Pregnant Women and Over-the-Counter Drugs
Health spoke to Dr. Craig V. Towers, who is board-certified in obstetrics, gynecology and maternal-fetal medicine (perinatology). Towers, who practices at Long Beach Memorial Medical Center, wrote the 1999 book “I’m Pregnant & I Have a Cold, Are Over-the-Counter Drugs Safe to Use?”
Question: What’s the most common misconception that pregnant women make about over-the-counter drugs?
Answer: One thing many people don’t realize is that an over-the-counter pill may contain several active ingredients. A pill to unclog a stuffy nose, for instance, may contain three such ingredients, only one of which you need, while its other active ingredients may not be appropriate for certain pregnant women. Also, a drug may contain inactive ingredients such as sugar, sugar substitutes and alcohol. A diabetic, for instance, needs to know if a medication contains sugar.
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Q: How do you isolate the needed ingredient and bypass the rest?
A: A woman should write down her symptoms--such as itchy, watery eyes, sinus pressure, a runny nose--and talk to her health care provider or pharmacist to find out what kind of active ingredient is needed for those symptoms. That way the provider can recommend medication to relieve those symptoms and nothing more. Many pills contain a decongestant as well as an antihistamine, for instance, and decongestants are a category of over-the counter drug that pregnant women need to be very careful about.
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Q: Why?
A: Decongestants can increase blood pressure, affect blood sugar, cause the uterus to contract (affecting women at risk for premature labor) and have adverse affects on women suffering from diabetes, high blood pressure and toxemia. A pregnant woman shouldn’t take a decongestant unless she’s spoken to her doctor first. Antihistamines, by contrast, are relatively safe. They can be sedating and make you tired, so you need to be careful not to mix them with other sedating products. But as a whole, they’re not as concerning as decongestants.
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Q: What are some other common pitfalls?
A: There’s a big push today to make sure you’re taking enough folic acid to minimize spinal defects, but it’s very important that pregnant women don’t achieve that level by taking extra multivitamins, because then they could get too much Vitamin A, and that can cause birth defects of the brain, heart and face. Some health food megavitamins have too much vitamin A for pregnant women, up to 20,000 IU. Most reports recommend 5,000 IU. As for folic acid, we’re not aware of any toxicity from it. Many prenatal vitamins already contain a milligram or 1 milligram. Some studies say up to 4 milligrams daily is OK. The point is, if you want to supplement your folic acid, buy folic acid pills, don’t up your consumption of multivitamins. And since most spinal birth defects occur before a woman knows she’s pregnant, even women contemplating pregnancy may want to take folic acid and not take extra multivitamins.
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Q: What about acetaminophen versus other pain killers?
A: The pain medication of choice in pregnancy is acetaminophen, which is found in drugs such as Tylenol. But too much acetaminophen at one time can cause liver damage in mother and baby. Aspirin and drugs we call non-steroidal anti-inflammatories such as Advil are acceptable to use but not regularly. If you had a headache and acetaminophen didn’t work, you could take two Advil, but not every day, because it could decrease amniotic fluid around the baby. The amniotic fluid is primarily made by a baby’s kidneys, and anti-inflammatories can temporarily decrease production of that fluid. Also, aspirin, if used near delivery, can lessen the ability of blood to clot.
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Q: These days, almost any over-the-counter medication urges pregnant women to consult with a doctor before using. Why such strict labeling?
A: If there is a problem with the baby or a birth defect, the drug companies can be sued by parents who say over-the-counter drugs caused the problem. So it’s basically telling the consumer not to use anything until you talk to your doctor.
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Q: Can over-the-counter drugs really cause birth defects?
A: The majority of birth defects are genetically related. The risk with over-the-counter drugs is not so much for birth defects as for other medical conditions. They can affect blood pressure, decrease the amount of amniotic fluid around the baby, alter blood flow and affect labor.
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Q: What about some other common over-the-counter drugs, such as cough suppressants, expectorants, sleeping aids?
A: The cough suppressants that seem most effective are related to narcotics. Codeine, which is currently available in 10-milligram doses in 33 states [but not California], is OK if it’s used for three or four days. It’s mainly a problem if it’s used continually, due to the risk of addiction. Studies with pregnant women using Dextromethorphan don’t show any human problems. That’s often labeled as DM, such as Robitussin-DM. With expectorants, there’s only one FDA-approved one, and that’s Guaifenesin, which is OK to use in pregnancy. As for sleeping aids, the over-the-counter ones are antihistamines in disguise, so technically they’re OK. The concern comes if you double up on the medication without realizing it. For instance, you take Benadryl for allergies, which is an antihistamine, and then you’re having trouble sleeping so you take an over-the-counter medication that also contains antihistamine. Another example is if you take a cold pill with Tylenol in it and then you have a headache so you take more Tylenol.
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Q: OK, now I’ve had the baby and I’m nursing. Am I off the hook?
A: No. A lot of over-the-counter medications are found in breast milk. Often the amount is small, so the effect on the baby is minimal. But some medications can cause the baby to be irritable and fussy, such as moderate to heavy use of decongestants and antihistamines.
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Q: What about herbal medicines?
A: In a nutshell, herbal medications are drugs, and they do things to you. We know even less about those than over-the-counter drugs. We have to remember that just because it’s natural doesn’t mean it’s safe.
