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Michael D. Geurin

Michael D. Geurin

The best time to think about which medications and supplements you should avoid during pregnancy is before you are pregnant. The best way to set the stage for the healthiest possible pregnancy is to schedule a preconception counseling session with your healthcare provider. Together you can review the medications and supplements you are using, along with your health habits and risk factors.

If you become pregnant unexpectedly, set up a prenatal appointment as soon as possible. Until you’ve talked with your doctor, immediately cut down on or stop using over-the-counter medications and supplements other than prenatal vitamins. During the first eight weeks of pregnancy, most of the fetus’s organs are formed, which makes it a very vulnerable time for your developing baby.

Medications and supplements can affect how the fetus develops its organs, how the fetus grows, and how the placenta supplies the fetus with blood and nutrients. They can also affect pregnancy hormones and even the muscles of the uterus, risking preterm labor and other complications.

Aches and pains are common, especially later in pregnancy. The safest medication in pregnancy for pain and fever is acetaminophen, the active ingredient in Tylenol. You should avoid non-steroidal anti-inflammatories (NSAIDs) in the first three months of pregnancy and the last three months. Those include ibuprofen, such as in Advil and Motrin; naproxen, such as in Aleve; and aspirin, such as in Bayer and Excedrin. In early pregnancy, these medications can affect the development of the baby’s kidneys, and in late pregnancy, they can affect the baby’s blood vessels. One exception is if your doctor prescribes low-dose aspirin to prevent preeclampsia in certain high-risk situations.

There are some common over-the-counter ingredients to avoid:

  • Decongestants, like phenylephrine or pseudoephedrine, found in Sudafed or Sudafed PE
  • Diarrhea control medications, like loperamide, found in Imodium, should be avoided in early pregnancy, and bismuth subsalicylate, in Pepto Bismol, should be avoided in the second half of your pregnancy.

Nausea is common in pregnancy, particularly “morning sickness” in the first trimester. The safest and best medication for morning sickness is vitamin B6, pyridoxine, an OTC supplement. Common dosing of B6 for morning sickness is 10-25 milligrams up to every 6 hours. Another OTC medication, doxylamine, can be added for morning sickness if necessary. This is the ingredient in Unisom tablets (but not the capsules), and a common dose is 25 milligrams at bedtime. If your morning sickness doesn’t respond to diet changes, ginger supplements and these over-the-counter treatments, you should talk with your doctor. Other treatments may be needed, but they pose greater risks.

While things like vitamin B6 and ginger are generally safe in pregnancy, other supplements can be dangerous. Many people mistakenly believe that chemicals are safe if they occur naturally. Some of our most dangerous toxins occur naturally in plants and animals, so you have to be cautious and skeptical about supplements you find on store shelves or online, especially when you are pregnant. Websites like AmericanPregnancy.org can help you find out what is safe, since a number of herbal supplements can threaten the pregnancy.

The bottom line: If you are pregnant and you aren’t sure if a specific medication or supplement is safe, contact your primary care physician or OB/GYN specialist for solid advice to help ensure a healthy pregnancy and a healthy baby.

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Michael D. Geurin, MD, FAAFP, is a faculty physician at the Montana Family Medicine Residency at RiverStone Health.

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