Articles

Key takeaways

• Always check with a doctor, midwife, or pharmacist before taking any medicine.
• Never stop prescribed medication without first speaking to your healthcare professional.
• Some medicines can harm your baby, while others are safe to use.
• Even over-the-counter and herbal remedies need professional approval.

Navigating medications during pregnancy

Taking medicines during pregnancy requires extra care. Most medicines can cross from your bloodstream to your baby.

Some medicines can affect your baby's development, so it is important to know which ones are safe. It is always best to ask a professional before you take anything. This includes your doctor, midwife, pharmacist, or dentist. This applies to both prescribed and basic over-the-counter medicines.

Make sure your healthcare professional knows you are pregnant before they prescribe anything.

If you are taking any prescription medications, talk to your healthcare professional as early as possible in the pregnancy, or sometimes before conception. This is an important step to keep your baby safe and for planning your pregnancy care.

Sometimes, the benefits of taking medication outweigh any risks to your pregnancy.

Your healthcare professional will discuss what is best for you.

Do not stop taking any medication before talking to a doctor or specialist. Stopping suddenly may be harmful to both you and your baby.

Managing prescription medications

If you are already taking any prescribed medicine, tell your GP you are pregnant as soon as possible. Do not stop taking medications without checking with your GP first. Stopping important medicines suddenly could harm both you and your baby.

You may be advised to stay on your current medication. Alternatively, a GP or obstetrician may recommend changing your medication dose or switching to another drug type. This is your choice, but if offered it is to keep you and your baby as safe as possible.

Make sure you understand the risks and benefits of all your options and make a decision which feels right for you. It is important to understand that advice and information will likely change depending on your stage of pregnancy.

For some conditions, such as epilepsy, you may likely need to keep taking your medicine. This gives you the best chance of controlling seizures. This should be assessed and discussed on an individual basis.

Specific medications to discuss

If you are taking medication before or when you discover that you are pregnant, speak to your GP or midwife as soon as possible. These include:

• Medicines that help prevent blood clots (anticoagulants). Anticoagulants like warfarin can affect the way a baby develops or can increase the risk of bleeding.
• Mental health medications. There is a wide variety of medications used to assist with mental health conditions. Please speak with your GP or mental health professionals. Do not suddenly stop any medication before seeking advice.
• Treatment for epilepsy (Sodium valproate is commonly used). Sodium valproate is not recommended in pregnancy as it can affect how a baby develops. Speak with your GP or specialist as prior to pregnancy or as soon as you find out.

If you cannot find information about a specific medicine, ask your doctor, midwife, or pharmacist. They can contact the UK Teratology Information Service (UKTIS) or British National Formulary (BNF) for advice.

A guide to over-the-counter medicines

Even over-the-counter (OTC) medicines need careful consideration during pregnancy. Always check with your pharmacist, midwife, or GP before taking any OTC medicine.

All medication should be taken as instructed on the pack. Do not go over the recommended dose.

Pain relief

Paracetamol – This is usually the first choice for pain relief during pregnancy. It has been well-studied and has a good safety profile. Take the lowest dose that works for the shortest amount of time.

Ibuprofen – This is not recommended in pregnancy, especially after 20 weeks. It can affect your baby's circulation and kidneys.

Avoid in both tablet and cream form. These contain a type of medicine called non-steroidal anti-inflammatory drugs (NSAIDs), which also includes diclofenac and naproxen. Only use them if prescribed by your doctor.

Aspirin – Do not take medicines containing aspirin for pain relief during pregnancy. Aspirin may be listed as salicylate or acetylsalicylic acid.

Codeine – It is usually used when other treatments have not worked, but it should be avoided where possible. This should be used only if your doctor prescribes it.

If used close to your delivery, it can cause your baby to have some temporary difficulties after birth. These include being unsettled or having breathing difficulties, which are known as withdrawal symptoms. If this happens, the hospital team will monitor your baby closely in the days or weeks after birth.

Coughs and colds

Always check the ingredients in cough and cold remedies. Many contain a mixture of ingredients.

You can take:

• A home-made hot honey and lemon drink.
• Paracetamol – always stick to the recommended dose.
• Dextromethorphan – found in many cough syrups. In pregnancy you can take it where it is the only drug in the syrup.
• Simple linctus or lozenges – these contain honey or glycerol to coat your throat.
• Steam inhalations – for a blocked, stuffy nose.
• Nasal sprays- containing only saline fluid (salt water) can be used.

Decongestants – It is not clear whether these are safe during pregnancy, therefore they are not recommended. Only use them if told to by a healthcare professional or pharmacist.

Unfortunately, there are many medications for cold and coughs which are not recommended during pregnancy.

Allergies

You can use:

• Steam inhalations – for a blocked, stuffy nose.
• Nasal sprays which are saline only (salt water) are safe. Speak to your pharmacist if these drug free nasal sprays are not helping. Some containing corticosteroids – such as beclomethasone, can be used for short-term use depending on your stage of pregnancy.
• Cetirizine and Loratadine – These are usually recommended if you need an antihistamine. Please check with a pharmacist before commencing. They should be avoided in the first trimester where possible.
• Chlorphenamine – This can be used if recommended by a doctor in extreme cases but alternatives are preferable.

Heartburn and indigestion

You can use:

• Antacids – often in a tablet form, to help neutralise stomach acid.Do not take products containing sodium bicarbonate or magnesium trisilicate.
• Alginates – usually in liquid form, to relieve indigestion caused by acid reflux (when the acid pushes up from your stomach towards your mouth).

Do not take antacids within 2 hours of taking folic acid or iron supplements. Antacids can stop these supplements from being absorbed.

If your symptoms do not improve, your GP may prescribe omeprazole. Treatment for heartburn and indigestion should only be considered if changes in diet and habits are not relieving symptoms.

What about supplements and herbal remedies?

Many people think that "natural" remedies are always safe. However, this is not always true. Not all natural remedies or complementary therapies are safe in pregnancy.

For some remedies it is not clear if they are safe, so it is best to avoid them completely.

Most herbal medicines and natural remedies can cross from your bloodstream to your baby, just like manmade medicines. You must also be aware that some products may not be high quality, and contain other substances that are not suitable for use during pregnancy.

Some essential oils are also not recommended, or should be avoided until the end of pregnancy.

Always speak with your midwife, GP, or obstetrician before using any supplements or herbal remedies. Tell your practitioner that you are pregnant before discussing any treatment.

When in doubt, always ask a professional

It's really important to get the right advice about any medicine you take. Never start or stop any medication without speaking to a healthcare professional. This includes prescribed medicines, over-the-counter drugs, and herbal remedies.

Always make sure your healthcare professional knows you are pregnant. They can help you make the safest choices for you and your baby.

You can ask for advice from:

• Your GP
• Your midwife
• A pharmacist
• Your obstetrician
• Your dentist