by placing four to six inch bed blocks under the top two bed legs.
- Don’t chew gum.
OTC Drugs
Most OTC antacids are safe to use during pregnancy but it would be best to check with the doctor. Antacids should be used about half an hour after eating. Things to keep in mind are that products containing aluminum can cause constipation and products containing magnesium can cause diarrhea. Antacid with a combination of both aluminum and magnesium may prevent a change in bowel habit.
Products containing calcium carbonate can also be taken safely but may also cause constipation. Do not use any products that have sodium bicarbonate or aspirin. Products with alginic acid are designed for the type of heartburn that feels like “things are coming back up.” ZantacΤΜ and PepcidΤΜ should only be used under the supervision of your doctor and are generally not recommended in pregnancy.
Hemorrhoids and Constipation
The chance of a pregnant woman getting hemorrhoids is twice that of a person who is not pregnant. Expectant mothers often get constipated because of the pressure from the fetus and the change in hormones. As they strain to have a bowel movement, hemorrhoids sometimes develop. The best way to avoid getting hemorrhoids is to eat a diet high in grains, vegetables and fruits to encourage regular bowel movements. Also, developing good bowel habits by not delaying a bowel movement when the urge first occurs, can help prevent straining.
Non-Drug Measures
- Increase the fibre in your diet.
- Drink plenty of water.
- Avoid spicy and fatty foods.
- Eat high protein foods in the evening.
- Maintain an active lifestyle which includes exercise.
OTC Drugs
You may want to use a stool softener or a glycerin suppository to help the constipation but these should not be used on an ongoing basis. You should NOT use the following laxatives on the market:
- Mineral oil - it can cause vitamin deficiency for the fetus.
- Stimulant laxatives, including castor oil - they may cause the uterus to contract (and severe bowel pain).
The best types of products to use are the bulk forming laxatives that contain methylcellulose or psyllium. If you develop hemorrhoids during pregnancy, you should consult your doctor before using any OTC drugs. A sitz-bath can relieve the irritation and petrolatum (VaselineΤΜ) may be soothing.
Diarrhea
Hormone changes can cause a pregnant woman to have diarrhea. Excess diarrhea may be a signal the pregnancy is at risk. If it is only occasional, some simple remedies may help.
Non-Drug Measures
It is important to remember that when diarrhea occurs, adequate fluids should be taken to prevent dehydration. Simple carbohydrate foods like bread and pasta, and low fat foods may be helpful. Also avoiding dairy products for 24-48 hours is often advised.
OTC Drugs
OTC medications to stop diarrhea should not be used unless absolutely necessary. If you do use one, a local acting agent containing attapulgite is appropriate. Bulk forming laxatives, containing methlylcillin or psyllium, may help control diarrhea by forming the stool.
Colds and Allergies
The common cold and allergies can occur in pregnant women just as often as in anyone else. However, it is best for pregnant women not to use OTC drugs to treat the symptoms associated with these conditions until after talking to the doctor.
Non-Drug Measures
- Get plenty of rest.
- Drink lots of fluids.
- Avoid stress.
- Try saltwater gargles for sore throats.
- Avoid the allergen whenever possible to prevent an allergy attack.
- Use nasal saline drops for nasal congestion.
OTC Drugs
The cough suppressant dextromethorphan can be used in pregnancy but only after discussion with a doctor. Codeine can also be used but again, only after the doctor agrees. These drugs should only be used when the benefit to the mother outweighs the risk to the fetus.
You should avoid using decongestants, especially in the first trimester. Nasal spray decongestants would be a better choice if you must use some form of treatment, as long as you stay within the recommended dose, and for no more than three days. Lozenges may be used as long as a woman is not diabetic. Many antihistamines should not be used by pregnant women especially in the last two weeks of pregnancy so it is important to discuss antihistamine use with your doctor.
Pain
Everyone knows the pain of headaches and muscle aches and pregnant women are no exception. The strain of carrying a baby can cause backaches and muscle aches as well.
Non-Drug Measures
- Exercise.
- Massage areas that are painful.
- Relieve headaches with a cool cloth on your forehead.
- Keep a good posture and relax.
- Increase calcium intake by drinking milk may help prevent painful muscle cramps.
OTC Drugs
Analgesics (pain killers) should not be used unless necessary. If you must use an analgesic, acetaminophen is the drug of choice. Products containing acetylsalicylic acid (AspirinΤΜ) or non-steroidal anti-inflammatory drugs such as ibuprofen should be avoided. These can increase the length of labour time, increase the risk of a hemorrhage, or cause premature closing of the fetal arteries. You should also avoid codeine. If, for some reason, you must use it, do so for the shortest period of time possible because it can cause the fetus to become addicted to the drug.
Insomnia
Due to the various discomforts during pregnancy, many women find it hard to sleep. To help fall asleep, the following methods may help.
Non-Drug Measures
- Avoid caffeine.
- Have a regular sleep pattern and relax before going to bed.
- Take daily exercise.
- Keep the bedroom dark and quiet and try not to have it too cold or too hot.
- Drink warm milk before bedtime.
OTC Drugs
OTC sleeping pills are not recommended if you are pregnant. Many of them are antihistamines used as sleeping pills because of their drowsy-making side.
Acne
Hormone changes during pregnancy can cause an outbreak of acne. There are a few ways this can be controlled.
Non-Drug Measures
- Eat a healthy diet and exercise regularly.
- Wash face regularly.
- Use oil-free makeup.
OTC Drugs
You should NOT use acne care products with vitamin A if you are pregnant. These products contain Vitamin A acid that can be teratogenic if taken by mouth. Topical preparations (those rubbed on the skin) with benzoyl peroxide may be used by pregnant women but you should check with your doctor first.
Foot Care
With the added weight from carrying a baby, there is more pressure put on the feet. This can cause corns and calluses to appear.
Non-Drug Measures
- Use good footwear and avoid friction to the top of the feet
- Padding may be used to cover the corn and prevent further rubbing
OTC Drugs
You may use topical preparations containing salicylic acid to treat corns and calluses until the third trimester of pregnancy. After that, they should be avoided.
Many women develop high blood sugar levels during their pregnancy, called gestational diabetes. If this happens to you, you should talk with your doctor before you start treating your corns or calluses.
Eye Care
Due to hormone changes in pregnant women, the eyes may become dry. The use of OTC eye drops containing a decongestant to decrease redness is not recommended, however, saline eye drops or artificial tears may be used for this purpose. Contact lens solutions are safe to use during pregnancy but contacts may not be as comfortable because of the dry eyes.
Lice
If a pregnant woman gets lice, some non-drug measures can control them, but will not kill them.
Non-Drug Measures
- Wash all clothing and bedding in hot water and dry in the dryer for 20 minutes.
- Dry-clean other articles or store them in a plastic bag for two weeks.
- Vacuum all carpets and furniture.
- Soak combs and brushes in a two per cent solution of Lysol for one hour.
- Backcomb hair towards the scalp to remove the nits.
- Iron the seams of clothing as there are types of lice that live in these seams.
- Apply petrolatum ointment (Vaseline‘) to lice that are in the eyelashes. This will suffocate them.
OTC Drugs
The drug of choice for pregnant women with lice is R + CΤΜ (pyrethrin with pieronyl butoxide) or NixΤΜ (permethrin) and you should use it only with your doctor’s advice. If you have allergies to ragweed or chrysanthemum you should avoid this product and ask your doctor for suggestions. Products with lindane can be used but never as a first choice because this drug is absorbed through the skin more than all other drugs used to treat lice. These products should not be applied more than two times during a pregnancy.
Skin Pigmentation
Due to the hormone changes during pregnancy, pigmentation (darkening) may appear on some areas of the skin. A two per cent hydroquinone cream can help the problem but there is no evidence about its safety in pregnancy. It is best to wait until after the pregnancy and then it can be applied safely. Using a sunscreen to protect against the sun’s rays will reduce the pigmentation changes.
Pin Worms
Pregnant women should not treat this condition by taking OTC medications even though it may be uncomfortable. They must consult their doctors.
Non-Drug Measures
- Keep fingernails short to avoid scratching the area.
- Avoid re-infestation by washing hands well.
Vaginal Infections
Pregnant women are more at risk of yeast infections because of changes in hormones.
Non-Drug Measures
- Use more yogurt in your diet (yogurt contains a bacterium called Lactobacillus that may help prevent yeast infections).
- Decrease the sugar in your diet
- Avoid douching
OTC Drugs
The OTC drugs available to treat yeast infections are safe in pregnancy. The only precaution is to avoid inserting the applicator too deeply towards the end of pregnancy when the cervix is starting to open up.
Vitamin and Mineral Supplementation
In order to give the fetus enough vitamins and minerals, the mother will need to be sure to follow the recommended daily intake. A deficiency or lack of vitamins can cause harm to the fetus. Your doctor will recommend an appropriate vitamin to take while pregnant. Care should be taken to avoid using Vitamins A and D in excess amounts.
It has been shown that if a woman takes folic acid supplements before and during early pregnancy, she can reduce the risk of her baby being born with a neural tube defect. Neural tube defects (NTD) are problems with the brain and spinal cord. Most women should take 0.4 mg of folic acid before getting pregnant and during pregnancy to lower the risk of NTD. There are two groups of women who need even more folic acid supplement. They are:
- Those women who have had a baby with NTD. These women are recommended to take 4 mg of folic acid a day.
- Those women on anti-epileptic medications.
These women are recommended to take 1 mg of folic acid a day because of the effect of their antiepileptic medication.
If you are pregnant, you must always be aware of the possible harm that can come to your unborn baby from any medications, whether by prescription or over-the-counter. The greatest risk time for malformations to occur in the fetus is between 18 and 60 days after conception. All drugs should be avoided during this time. Later during the pregnancy if drugs are taken, the growth and behaviour of the baby may be affected.
In summary, if you are pregnant, it is best to avoid any drugs. Unfortunately, even if all drugs are avoided, there is still a small chance a malformation will occur (one to three per cent) but the risk is less. If a drug must be used, carefully consider the advice of your doctor and pharmacist. Weigh the risks and benefits before you decide to go ahead.
FAMILY HEALTH is written with the assistance of |
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FAMILY HEALTH is written with the assistance of |
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