Medicines and drug use during pregnancy

Medicines

While pregnant and when trying to get pregnant, avoid using any medicines or dietary supplements unless your health professional prescribes or recommends them. Nonprescription medicines are generally not well studied for use during pregnancy. However, some medicines have been widely used with no ill effects and are therefore thought to be safe. For example, acetaminophen (such as Tylenol) is safe at recommended doses to control fever or treat pain.

If you are pregnant or trying to conceive, follow these guidelines about medication use, and be sure to check with your health professional before taking anything:

• Avoid medication use before the second trimester if at all possible. The first trimester is the most high-risk period for taking medication. This is when early cellular division, placenta growth, and organ development are taking place.
• Some cold and allergy medicines are thought to be safe during pregnancy, though none are well-studied.¹ Many health professionals discourage their use unless absolutely necessary. If your symptoms are severe, talk to your health professional about the right cold or allergy treatment for you.
• Some complementary and alternative medicines, such as herbs or vitamin and mineral supplements, are safe during pregnancy. Many are not, and some supplements are dangerous when taken in too high a dose.
• Acetaminophen (such as Tylenol) is considered the pain reliever of choice for pain or fever relief during pregnancy.¹ However, too much Tylenol can damage your liver. And its safety profile is based on wide use, rather than a lot of medical research. Check with your health professional before using it.

There are a lot of medicines that are not safe to use when you're pregnant. Common medicines to avoid include:

• Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen, and naproxen. Do not use an NSAID when trying to become pregnant and during pregnancy. NSAIDs have been linked to increased miscarriage risk, especially at the time of conception and when an NSAID is used for longer than a week.² Taking ibuprofen during the third trimester has also been linked to fetal heart problems.
• The antidepressants Paxil and Paxil CR (paroxetine). The U.S. Food and Drug Administration (FDA) has issued a warning on paroxetine and birth defects. One study has shown that women who took Paxil during their first 12 weeks of pregnancy had a slightly higher chance of having a baby with birth defects.
• The acne medicine called isotretinoin (such as Accutane). This medicine causes birth defects.
• The heart medicines called ACE inhibitors (such as lisinopril, also known as Prinivil, Zestoretic, and Zestril). This type of medicine causes birth defects.

Information about medication safety during pregnancy sometimes changes with new research, so be sure to check with your health professional before taking something that you've heard was safe in the past.

Drug use

Use of cocaine or methamphetamine during pregnancy can cause fetal harm or death resulting from:

• Placenta abruptio, which is the separation of the placenta from the uterus before a baby is delivered.
• Early (preterm) labor and premature birth.
• Fetal drug exposure.

Injected drugs are linked to an increased risk of infections, such as hepatitis or human immunodeficiency virus (HIV), the virus that causes acquired immunodeficiency syndrome (AIDS).

Citations

1. Black RA, Hill DA (2003). Over-the-counter medications in pregnancy. American Family Physician, 67(12): 2517–2524.

2. Li D, et al. (2003). Exposure to non-steroidal anti-inflammatory drugs during pregnancy and risk of miscarriage: Population-based cohort study. BMJ, 327(7411): 368–372.