Health I.Q.: Navigating the Medicine Cabinet

Pregnant women spend a lot of time thinking about what they put in their bodies, but the debatable items go far beyond sushi and raw-milk cheeses. Medications, from anti-inflammatories to cold pills, pose another area of unknown, begging the question: What is safe to take when you’re not feeling well?

It’s a valid concern. According to a report released by the Centers for Disease Control and Prevention, nearly half of Americans take at least one prescription drug. And when it comes to over the counter (OTC) medications, the American College of Preventive Medicine reported in 2011 that 35 percent of Americans are on an OTC medication—a number that has most likely grown as more prescription drugs have become available without a doctor’s order.

We turned to Dr. Carl P. Weiner—coauthor, along with journalist Kate Rope, of The Complete Guide to Medications During Pregnancy and Breastfeeding (St. Martin’s Griffin), a perinatologist and professor of pharmaceutical sciences at the University of Kansas School of Medicine and associate director of the Institute for Reproductive Health and Regenerative Medicine—for some guidance.

Think It Through

Dr. Weiner recommends taking three factors into consideration when weighing the pros and cons of taking any type of medication:

• Does the problem for which the medication is being used actually require drug treatment: “The answer is clearly yes for a drug used to treat a life-threatening or debilitating illness, which can include depression,” he says. “Thereafter, the answers become grayer and more personal.”
• How significantly does the drug cross the placenta into the bloodstream of a developing fetus: “If very little reaches the bloodstream and does not increase the risk of preterm labor, the risk to the fetus is typically negligible,” he says.
• If the drug reaches a developing fetus in high enough concentrations to have an effect, how long will the drug be required: “A short exposure may be too limited to have any impact,” he notes. “And sometimes the risk only applies to taking the medication during a specific time period of pregnancy, such as the first trimester.”

Drug 101

When it comes to OTC medications, Dr. Weiner says that most are relatively safe, though always check in with your doctor before making a decision. Here’s a handy list of common drugs and their caveats:

• Aspirin: Should only be used for specific reasons, such as to reduce the risk of preeclampsia during pregnancy.
• Acetaminophen: The drug of choice for pain relief in the first trimester, as ibuprofen may increase the risk of gastroschisis—a repairable condition in which the fetus’s intestines develop outside the body.
• Ibuprofen (or related NSAIDs): Should not be taken after 32 weeks of pregnancy because it can adversely effect fetal blood flow and decrease levels of amniotic fluid.
• Pseudoephedrine (decongestant): Best sidestepped during the first trimester (it also may increase the risk of gastroschisis) and by women with high blood pressure. Same goes for Afrin nasal spray and guaifenesin, an expectorant found in Mucinex and some cough suppressants.
• Medications Containing More Than One Active Ingredient: Pepto-Bismol, for instance, should be avoided in the first trimester because it contains aspirin.