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Do's and Don'ts of Taking Medicine During Pregnancy

Nasal Congestion and Sinusitis
5 ways to safely end nasal and sinus congestion
Living with Asthma
Understanding medications for asthma
Coping with Urinary Tract Infections (UTTs)
Treating Intestinal Disorders
Medications for Vomiting
Antidiarrhea Medications
Heartburn Medications
5 Safe Ways to Reduce a Fever
Medications for pain and fever

• Do take the medicine in the exact dosage and for the length of time your doctor recommends. Taking more is not better, and it is often worse.
• Don't take a lower dose than your doctor prescribes without consulting your doctor. The lower dose may do you no good, yet baby may still get the effects of the drug.
• Don't read the PDR (Physician's Desk Reference). The information in the PDR about drugs during pregnancy is there to protect the manufacturer rather than to inform the consumer. The warnings are needlessly scary and are often based upon research in which huge doses of a drug are given to experimental animals; the research may have little application to humans.
• Don't take medicines, even over-the-counter ones, without consulting with your doctor.
• Don't take over-the-counter remedies that contain several drugs unless advised by your doctor (e.g., cold remedies may contain mixtures of antihistamines, decongestants, aspirin, etc.).
• Don't panic if you've taken a drug that you later read may be unsafe. Odds are greatly on your baby's side that no harm was done.
• Do compromise. While some medications pose some risks to baby, a sick mom is not good for baby either. For example, if your nasal passages are so clogged you can't breathe, a one-time dose of a decongestant spray, such as AfrinR, has been shown not to have any harmful effects on the fetuses that were studied.
• Do think about the effect of the drug on your baby. Because your baby's liver and kidneys are immature, he cannot eliminate the drug as you can, so the drug may stay in baby's system longer and at a higher level.
• Don't use medicines if you are trying to conceive, especially in the first month. The first month of fetal organ development is a high-risk period for the effects of drugs. The "flu" you're experiencing may turn out to be early-pregnancy nausea.
• If you are already taking physician-approved medications while pregnant, check with your doctor before taking an additional drug. Also, when your doctor gives you a prescription for a new medication, be sure to tell him or her about any other medications you are taking. Certain drugs may be safe if taken individually, but not be safe if taken in combination with others.

The mucus membranes in the nasal passages of the sinuses often swell and become congested during pregnancy, probably due to the same hormones that cause vaginal membranes to become congested. Some women feel they have a persistent "cold" or sniffles throughout pregnancy.

Because the sinuses are an extension of the nasal passages, nasal congestion can lead to sinusitis. Swollen nasal membranes trap secretions in the sinuses, and fluid that can't drain, like water in a stagnant pond, becomes infected. Signs that you may have developed a sinus infection are: feeling of fullness or pain in the sinuses, alongside the nose, or over the eyebrows, snotty nasal discharge; increasing tiredness; or feeling that you have a cold that just won't go away.

1. Avoid unnecessary exposure to nasal allergens and pollutants, such as smog and cigarette smoke.

2. Drink even more water each day.

3. Flush your nasal passages with saltwater nose drops several times a day. These are available without prescription, or you can make your own: a quarter teaspoon of salt to a cup of water.

4. Use a facial steamer (basically a hot mist vaporizer attached to a face mask) to "steam clean" your nasal passages and sinuses.

5. Consider nasal sprays (decongestants, antihistamines). In theory, medicines that constrict the blood vessels of the nose may enter the bloodstream and constrict the blood vessels of the uterus or placenta; therefore, decongestants should be used only under a doctor's supervision, and only in the dosage and frequency your doctor recommends. (Women with decreased placental circulation should be particularly careful about taking any form of inhaled or oral decongestants.) Some nasal sprays are safer than others but except for saltwater (or saline) nasal spray, none should be used without first consulting your doctor.

• AfrinR (oxymetazoline) when used only twice a day and for a couple of days have not been shown to cause harmful effects on the developing baby.
• Inhaled nasal steroids (e.g., Vancenase and Beconase) are in the "probably safe" category, especially when taken only a couple of times a day and for a short period of time. Best to stick with the lower potency inhaled steroids unless advised by your doctor.
• Cromolyn (Intal) is safe to take during pregnancy. It is not a decongestant, a steroid, or antihistamine, but rather a medication that when taken over a long period of time lessens nasal congestion due to allergies. It is especially helpful during seasonal allergic rhinitis or hayfever. It is not helpful during an acute attack of a stuffy nose.
• Nasal or oral decongestants that contain the following compounds have been shown to be possibly harmful to the developing baby and should not be taken unless all other alternatives have been tried and your doctor judges that the benefits outweigh the risks: ephedrine, phenylpropanolamine, Neo-synephrine, phenylephrine. The main worry with these decongestants is that because they constrict the vessels in the airway passages, they may also constrict the blood vessels delivering blood to the baby.
• Antihistamines. Some antihistamines, such as chlorpheniramine and tripelennamine, are categorized as safe to take during pregnancy (green light). Others are recommended only with reservation (yellow light), such as those containing brompheniramine, diphenhydramine, terfenadine, and clemastine. These have been implicated in causing eye damage in premature infants if taken in the last two weeks of pregnancy, yet this is a rare finding.
• If you have been taking allergy shots before becoming pregnant, your doctor may advise continuing these shots during your pregnancy, but because reactivity to these injections may change during pregnancy, your doctor may elect to change the dosage. It is unlikely that your doctor would advise starting allergy shots during a pregnancy.
• Cough syrups should be taken with caution while pregnant and are best limited to nighttime-use or to severe coughs. Available studies have shown no link between guaifenesin and fetal defects.

Like most chronic allergic problems, asthma may get better for some women during pregnancy and worse for others. Because the airway is already working overtime during pregnancy (the amount of air you move with each breath increases), asthma can be particularly worrisome at this time. If your airway is compromised and you're not getting enough oxygen, your baby may not be getting enough oxygen either. So, for your health and your baby's, it's particularly important to take care of asthma during pregnancy. Try these helps in managing your asthma:

• Early in your pregnancy (or even better, when you are planning to conceive) consult your family physician or allergist and your obstetrician to review your current asthma management program. Determine what self-help regimens you can use and which medications you can take while you're pregnant. Depending on the frequency and severity of your asthma, it may be wise to repeat this consultation later in your pregnancy. Some medications cause different problems at different stages of pregnancy.
• Avoid unnecessary exposure to allergens, primarily cigarette smoke and pollutants. Pay particular attention to your sleeping environment.
• Keep your nasal passages and sinuses.
• Seek medical attention and treat your asthma early, before the attack escalates to compromise your breathing. While pregnant, many women find it's necessary to call the doctor earlier and to treat their asthma more aggressively than before they were pregnant.

If you have chronic asthma and are on a treatment regimen that has been working for you, do not stop or change your medication before checking with your doctor. Don't let the fear of taking medicine set you up for an asthmatic attack, which may be more harmful to your baby than the rare chance of the medication harming your baby.

• Albuterol, the mainstay of asthma treatment, is the most common medication used in pocket inhalers and home nebulizers. Because albuterol can elevate the heart rate in mother and baby, raise maternal blood pressure, and cause changes in maternal and fetal blood sugar, it must be used exactly as prescribed by the physician. Even though albuterol is generally considered safe during pregnancy and is an example of a medication where the benefits usually outweigh the risks, it still is in the "yellow light" category, meaning it needs to be used with caution.
• Cromolyn is in the "green- light," safe category as a maintenance medication for chronic asthma.
• Epinephrine-containing products should be avoided unless recommended by your doctor; they are usually used only in severe asthmatic attacks.
• Inhaled steroids are considered safe for treating asthma as long as they are used under a physician's close supervision and in the dosage and frequency advised by the doctor.

A full bladder competes for pelvic space with a growing uterus. Urinary tract, bladder or kidney infections may result. Many women will have at least one episode at some time during their pregnancy. The symptoms of a urinary tract infection (UTI) or bladder infection (cystitis) include: painful urination, burning on urination, increased urgency and frequency of urination, lower abdominal or pelvic pain, and possibly blood in the urine. Sometimes the infection can spread upward into the kidneys (called pyelonephritis), causing severe back pain, fever, chills, rapid heart rate, vomiting, and a generally very ill feeling. Urinary tract infections are treated with a combination of self-help and medicine prescribed by your doctor:

• To lessen your chances of getting UTI's, drink extra fluids. Cranberry juice in particular is thought to kill bacteria in the urine.
• Don't hold onto your urine; go as soon as you feel the urge.
• Empty your bladder thoroughly at each urination by triple voiding: urinate once, wait about ten seconds, urinate again, and then a third time.
• Empty your bladder before and after intercourse.
• Wear loose-fitting underwear, pantyhose, and slacks.
• Keep your regularly scheduled prenatal appointments in which your doctor will routinely check your urine for signs of infection.
• If you suspect you have a bladder or kidney infection, have your urine checked immediately. Oftentimes, your doctor can detect a UTI immediately with routine urinalysis; sometimes an overnight culture is needed. Some women will grow bacteria in their urine even without symptoms (called asymptomatic bacteriuria), and this condition increases the chances of getting UTI's. To screen for this, your doctor may perform frequent urine cultures as part of your prenatal care.
• If you have a urinary tract infection, your doctor will prescribe an antibiotic that is safe for you to take while pregnant. The type and the duration of the antibiotic will depend upon the severity of your UTI and your stage of pregnancy. Improperly treated UTI's increase the risk of having a problem pregnancy or premature delivery.

The intestinal flu can strike the already queasy stomach of pregnancy. An infection of the intestinal lining is called gastroenteritis. It is recognized by the symptoms of nausea, vomiting, diarrhea, crimpy lower abdominal pain, and often fever. While you don't have to worry that the infection affects your baby, the resulting loss of fluids and body salts (electrolytes) could cause you to become dehydrated, jeopardizing your health and that of your baby.

• Go to bed and rest as many hours a day as you can.
• Prevent dehydration. Sip on fluids all day long. Small, frequent sips are best. You may need to drink an additional quart of fluids in addition to your already increased fluid intake. To be sure you're replenishing adequate electrolytes, try oral electrolyte solutions (Pedialyte, Resol, Rehydralyte, Ricelyte) available over-the-counter. Commercially available oral rehydration fluid has the proper balance of sugar and electrolytes to promote adequate absorption of fluids from inflamed intestines. Many homemade mixtures contain either too much sugar or not enough sodium. Too much sugar in the solution can actually increase the diarrhea. You can make your own solution: to one quart of juice (orange, grape, apple, or pineapple) add two teaspoons of table salt.
• Because of nausea and vomiting you may find it easier to retain fluids taken in the form of juice bars or ice chips.
• Unless you really can't keep them down, it's important to eat some solid foods, otherwise the diarrhea may worsen and your nutrition may be inadequate. Try easy-on-the-intestine foods: rice, baked potatoes, bananas, and yellow vegetables.

Some medicines to treat vomiting (called antiemetics) are safe, some are not. Emetrol (basically Cola syrup) is a safe and sometimes helpful medication for nausea and vomiting. A tablespoon taken several times a day may relieve stomach upset. Phenothiazines (Compozine, Tigan, Phenergan) despite the "yellow light" caution category are generally considered safe for pregnancy, especially in the short course used for the treatment of occasional vomiting from gastrointestinal disorder or severe morning sickness.

No antidiarrhea medications (even those obtained over-the-counter) should be taken without your doctor's advice. Increased intestinal motility and consequent diarrhea is the body's natural way of getting rid of harmful bacteria and toxins in the intestines. Medicines that slow down intestinal motility or cause the infected material to remain longer in the intestines may actually be dangerous because they prolong the time the bacteria and toxins remain in the intestines. Unless there is severe discomfort or the woman is in danger of dehydration, most doctors suggest their patients not use antidiarrheas. The combination of kaolin and pectin (Kaopectate), even though it is safe to take during pregnancy, is not very helpful. Imodium A-D is a more effect antidiarrhea, and is reported to be safe to take during pregnancy. Still, it may be better to allow the intestines to rid themselves of bacteria and toxins naturally, so we have put these two medications in the "yellow light" or caution category. However, if your doctor feels that it would be better in your situation to slow down the diarrhea, Imodium A-D may be the best choice. Pepto- Bismol contains salicylate (similar to that found in aspirin), which may cause bleeding in mother and/or baby; Bismuth has been linked to birth defects in experimental animals. Neither of these medications is regarded as safe to take while pregnant.

If you are in danger of becoming dehydrated from vomiting and/or diarrhea, and your illness does not seem to be self-limiting, your doctor may choose to rehydrate you with intravenous solution that can be administered over several hours while you are an outpatient in the doctor's office or in an emergency room.

Medications that block gastric acid secretion (called H2-receptor antagonists), such as Tagamet, Zantac, and Pepcid, seem to be safe to take while pregnant and fall into the "green light" category. However, even these medications should not be taken without a doctor's advice. Over-the-counter antacids, such as Tums, Mylecon, Milk of Magnesia, and Maalox are all safe to take during pregnancy and are also in the "green light" category. Because it contains aspirin, Alka seltzer is not safe to take during pregnancy, although Alka Seltzer brand compounds that do not contain aspirin are safe. Phenobarbital-containing anti-spasmodics (e.g., Donnatal) are in the "red light" category since phenobarbital has been reported to harm fetal development.

1. Dress for the temperature. Don't overdress or underdress yourself. Putting on too many clothes retains your body's heat; underdressing encourages shivering, which produces more heat. Wear lightweight, loose-fitting clothes that allow the air to circulate over your skin.

2. Keep cool. Open a window, turn on the air conditioner, or go outside. Cool, fresh air removes the heat from your body.

3. Drink lots of fluids. Sweating and fast breathing cause your body to lose fluids that need replacing. Carry around a water bottle and sip all day long.

4. Feed the fever. The extra heat you produce burns up fuel that needs replacing with nutritious calories. Calorie-filled, cool smoothies combine the need for food and fluids.

5. Take a cool dip. Soak in a lukewarm bath or shower that is cool enough not to be uncomfortable or make you shiver. Then step out of the tub while still wet and allow your body to cool by evaporation.

Aspirin is not the preferred fever-reducing medication to take while pregnant, because there are safer and equally effective alternatives. Yet don't worry if you have unknowingly taken a couple of aspirin on a couple of occasions. This is unlikely to harm your baby. The main concern with aspirin is that prolonged high doses, especially in the third trimester, may cause bleeding in mother or baby (aspirin is an anticoagulant) or interfere with the normal onset of labor (aspirin inhibits prostaglandin's). Obstetricians sometimes use low-dose aspirin to prevent pregnancy-induced hypertension, eclampsia, and other intrauterine problems.

Ibuprofen (Motrin, Nuprin, and Advil) is safer than aspirin during pregnancy, but take it only with a doctor's advice. It seems to be safe to take in the first two trimesters because there have been no studies linking ibuprofen with congenital defects. Ibuprofen does not have the anticoagulant effect of aspirin, and is therefore unlikely to cause bleeding in mother or baby when taken in the third trimester. Because it inhibits prostaglandins (natural hormones that influence labor), it must be used with caution during the third trimester. Ibuprofen can also interfere with the normal blood flow within the heart and blood vessels of the baby during the third trimester. These effects are likely to disappear when the drug is stopped and have not been shown to harm baby.

Acetaminophen is safe to take throughout all stages of pregnancy. It is an effective fever-reducer and an analgesic for pain. Studies have shown that high doses of acetaminophen taken throughout pregnancy may be harmful to mother and baby. Acetaminophen, if used in the proper dosage and for the usual 2-3 day illnesses associated with fever, is safe for mother and baby.