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Pain Medications[edit]
The most common over-the-counter pain relieving medications include aspirin, acetaminophen (Tylenol), and non-steroidal inflammatory drugs (NSAIDs), which include naproxen (Aleve), ibuprofen (Motrin), among others. The safety of these medications vary by class and by strength. [1]
Usage of aspirin has not demonstrated increased risk of spontaneous abortion within the early weeks of pregnancy. However, its usage during organogenesis and the third trimester can lead to elevated risk of intrauterine growth retardation and maternal hemorrhage.[2]
Ibuprofen and naproxen have not frequently been studied during pregnancy, but recent studies do not show increased risk of spontaneous abortion within the first six weeks of pregnancy.[1] [2] However all NSAIDs showed association with structural cardiac defects with usage during the early weeks of pregnancy. When ibuprofen and naproxen are used within the third trimester there is a significant increase in the risk of premature closure of the ductus arteriosus with primary pulmonary hypertension in the newborn. [2] Between the lack of studies of the effect of ibuprofen and naproxen on pregnancy, it recommended to not take these medications or to use them sparingly per doctor recommendations. [1]
Acetaminophen can be used throughout pregnancy. There is no established association with teratogenicity or elevated occurrence of birth defects and the usage of acetaminophen at any point during a pregnancy. [2] However there is potential for fetal liver toxicity in cases of maternal overdose, where the mother consumes more than the recommended daily dose.[3]
Antihistamines[edit]
Antihistamines can be split into first and second generation categories. First generation antihistamines can include diphenhydramine (Benadryl), chlorpheniramine, hydroxizine, and doxepin. [4] Second generation antihistamines include loratadine (Claritin), cetrizine (Zyrtec), and fexofenadine (Allegra).[2] Antihistamines often are used in early pregnancy for the treatment of nausea and vomiting along with symptoms of asthma and allergies.First generation antihistamines have the ability to cross the blood-brain barrier which can result in sedative and anticholinergic effects while effectively treating allergic reactions, nausea and vomiting of pregnancy. On the other hand second generation antihistamines do not cross the blood-brain barrier, thus eliminating sedating effects. Currently there is a lack of association between prenatal antihistamine exposure and birth defects.[5]
Decongestants[edit]
Decongestants are often used in conjunction with cold medications or to combat pregnancy rhinitis in pregnant women. Common decongestants include pseudoephedrine and phenylephrine. [1] Pseudoephedrine is an alpha-adrenergic receptor agonist that enacts a vasoconstrictive effect to reduce airflow resistance in the nasal cavity and allow easier breathing by relieving a stuffy or congested nose. When taken in early trimesters there has been limited evidence to associate pseudoephedrine with birth defects. However, studies often found it difficult to isolate pseudoephedrine's involvement, due to the variety of combination products that contain pseudoephedrine in conjunction with other medications.[3] Since pseudoephedrine activates alpha adrenergic receptors, it has the ability to elevate blood pressure and cause vasoconstriction within the uterine arteries. This can negatively affect blood flow to the fetus. [1] Due to the lack of studies, decongestants in combination drugs or isolated forms are suggested to be used sparingly during pregnancy. Saline nasal sprays among other non-pharmacological treatments are considered to be safe alternatives for decongestants. [2]
Antacids[edit]
Heartburn is a common symptom of late term pregnancy where up to 80% of pregnant women have experienced it by the end of their third trimester.[2] Heartburn often indicates the development of gastroesophageal reflux disease (GERD), where the lower esophageal sphincter relaxes due to elevated progesterone levels causing the increased frequency and severity of gastric reflux or heartburn. If heartburn appears after 20 weeks gestational age or is severe and persistent, this can indicate other conditions including HELLP syndrome and preeclampsia.[6]
Common antacid include aluminum hydroxide/magnesium hydroxide (Maalox) and calcium carbonate( Tums). Histamine H2 blockers and proton pump inhibitors, such as omeprazole (Prilosec) can also be used to help relieve heart burn, with no known teratinogenic effects or congenital malformations.[2] Aluminum hydroxide/magnesium hydroxide and calcium carbonate when consumed do not cross the placenta and are regarded as safe pharmacological options to treat heartburn, since there are no significant association maldevelopment or injury to fetus.[1]
Ginger and acupressure are common non-pharmacological options used to treat nausea and vomiting as alternatives to antacids, histamine H2 blockers, and omeprazole[7]. Lifestyle modifications are often recommended as well. Recommended modifications can include avoiding fatty food, reducing size and frequency of meals, and reducing caffeine intake.[8]
Antidiarrheal[edit]
Diarrhea is not a common symptom of pregnancy, however it can occur as a result of reduced gastric acidity and slowed intestinal motility.[9] Bismuth subsalicylate (Pepto-Bismol), loperamide (Imodium), atropine/diphenoxylate (Lomotil) are antidiarrheal agents that can be used to treat diarrhea, however not all of them are safe to use during pregnancy. Since one of the components of bismuth subsalicylate is salicylate there is an increased risk for intrauterine growth retardation, fetal hemorrhage, and maternal hemorrhage within organogenesis and the second/third trimester, due to salicylate's ability to cross the placenta.[2] Loperamide has limited data on the impact it has in pregnancy, but there is association with cardiovascular malformation in the first trimester. [1][2] Atropine/diphenoxylate currently has insufficient evidence of teratogenicity in humans, but trials with animals showed evidence of teratogenic effects. [1]
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- ^ a b c d e f g h Black, Ronald A.; Hill, D. Ashley (2003-06-15). "Over-the-Counter Medications in Pregnancy". American Family Physician. 67 (12): 2517–2524. ISSN 0002-838X.
- ^ a b c d e f g h i j Servey, Jessica; Chang, Jennifer G. (2014-10-15). "Over-the-Counter Medications in Pregnancy". American Family Physician. 90 (8): 548–555. ISSN 0002-838X.
- ^ a b Chambers, Christina (2015-11-01). "Over-the-counter medications: Risk and safety in pregnancy". Seminars in Perinatology. Medications in Pregnancy and Lactation. 39 (7): 541–544. doi:10.1053/j.semperi.2015.08.009. ISSN 0146-0005.
- ^ Fein, Michael N.; Fischer, David A.; O’Keefe, Andrew W.; Sussman, Gord L. (2019-10-01). "CSACI position statement: Newer generation H1-antihistamines are safer than first-generation H1-antihistamines and should be the first-line antihistamines for the treatment of allergic rhinitis and urticaria". Allergy, Asthma, and Clinical Immunology : Official Journal of the Canadian Society of Allergy and Clinical Immunology. 15. doi:10.1186/s13223-019-0375-9. ISSN 1710-1484. PMC 6771107. PMID 31582993.
{{cite journal}}: CS1 maint: unflagged free DOI (link) - ^ Gilboa, Suzanne M.; Ailes, Elizabeth C.; Rai, Ramona P.; Anderson, Jaynia A.; Honein, Margaret A. (2014). "Antihistamines and Birth Defects: A Systematic Review of the Literature". Expert opinion on drug safety. 13 (12): 1667–1698. doi:10.1517/14740338.2014.970164. ISSN 1474-0338. PMC 4474179. PMID 25307228.
- ^ Gregory, David S.; Wu, Velyn; Tuladhar, Preyasha (2018-11-01). "The Pregnant Patient: Managing Common Acute Medical Problems". American Family Physician. 98 (9): 595–602. ISSN 0002-838X.
- ^ Festin, Mario (2014-03-19). "Nausea and vomiting in early pregnancy". BMJ Clinical Evidence. 2014. ISSN 1752-8526. PMC 3959188. PMID 24646807.
- ^ Vazquez, Juan C (2010-08-03). "Constipation, haemorrhoids, and heartburn in pregnancy". BMJ Clinical Evidence. 2010. ISSN 1752-8526. PMC 3217736. PMID 21418682.
- ^ Giddings, Stanley L.; Stevens, A. Michal; Leung, Daniel T. (2016). "TRAVELER'S DIARRHEA". The Medical clinics of North America. 100 (2): 317–330. doi:10.1016/j.mcna.2015.08.017. ISSN 0025-7125. PMC 4764790. PMID 26900116.