Diphenhydramine is widely used in pregnancy as a sedative, an antihistamine, and an anti-nausea drug, although few data confirm its safety during pregnancy. The drug has been shown to have oxytocin-like effects, especially in high dosages. For example, one study 13 showed a significant increase in fetal morbidity when diphenhydramine was taken in combination with temazepam Restoril.
In , the American College of Obstetricians and Gynecologists and the American College of Allergy, Asthma, and Immunology released a position statement 10 regarding the use of asthma and allergy medications, including antihistamines and oral decongestants.
Chlorpheniramine and tripelennamine PBZ were recommended as antihistamines of choice. Pseudoephedrine was recommended as the oral decongestant of choice, based on animal studies and a large prospective human experience with the drug during pregnancy. However, because pseudoephedrine may be associated with gastroschisis and because other choices are available, it may be prudent to avoid using this medication during the first trimester unless the benefit outweighs the risk.
Dextromethorphan has been associated with birth defects in chicken embryos. The Collaborative Perinatal Project 14 monitored 50, pregnant women, of whom were exposed to dextromethorphan in the first trimester. Birth defects did not increase above the baseline rate. Another study 15 of 59 women who had used dextromethorphan in the first trimester documented one malformation.
Thus, sufficient evidence indicates a lack of adverse effects of dextromethorphan use during pregnancy. When used during the first trimester in the presence of a febrile illness, guaifenesin has been associated with an increased risk of neural tube defects. The safety of the various agents is outlined in Table 4. A possible association has been identified between the ingestion of clays containing kaolin and the development of iron deficiency anemia.
Loperamide has not been found to be teratogenic in animals. However, at least one study 4 involving first-trimester exposure in humans showed a possible increase in fetal cardiac malformation. Several antacids are available in OTC forms, including preparations that contain alginic acid, aluminum, magnesium, and calcium. All of these preparations generally are regarded as safe in pregnancy Table 5.
There have been sporadic reports of fetal maldevelopment and injury associated with prolonged use of high dosages of aluminum-containing antacids during pregnancy. Magnesium compounds contain magnesium sulfate, a known tocolytic agent. Despite the minimal magnesium absorption that occurs with antacid ingestion, some clinicians prefer the use of calcium-containing preparations.
Simethicone Mylanta Gas is not absorbed. The histamine H 2 -receptor blockers are effective in treating symptoms of heartburn and gastroesophageal reflux disease in pregnancy, 20 but these drugs readily cross the placenta. Studies of these agents generally have shown significant improvement of symptoms with no significant adverse effects. Animal studies also fail to show an increased fetal risk with the use of these medications in pregnancy, the notable exception being nizatidine Axid.
The OTC doses are one half of the prescription strength. Although studies have indicated that there is probably no increased risk of fetal morbidity or mortality, few studies have evaluated first-trimester use of H 2 blockers. Therefore, most investigators recommend avoiding these drugs in the first trimester. The most common antifungal medications available as OTC drugs include the imidazole agents clotrimazole Mycelex , butoconazole Femstat , miconazole Monistat , and tioconazole Vagistat Table 6 23 , 24 describes the safety of various OTC antifungal agents in pregnancy.
One of the largest studies 24 to date investigated the teratogenicity of clotrimazole. The population-based, case-control study of 18, case pregnancies and 32, control pregnancies did not show an association between fetal malformations and the use of clotrimazole.
Several small trials have indicated that butoconazole and miconazole are likely to be safe during the second and third trimesters. Insufficient data are available regarding the safety of tioconazole in pregnancy. Many clinicians use oral fluconazole Diflucan to treat vulvovaginal candidiasis. A study 26 of women exposed to fluconazole during the first trimester of pregnancy revealed that patients taking fluconazole were no more likely than unexposed control patients to experience miscarriage, stillbirth, or congenital anomalies.
Ketoconazole Nizoral , flucytosine Ancobon , and griseofulvin Grisactin may be teratogenic or embryotoxic in animals. The Centers for Disease Control and Prevention recommends using only topical vaginal antifungal agents including butoconazole, clotrimazole, miconazole, and the prescription medications terconazole [Terazol] and nystatin [Mycostatin] in pregnancy. Nicotine replacement therapy presents an interesting clinical dilemma.
Researchers believe that nicotine and its metabolic byproduct, cotinine, are harmful to the developing fetus because smoking is known to cause harmful fetal effects, including intrauterine growth retardation, premature birth, hyperviscosity in the newborn, spontaneous abortion, fetal neurotoxicity, and pulmonary defects, and an increased risk of sudden infant death syndrome.
The primary mechanism of these deleterious effects is believed to be uteroplacental insufficiency. Reduced perfusion of oxygenated blood through the placenta at various stages of development may cause the various manifestations of fetal maldevelopment and injury. Safe in second and third trimesters human trials , 24 first trimester probably safe Information from Lagace E. Safety of first trimester exposure to H 2 blockers. No teratogenic effect after clotrimazole therapy during pregnancy.
Epidemiology ;— Physicians should educate pregnant patients about the harmful effects of smoking to themselves and the developing fetus, and help these patients develop a plan for smoking cessation. The safety of nicotine replacement products in pregnancy has not been adequately studied. However, smoking is likely to be more harmful than nicotine replacement therapy, particularly because cigarette smoke contains more than 3, different chemicals that can potentially harm humans, and one of the main components of cigarette smoke is carbon monoxide, a known fetal toxin.
Therefore, it is reasonable to consider the use of nicotine replacement products in patients who cannot maintain smoking abstinence without pharmacologic intervention. If pregnant women require nicotine replacement to quit smoking, the amount of nicotine administered should be minimized as much as possible while still maintaining efficacy.
Until further research is available, physicians should consider recommending the intermediate-release nicotine preparations nicotine gum, nicotine spray, and nicotine inhaler rather than the continuous-release method nicotine patches. Already a member or subscriber? Log in. Interested in AAFP membership? Learn more. He recently completed a fellowship in family practice obstetrics at Florida Hospital, Orlando.
Address correspondence to D. Ashley Hill, M. Rollins St. Reprints are not available from the authors. The authors indicate that they do not have any conflicts of interest. Sources of funding: none reported. Jacobs LR. Prescription to over-the-counter drug reclassification. Am Fam Physician. Toxic effects on the female reproductive system during pregnancy, parturition, and lactation.
In: Witorsch RJ, ed. Reproductive toxicology. New York: Raven, — Wilson JG. Pregnancy-safe medications When it comes to taking medication during pregnancy, it's best to keep these things in mind: Take the smallest effective dose, and never take more than the recommended dose.
Read the label and check with your healthcare provider to confirm dosage information. Ask your provider how long it's safe for you to take the product. Some medications aren't safe to take long term during pregnancy. Never discontinue a medication that you've been prescribed without talking with your healthcare provider first.
Cough drops Vicks VapoRub Not safe to take: Cold remedies that contain alcohol The decongestants pseudoephedrine and phenylephrine, which can affect blood flow to the placenta Pain relief, headache , and fever Acetaminophen Tylenol Note that many combination medications contain acetaminophen. Where can I learn more about safe medicines during pregnancy?
Learn more: Is it safe to take herbal sleep remedies while I'm pregnant? Is it safe to take antibiotics during pregnancy?
Pregnancy medicine cabinet checklist Is it safe to take ibuprofen during pregnancy? Sources BabyCenter's editorial team is committed to providing the most helpful and trustworthy pregnancy and parenting information in the world.
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