For the first six months that Suzanne Bartlett was pregnant with her daughter Everly, now eight months old, she was plagued by debilitating allergies. “I had sinus headaches that felt like a migraine, a constant stuffed-up nose, and there were days that I felt so bad I couldn’t get out of bed,” she says.
Her doctor said she could take Benadryl, but not the non-drowsy kind. Ultimately, she decided to power through without it. “I avoided taking any over-the-counter meds despite how much feeling sick was taking over my life—there’s just so much conflicting info for pregnant women I thought it better to avoid everything,” she says.
It’s easy to see why there’s confusion about safety. “Because drug companies are concerned about liability, most medications have never been studied during pregnancy,” says Robyn MacQuarrie, an OB/GYN at the Cumberland Regional Health Centre in Amherst, NS. As a result, many doctors or pharmacists are loath to recommend over-the-counter medications.
However, there is good longitudinal data that shows some drugs are safe in pregnancy, says Gideon Koren, founder and director of the Motherisk program and a professor of paediatrics, pharmacology, pharmacy and medical genetics at the University of Toronto. Here’s the lowdown on common over-the-counter meds.
Acetaminophen (Tylenol) has long been considered one of the few drugs safe to take during pregnancy, but a 2016 study in the International Journal of Epidemiology found a link between acetaminophen and autism. While studies like this are scary, it doesn’t mean women shouldn’t take Tylenol. “It’s not a warning that women should stay completely clear of acetaminophen,” says David Olson, a professor of obstetrics and gynecology, pediatrics and physiology at the University of Alberta. As with all medications during pregnancy, women should take the lowest dose possible of for the shortest period of time.
You’re having a baby—subscribe to our Today’s Parent Pregnancy by Week newsletter!Ibuprofen (Advil) is metabolized in the mother’s and baby’s kidneys and “we worry about the baby going into renal failure,” MacQuarrie says. “We also worry that ibuprofen can close the ductus arteriosus, a blood vessel between the main pulmonary artery and the aorta that’s only open in fetal circulation, and should only close after the baby is born.”
For a hacking cough, MacQuarrie says that syrups containing dextromethorphan (sometimes labelled DM) can be taken as directed on the package if needed. “Our general advice is the lowest dose possible for the shortest amount of time,” she says. But she suggests first trying a lot of honey and water to suppress the cough reflex, which has been shown to be surprisingly effective.
Pregnant women need to be very careful with cold and flu medications because many contain pseudoephedrine: “It can affect maternal blood flow, which can have an adverse effect on the baby,” says MacQuarrie. Koren recommends treating symptoms topically with medicated nose drops. “These have much lower concentrations of the chemicals that constrict the blood vessels in the nose, and that’s much safer,” he says. “Very little of the medication is getting into your system, or the baby’s.” Read the box or ask a pharmacist if you’re not sure if a product contains pseudoephedrine.
“Antihistamines have, for the most part, been shown to be safe,” says Koren. Benadryl is often recommended for pregnant women because there are many years of data associated with use, and Koren adds that there’s also been a very large review of the use of non-drowsy antihistamines that did not show any problems.
Koren says there’s no reason for pregnant women to take less than the dosage listed on the packaging—in fact, taking a lower dose may not provide the relief you need. “Your body is probably larger, and many drugs in late pregnancy leave the body quicker because the liver and kidneys are working harder,” he says. Moms-to-be should talk to their doctor before taking over-the-counter medications, even those considered safe for use during pregnancy. “As a rule of thumb, don’t self-prescribe in pregnancy,” says Koren. “Talk about it with your physician or call Motherisk.”
The Hospital for Sick Children’s Motherisk program in Toronto provides evidence-based information about medications for pregnant women. If you have questions or concerns, call the Motherisk Helpline at 877-439-2744, Monday to Friday, 9 a.m. to 5 p.m., in each of Canada’s time zones, or visit motherisk.org.
A version of this article appeared in our April 2015 issue with the headline, “Drug safety,” p.57