Medicines in pregnancy: what is safe, and who to ask

Pregnancy makes people cautious about medicines, which is reasonable. Unfortunately it often tips into avoiding everything, including treatment that both mother and baby need. Uncontrolled asthma, untreated infection, a seizure or dangerously high blood pressure all carry real risks, and those risks do not disappear because somebody is pregnant.

The sensible position is neither "avoid everything" nor "carry on regardless". It is to check each thing individually, with somebody who has the information.

The first rule: do not stop without asking

If you take a medicine for a long-term condition and discover you are pregnant, do not stop it that morning. Make an appointment and keep taking it until you have spoken to somebody. For epilepsy, diabetes, asthma, thyroid disease, mental health conditions and blood pressure, abrupt stopping is frequently the more dangerous option by a considerable margin.

Where a change is needed, there is usually a well-established alternative with a long record of safe use in pregnancy. Making that change calmly, with monitoring, is a very different thing from stopping suddenly in a panic.

Common complaints, and what is generally used

Paracetamol is the usual first choice for pain and fever in pregnancy, at the lowest dose that works and for the shortest time. Anti-inflammatory painkillers such as ibuprofen are generally avoided, particularly in the third trimester.

Heartburn is extremely common and there are antacids considered suitable; some, however, contain ingredients better avoided, so ask rather than taking whatever is on the shelf. Constipation responds first to fluid, fibre and movement, and then to specific gentle options we can point you to. Nausea in early pregnancy has both non-medicine measures and, where it is severe, treatments that are well studied.

The theme running through all of this is that the answer exists and is usually reassuring, but it is specific to the product rather than the category. That is exactly what a pharmacist is for.

Things to be careful about

• Herbal remedies and traditional preparations, because very few have been studied in pregnancy.
• Supplements containing vitamin A as retinol, including cod liver oil.
• Acne treatments, some of which are seriously harmful to a developing baby.
• Medicines somebody else was prescribed, at any time, for any reason.
• Anything bought online from an unknown source.

"Natural" and "safe in pregnancy" are entirely separate claims, and only one of them is usually supported by evidence. A number of plants have genuine pharmacological activity, which is precisely why some medicines came from them in the first place.

What you should be taking

Folic acid through the first twelve weeks, and iron if it is recommended for you. Many pregnancies in Kenya are also supported with a pregnancy multivitamin, which is sensible provided it is formulated for pregnancy rather than being a general one from the shelf.

Iron tablets commonly cause constipation and dark stools. The dark colour is harmless. The constipation is manageable with fluid, fibre and sometimes a change of preparation, and it is a poor reason to stop something you need.

Infections in pregnancy

Urinary infections are more common in pregnancy and are worth treating promptly, because untreated they can lead to kidney infection and premature labour. Several antibiotics have long, reassuring records in pregnancy and others are avoided, which is why self-treating with a leftover packet is a particularly poor idea here.

The same applies to malaria, which is more serious in pregnancy than outside it. Prevention matters, treatment choices differ, and this is not a situation for guesswork.

Keep one list

Write down everything you take, including supplements and anything occasional, and bring it to every antenatal appointment. Different clinicians see different parts of the picture, and the person holding the whole list is you.

Take to every antenatal appointment

• A written list of everything you take, including supplements.
• Anything occasional, such as painkillers or antacids.
• Any herbal or traditional preparation you have been given.
• Questions about anything you took before you knew you were pregnant.
• Your folic acid and iron, so somebody can check the dose.

Questions we are asked about this

The leaflet says avoid in pregnancy. Does that mean it is harmful?

Usually it means it has not been studied in pregnancy, which is not the same as evidence of harm. Specialist references often reach a much more reassuring conclusion for the same product. Ask before deciding on the basis of the leaflet alone.

I took something before I knew I was pregnant. What now?

Bring in the packet and let us check it rather than worrying. For the great majority of ordinary medicines the answer is reassuring, and knowing that is better than weeks of anxiety.

Are herbal remedies safer because they are natural?

No. Very few have been studied in pregnancy, several have genuine pharmacological activity, and some are known to be unsafe. Natural and tested are separate claims.

Can I treat a urine infection myself?

Please do not. Urine infections are more common in pregnancy and are worth treating promptly and correctly, because untreated they can lead to kidney infection and premature labour. Some antibiotics are suitable in pregnancy and others are avoided.

This article is general information from the Dantrio Pharmacy team. It cannot take the place of advice from a pharmacist or doctor who knows your medical history. If you feel seriously unwell, seek medical help straight away.