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Family Health Magazine
PHARMACY CARE

Using OTC Medication during Pregnancy
Making informed decisions keeps your baby safe

Along with the joy and excitement of being pregnant come discomforts and complaints. Pregnant women use over-the-counter (OTC) medication to cope with problems more often than prescription drugs. OTC drugs are easy to buy. Since they are available without prescription, they may not seem like medication. Herbal products, being ‘natural,’ may also appear harmless. Even medicated creams can get into the mother’s bloodstream. All of these are medications. While many products are safe during pregnancy, some are not.

Many medications, whether prescription or over the counter, can harm a pregnancy. The greatest risk of malformation to your unborn baby comes between 18 and 60 days after conception. Avoid all drugs during this time unless your prenatal care provider tells you otherwise. Even later in pregnancy, medications can affect your baby’s growth and behaviour.

If you can, try to care for yourself without using medications. Pharmacists, doctors and midwives are a valuable source of information. They can recommend various safe options to help you feel better.

If you are considering an OTC medication, it is essential to talk with your pharmacist, doctor or midwife. These professionals can help you to make an informed decision. They can suggest the most effective medication and the lowest possible dose to take for the shortest possible amount of time. Sometimes an option might be a local application of the medication that will not affect the unborn baby.

Morning sickness

Many women feel nauseous during pregnancy, especially during the early months. Although it may be normal, the symptoms can be a nuisance.

• Eat smaller meals with carbohydrates, such as pasta, bread or crackers.
• Separate the liquids and solids of your meal rather than having them together.
• Avoid eating fatty foods.
• Try to eat before the usual time that nausea strikes.
• Ask your partner or a friend to cook meals. Nausea can come from the smell of some foods.
• Try using Sea Bands™. These wristbands use pressure points on the wrist to reduce nausea.
• Drink plenty of fluids, keep stress levels down and get plenty of rest.

Pregnant women should not treat themselves with any over-the-counter medication for nausea as these drugs may not be safe to use during pregnancy. If the suggestions above do not work, ask your doctor for advice. Sometimes 50 milligrams of vitamin B6 taken at bedtime helps. One prescription drug, Diclectin™, is completely safe to take in pregnancy.

Heartburn and gas

Pregnant women go through a lot of changes, including hormone changes and an expanding uterus. Stomach acid irritation, heart burn and gas can result.

• Do not smoke or drink alcohol. Pregnant women should not do either, whether they experience heartburn or not.
• Try smaller and more frequent meals rather than three regular meals a day.
• Eat slowly and stay upright after meals. Avoid slouching or bending after meals.
• Avoid foods that can cause heartburn and gas, like spicy foods, chocolate, caffeine, fatty foods, and carbonated beverages.
• Wear loose clothing.
• Avoid eating immediately before bedtime.
• Elevate the head of your bed by placing four to six inch bed blocks under the bed legs at the head of the bed.
• Do not chew gum.

Although most OTC antacids are safe to use during pregnancy, check with your doctor. The best time to use antacids is about half an hour after eating. Keep in mind that products containing aluminum can constipate, while those with magnesium can cause diarrhea. An antacid that combines both aluminum and magnesium may prevent a change in bowel habit.

Products containing calcium carbonate can also be safe but may cause constipation. Do not use any products that have sodium bicarbonate or acetylsalicylic acid, such as Aspirin™. Products with alginic acid are designed for the type of heartburn that feels like something is coming back up. Zantac™and Pepcid™ should only be used under the supervision of your doctor.

Simethicone is a silicone product in anti-gas medicines. It is not absorbed into the bloodstream. It can be used to help treat gas temporarily.

Hemorrhoids and constipation

A pregnant woman is more likely to get hemorrhoids than someone who is not pregnant. Expectant mothers often get constipated. Straining to have a bowel movement can result in hemorrhoids. The best prevention is to eat a diet high in grains, vegetables and fruits to encourage regular bowel movements. Develop good bowel habits.

In particular, avoid straining by going to the bathroom when the urge first occurs.

• Increase the fibre in your diet.
• Drink plenty of water.
• Avoid spicy and fatty foods.
• Eat high protein foods in the evening.
• Maintain an active lifestyle that includes exercise.
• Avoid straining or lifting heavy weights as these increase back pressure in the rectal veins.

You might try a stool softener or a glycerine suppository to help with constipation, but do not use it on an ongoing basis. Stay away from the following laxatives:

• mineral oil as it can rob your baby of necessary vitamins
• stimulant laxatives, including castor oil, which may make the uterus contract or cause severe bowel pain.

The best types of products to use are bulk-forming laxatives that contain methylcellulose or psyllium. If you develop hemorrhoids during pregnancy, consult your doctor before using any OTC drugs. A sitz bath can relieve irritation in the rectal area and petroleum jelly (such as Vaseline™) may be soothing.

Diarrhea

Hormone changes can cause diarrhea. Excess diarrhea may be a signal that the pregnancy is at risk. Consult your doctor if diarrhea is very frequent (more than three times in a day), watery, bloody, mucousy or accompanied by a fever.

If you are experiencing diarrhea, remember to take enough fluids to prevent dehydration. Simple carbohydrate foods like bread, pasta, and low fat foods may be helpful. Avoiding dairy products for 24 to 48 hours is often advised.

OTC medications to stop diarrhea should not be used unless absolutely necessary. If you must use one, a local acting agent containing attapulgite is appropriate. Bulk forming laxatives containing psyllium may help control diarrhea by helping form stool.

Colds and allergies

Common colds and allergies can affect pregnant women just as in anyone else. However, it is best not to use medication to treat symptoms until you have talked with your doctor.

• Get plenty of rest.
• Drink lots of fluids.
• Avoid stress.
• Try saltwater gargles for sore throats.
• Avoid the allergen whenever possible to prevent allergy symptoms
• Use nasal saline drops for nasal congestion.

The cough suppressant dextromethorphan (DM) can be used in pregnancy but only after discussion with a doctor. Codeine is another possibility, but again only if your doctor agrees. Only consider these medications if the benefit outweighs the risk to the unborn baby.

Read labels carefully when choosing any medications. Some liquid medications may contain ethanol. Consult your pharmacist if you are unsure.

If you have nasal congestion, avoid oral decongestants, especially in the first trimester. A nasal spray decongestant is a better choice, if an inhaled saline nasal spray does not work. Use it sparingly and for no more than three days. Lozenges may be used as long as you do not have diabetes. You should discuss with your prenatal care provider if you require antihistamines.

Pain

Everyone knows the pain of headaches and muscle aches. Pregnant women are no exception. The strain of carrying a baby can cause backaches and muscle aches as well. Low back pain similar to menstrual pains can be a sign of preterm labour and requires attention by your prenatal care provider.

• Exercise.
• Massage areas that are painful.
• Relieve headaches with a cool cloth on your forehead.
• Straighten your posture.
• Relax.
• Increase calcium intake by drinking milk. This may help prevent painful muscle cramps.

Analgesics (pain killers) should not be used unless necessary. If you must use an analgesic, acetaminophen is the drug of choice. Avoid products containing acetylsalicylic acid (ASA) or non-steroidal anti-inflammatory drugs like ibuprofen. These may interfere with the baby’s kidney function or cause premature closing of the fetal arteries.

Insomnia

Due to various discomforts of pregnancy, many women find it hard to sleep.

• Avoid caffeine.
• Follow a regular sleep routine and relax before going to bed.
• Do light exercise during the day along with yoga or stretching.
• Keep the bedroom dark and quiet and try not to have it too cold or too hot.
• Drink warm milk before bedtime.

OTC sleeping pills are not recommended if you are pregnant. Many of them are antihistamines with sedating effects.

Acne

Hormone changes during pregnancy can cause acne. There are a few ways to control it.

• Eat a healthy diet and exercise regularly.
• Wash your face regularly with a gentle cleanser.
• Use oil-free make up.

You should not use acne care products with vitamin A if you are pregnant. Pregnant women can try topical (skin) preparations with benzoyl peroxide, but check with the doctor first.

Foot care

More pressure is put on the feet with the added weight of carrying a baby. Corns and calluses may develop.

• Be sure your footwear does not put any friction or pressure on your foot.
• Padding may be used to cover a corn and prevent further rubbing.
• Consider a pedicure by a skilled provider.

You may use topical preparations containing salicylic acid to treat corns and calluses until the third trimester of pregnancy. After that, avoid them.

Eye care

The hormone changes of pregnancy may make eyes dry. However, using OTC eye drops containing a decongestant to get rid of redness is not recommended. Saline eye drops or artificial tears may be used safely and frequently. Ask your pharmacist about which brands contain just artificial tears.

Vaginal infections

Pregnant women are more at risk for yeast infections. You must be sure that the infection is yeast and not something else more serious in pregnancy.

• Include more yogurt in your diet. Yogurt contains a bacterium called lactobacillus that may help prevent yeast infections.
• Reduce the amount of sugar in your diet.
• Avoid douching.
• Wear cotton clothing and avoid tight fitting clothes that do not allow air to circulate well.

OTC yeast treatments are safe to use. When clotrimazole and miconazole are applied to the vagina, absorption is minimal. However, confirm a vaginal infection with your doctor before treating it again.

Skin pigmentation

Hormone changes during pregnancy may darken some areas of the skin. Using a sunscreen to protect against the sun’s rays will reduce pigmentation changes. Although a two per cent

hydroquinone cream can help, there is no evidence of its safety in pregnancy. It is best to wait until after the birth, so the cream can be applied without worry.

Lice

If a pregnant woman gets lice, alternative measures can control but will not kill them.

• Wash all clothing and bedding in hot water and dry in the dryer for 20 minutes.
• Dry-clean other articles or store them in a plastic bag for two weeks.
• Vacuum all carpets and furniture.
• Soak combs and brushes in a two per cent solution of Lysol for one hour.
• Backcomb hair towards the scalp to remove nits.
• Iron the seams of clothing, as some types of lice live in these seams.
• Apply petroleum jelly (Vaseline™) to lice in the eyelashes. This will suffocate them.

For pregnant women with lice R & C™ (pyrethrin with piperonyl butoxide) or Nix™ (permethrin) may be used but with your doctor’s advice. If you have allergies to ragweed or chrysanthemum, avoid these products and ask your doctor for suggestions. Do not apply these more than twice during a pregnancy. Other products are not recommended for use during pregnancy.

Pin worms

If a pregnant woman gets pin worms, she must consult her doctor. Even though it may be uncomfortable, she should not treat this condition by taking OTC medications.

• Keep fingernails short to avoid scratching the rectal area.
• Avoid re-infestation by washing hands well.
• Wash all clothing, bedding and towels thoroughly.
• Talk with your doctor about breaking the pin worm life cycle without medication.

If you are pregnant, it is best to avoid any unnecessary drugs to reduce the chance of harming your baby. There are many medical conditions, such as asthma and depression, that are a greater risk to the pregnancy than the medications used to treat them. If you must use a medication, carefully consider the advice of your prenatal care provider and pharmacist. Weigh the risks and benefits before you decide to go ahead.