When Sarah found out she was pregnant with her second child, she thought she knew the drill. She’d been through this before. But at her first prenatal appointment, her doctor asked about all her medications—including over-the-counter ones. Sarah rattled off her daily routine: prenatal vitamin, allergy medication, occasional ibuprofen for headaches, antacids for heartburn, and her asthma inhaler.
Her doctor stopped her at ibuprofen. “We need to switch you off that immediately,” she said. Sarah was confused—she’d taken it during her first pregnancy without issue. What she didn’t know was that new research had emerged about NSAIDs after 20 weeks of pregnancy, and the safety guidelines had changed.
Medication safety during pregnancy is one of the most confusing aspects of prenatal care. Guidelines change as new research emerges, the same medication might be safe in one trimester but risky in another, and the line between “safe” and “avoid” isn’t always clear.
Understanding Pregnancy Safety Categories
For decades, the FDA used a letter-based system (A, B, C, D, X) to categorize medication safety during pregnancy. In 2015, the FDA replaced this system with narrative summaries that provide more detailed risk information and context about timing.
Medications to Absolutely Avoid During Pregnancy
- Isotretinoin (Accutane): Causes severe birth defects
- Warfarin: Can cause bleeding and birth defects
- ACE Inhibitors/ARBs: Kidney problems in baby
- Methotrexate: Causes miscarriage and severe birth defects
- Valproic acid: High risk for birth defects
- Paroxetine (Paxil): Linked to heart defects
- NSAIDs after 20 weeks: Can affect baby’s kidneys, heart, and amniotic fluid
Common OTC Medications: What’s Safe
For Pain and Fever:
- ✓ Acetaminophen (Tylenol): Safe throughout pregnancy
- ✗ Ibuprofen/Naproxen: AVOID after 20 weeks
- ⚠️ Aspirin: Only if prescribed by doctor
For Colds and Allergies:
- ✓ Saline nasal spray: Completely safe
- ✓ Diphenhydramine (Benadryl): Generally safe
- ✓ Loratadine (Claritin): Safe with good data
- ⚠️ Pseudoephedrine: After first trimester only
- ✓ Dextromethorphan: Acceptable after first trimester
For Heartburn:
- ✓ Tums/Rolaids: Safe
- ✓ Famotidine (Pepcid): Safe
- ✓ Omeprazole (Prilosec): Generally acceptable
For Constipation:
- ✓ Fiber supplements: Completely safe
- ✓ Colace: Safe
- ✓ MiraLAX: Generally safe
- ✗ Castor oil: Can trigger labor
What About Zicam?
Zicam Nasal Products:
- Have been associated with loss of smell
- Most providers recommend avoiding during pregnancy
Zicam Oral Products (Lozenges):
- Safer than nasal products
- Watch total zinc intake (prenatal + Zicam should not exceed 40mg daily)
Better alternatives:
- Saline rinses
- Humidifier
- Rest and hydration
- Acetaminophen for fever
- Honey for cough
Prescription Medications
Safe Antibiotics:
- Penicillins (amoxicillin)
- Cephalosporins (cephalexin)
- Macrolides (azithromycin)
Asthma Medications:
- Continue all prescribed asthma medications
- Uncontrolled asthma is riskier than the medications
Antidepressants:
- Don’t stop without medical guidance
- Work with provider to weigh risks vs. benefits
Thyroid Medications:
- Essential to continue
- May need dose adjustment
Timing Matters: Risk by Trimester
First Trimester (Weeks 1-12):
- Most critical for organ development
- Highest risk for major birth defects
- Avoid most medications unless necessary
Second Trimester (Weeks 13-27):
- Some medications become safer
- Others become riskier (NSAIDs)
Third Trimester (Weeks 28-40):
- Focus on effects on labor/delivery
- Consider breastfeeding compatibility
Making Smart Decisions
- Ask: Is this necessary?
- Check with your provider first
- Use the lowest effective dose
- Read labels carefully
- When in doubt, call your provider
What If You Took Something Before Knowing You Were Pregnant?
Don’t panic. The “all-or-nothing” principle applies very early in pregnancy. Tell your provider at your first visit—many exposures cause no problems.
Resources for Checking Safety
MotherToBaby:
- Call/text: 1-866-626-6847
- Website: www.mothertobaby.org
- Free, evidence-based information
The Bottom Line
- Acetaminophen is your friend for pain/fever
- Avoid NSAIDs after 20 weeks
- Don’t stop necessary prescriptions without guidance
- When in doubt, call before taking anything
- Try non-drug approaches first when possible
At Women’s Integrated Healthcare, we’re here to answer your medication questions at every stage of pregnancy. Whether you’re dealing with a cold, managing a chronic condition, or just want to double-check if something’s safe, we’re a phone call away.
Schedule your prenatal consultation today and get personalized guidance on medication safety throughout your pregnancy.
References:
- American College of Obstetricians and Gynecologists. (n.d.). Medications and Pregnancy. Retrieved from https://www.acog.org
- MotherToBaby. (n.d.). Fact Sheets on Medications and Pregnancy. Retrieved from https://www.mothertobaby.org
- U.S. Food and Drug Administration. (n.d.). Pregnancy and Lactation Labeling. Retrieved from https://www.fda.gov
