Wellness

Medications to Avoid During Pregnancy

Talor Bianchini20 Sep 2021

Most women are advised to avoid medications altogether during the first three months of pregnancy. In general, pregnant women should not be taking antibiotics, pain relievers, or certain antidepressant medications unless a medical doctor approves the use of these medications. When in doubt, always consult your doctor about your current medications before adding any new drugs to your daily regimen.

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What Medications Should You Avoid During Pregnancy?

Getting sick during pregnancy can be a stressful experience for expecting mothers.  As a rule of thumb, pregnant women should generally avoid antibiotics, pain relievers, and antidepressant drugs unless a doctor suggests using such medications.

Dr. Kimberly Langdon provided insight for this article regarding which medications are okay to take during pregnancy. Langdon is a retired, board-certified OB/GYN with 19 years of clinical experience. After practicing, she founded a medical device company to commercialize her six patented medical devices for life-threatening and non-life-threatening conditions. 

The Food and Drug Administration (FDA) classifies drugs with letter categories to represent the prenatal safety of taking medication. The categories are A, B, C, D, and X, with Category A being the safest and Category X being the least safe. 

FDA Classification of Drug Safety During Pregnancy 

Category

Description

A

Tested on appropriate human studies - no risk associated with medication. 

B

Insufficient human studies, but animal research suggests safety OR animal studies show issues but human studies show safety. 

C

Insufficient human studies, but animal studies show problems OR no animal studies and insufficient human studies. 

D

Human studies, with/without animal research show fetal risks, but the drug is important to some women to treat their condition. 

X

Fetal risks are evident; there are no situations where the risk/benefit justifies use. 

Antibiotics

Antibiotics have a wide range of usage, and many women may be prescribed them during their pregnancy if they develop an infection that requires treatment. In these cases, the potential effects of antibiotics may cause less harm than allowing an ailment to run its course. For example, if you are faced with a bacterial infection, like a UTI, your doctor will more than likely prescribe you an antibiotic as treatment. 

Some antibiotics are known to cause congenital disabilities in a fetus if taken at any point throughout the pregnancy, so it is essential to do research and ask your doctor questions before taking anything. 

Dr. Langdon and other sources noted some dangerous antibiotics to look out for:

  • Tetracycline: can discolor a baby’s teeth and affect other bone development
  • Ciprofloxacin/Levoflaxine: can cause problems with the baby’s muscle and skeletal growth, joint pain, and potential nerve damage in the mother
  • Chloramphenicol: can cause severe blood disorders in the baby
  • Streptomycin/Kanamycin: can cause hearing loss
  • Sulfonamides: can cause jaundice in newborns and may also increase the chances of having a miscarriage

You should also be aware that because it is unethical to conduct drug trials on pregnant women, there is still a lot unknown about taking antibiotics during one’s pregnancy. 

Pain Relievers

Pain relievers are also often unsafe for pregnant women; this includes both prescribed and over-the-counter drugs. Physicians typically avoid recommending any over-the-counter medications because of the potential adverse effects on both the baby and mother. It is believed that over 10% of congenital disabilities are caused by maternal drug exposure. 

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In general, the over-the-counter pain reliever of choice during pregnancy is acetaminophen, which is popularly known by its brand name, Tylenol. Aspirin, ibuprofen, and other non-steroidal anti-inflammatory drugs (NSAID) tend to interfere with blood clotting and affect the baby’s heart and lungs. 

Below we outline the safety levels of various pain medications during the three trimesters of pregnancy. 

Over the Counter Pain Medications During Pregnancy

Pain Medication

FDA Drug Classification by Trimester

Drug Safety During Pregnancy

Acetaminophen (Tylenol)

B/B/B

Best for pregnancy

Aspirin

D/D/D

Not safe to use

Ibuprofen (Advil, Motrin)

B/B/D

Safe to use until 3rd trimester

Ketoprofen (Orudis)

B/B/D

Safe to use until 3rd trimester

Naproxen (Aleve)

B/B/D

Safe to use until 3rd trimester

Dr. Langdon also advises avoiding codeine, which is a prescription opioid or pain reliever. Opioids can have detrimental effects on the baby's development, including conditions like congenital heart defects, glaucoma, neural tube defects, and more

Opioids can lead to adverse effects for the mother as well, potentially causing premature labor. Other prescription opioids include morphine, fentanyl, and oxycodone. These opioids can show up in common over-the-counter medications like cough medicine. 

Antidepressants

Antidepressants and anti-anxiety medications are other classes of drugs that have been shown to have adverse effects on pregnancies. If you are taking this kind of medication before getting pregnant, you should meet with your doctor to determine if there is another medication you can take that is safe for both you and your baby. 

Do not stop taking your prescription without first consulting your doctor. Prioritizing mental health is extremely important during pregnancy, as untreated depression in pregnant mothers is associated with an increased chance of premature births, low birth weight, and postpartum depression, among other complications. 

Like antibiotics, a doctor will typically outweigh the risks and benefits of taking antidepressants during pregnancy. Some common medications used to treat depression that is associated with congenital disabilities are:

Staying Healthy During Pregnancy

Maintaining your health while pregnant is essential for the development of your baby and preventing future health problems. With pregnancy comes new dietary restrictions and concerns you may not have had in the past. It can be challenging to navigate all the information that discusses what is and isn’t recommended during pregnancy. 

Dr. Langdon provided some tips for staying healthy during your pregnancy:

  1. Use non-medical options when sick - things like drinking lots of fluids and even eating soup are often a much safer option for pregnant women to deal with cold symptoms than antihistamines and decongestants.
  2. Consult your healthcare provider often - don’t take any medications without first consulting your OB/GYN or another healthcare provider.
  3. Avoid combination products - multi-symptom cold and allergy medications typically contain ingredients from the off-limits list.
  4. Read labels - ingredients such as alcohol and caffeine turn up in surprising places.

Frequently Asked Questions About Medications to Avoid During Pregnancy (FAQs) 

There are a lot of decisions to make when pregnant, especially when it comes to taking medications. Here are some answers to common questions to help you stay informed during your pregnancy. 

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Can I use pain relief cream while pregnant?

Pregnancy can come with a lot of aches and pains, and without being able to utilize most pain-relieving medications, it is hard to find safe products. Pain relief creams, like Bengay and icy hot, should be avoided during pregnancy, especially in the third trimester. Methyl salicylate, an NSAID, is the main active ingredient in these products and can be absorbed into the body once it's rubbed into the skin.

Is it okay to take vitamins and herbal supplements when pregnant?

Even though vitamins and herbal supplements may seem harmless, you should still consult a doctor before taking anything new. Unlike prescription medications, these products are not reviewed by the FDA, and therefore may contain other ingredients that are harmful to pregnant women and babies. Women trying to get pregnant are recommended to take folic acid or another multivitamin that prevents congenital disabilities. 

Which trimester is most crucial in terms of monitoring what medications I take?

Although all trimesters are essential during pregnancy, the first trimester, when the baby is 0 to 13 weeks old, is crucial for their development. During this time, their organs and the structure of their body develop, and it's also the time when most miscarriages and congenital disabilities occur. One should be extremely careful about medications one is taking during this time. 

What skincare products should I avoid while pregnant?

Although it may not be something most people think about, many skincare products contain ingredients that can be harmful to pregnant women. The FDA lists the following ingredients as potentially posing a risk to you and your baby:

  • Vitamin A derivatives (retinol, Retin-A, retinyl palmitate)
  • Accutane
  • Benzoyl peroxide
  • Salicylic acid
  • Hydroquinone
  • And more

As Dr. Langdon stated, it’s crucial to read the ingredients list of products to watch out for harmful additives.  

Can I drink alcohol while pregnant?

No. It is unadvised to drink alcohol at any point in pregnancy. According to the CDC, drinking alcohol while pregnant can cause a baby to have abnormal facial features and affect brain development. All types of alcohol are advised against consumption, including wine and beer. 

Can I drink caffeine while pregnant?

The American College of Obstetricians and Gynecologists and the March of Dimes note that you can drink caffeine while pregnant, but you should be limiting the amount you are consuming each day. It’s recommended to limit your daily caffeine intake to 200 mg, which equates to a 12 oz cup of coffee. 

Remember to read ingredient labels because caffeine is found in other products like chocolate, tea, soft drinks, energy drinks, and even some medications. Below are some of the caffeine contents in some food and drinks: 

  • One mug of green tea: 40 mg of caffeine
  • One cup of black tea: 45 mg of caffeine
  • 8 oz of coffee: 95 - 165 mg of caffeine
  • 12 oz of Dr. Pepper: 37 mg of caffeine

Bottom Line

It can be challenging for pregnant women to navigate the list of medications they should and shouldn’t take. In general, most antibiotics, pain relievers, and antidepressants should be avoided during pregnancy when possible to decrease the risk of congenital disabilities and complications.

Additionally, pain-relieving creams, herbal supplements, skincare ingredients, and alcohol are also unsafe for pregnant women and their babies. Before adding anything new to your routine, make sure to consult your doctor to determine if it is safe for you to take. 

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