Brandel France de Bravo, MPH, Krista Brooks, BS
If you are pregnant or a breastfeeding mom, you probably have questions about which medications are safe for you to take and which could possibly harm your baby. Sometimes doctors don’t realize how a medicine can be harmful to a baby in the womb until after many babies have been born with problems. For instance, in the late 1950s and early 1960s, the drug thalidomide was prescribed for pregnant women to prevent morning sickness for years before doctors realized that the drug caused many babies to be born with deformed arms and legs. The fact that it took so long to recognize the link between the drug and the birth defects is surprising, given how unique the deformities were. It is often true that the effects of a medicine that a mother took while pregnant do not become apparent until long after the baby is born.
While that sounds frightening, it’s important to remember that many pregnant or breastfeeding moms take medications for a wide range of health conditions-from managing chronic illnesses to getting an annual flu shot or curing headache pain-without any negative effects.
If you are pregnant or breastfeeding and are planning to take a medication or get a vaccine, it’s important to learn more about the possible risks and to discuss any potential side effects with your health provider. Women taking herbal supplements or vitamins (other than recommended prenatal vitamins) should keep in mind that these products have not been tested on pregnant women, so potentially harmful effects on fetal development are unknown.1 It is also important to understand that your doctor may not know exactly what the risks are of certain medications, whether prescription medications or those available over-the-counter, because those risks might not have been determined, or because the possible risks might not be known by most doctors.
In addition, pregnant women’s bodies react differently to medications than women who are not pregnant. This means that medicines that you used to take may no longer be effective when you are pregnant or that the dose must be adjusted. Sometimes an alternative medication with less harmful effects can be taken for the same illness or health problem.
Experts are in the process of gathering information about the ways certain drugs can affect pregnant women and their developing babies. Some drugs have been studied more carefully than others. It would be unethical to expose women to prescription drugs with unknown side effects in research studies, unless the women made an informed choice to participate in such studies. National Pregnancy Exposure Registries have been established by various medical institutions to keep track of mothers who, in consultation with their doctors, decided to take specific medications and the health outcomes of their babies. These registries are important because they provide more information on medications and their potential risks to you and your baby’s health.
Common Medications to Avoid While Pregnant
Some common medications have already been proven to be harmful to both mother and baby when taken during pregnancy. For example, if you are pregnant, you may want to avoid common over-the-counter medications such as ibuprofen (Advil, Motrin), naproxen (found in Aleve), and aspirin. These medications may cause decreased blood flow to the fetus when taken during the last 3 months of pregnancy (3rd trimester). Aspirin, in particular, has been shown to increase the risk of bleeding problems during labor.2 Pregnant women with a stomach ache should NOT take bismuth subsalicylate (Pepto Bismol).3 If you have a cough, Mucinex, Robitussin, and other medications containing guaifenesin can increase the risks of neural tube defects in infants if taken during the first trimester of pregnancy.4 Some prescription drugs such as Accutane (commonly used for acne) or Topamax (helps with migraines or epileptic seizures) should not be taken at any time during pregnancy due to serious birth effects.5,6
Depending on your ailment, there may be a safe alternative. While many common pain-relief medications pose risks, acetaminophen (Tylenol) is usually considered safe. However, it is best to first consult a doctor.
Can I Take Medications While Breastfeeding?7
Some women decide not to breastfeed because they are worried that medications that they must take for chronic conditions or pain will be passed on to their nursing infant through breast milk. Fortunately, there are many medications that are not passed through breast milk or have limited to no side effects on infants. Sometimes women are able to reduce the amount of medicine in breast milk by breastfeeding just before taking it.
Two helpful rules of thumb are: 1) if the medicine is one that infants are sometimes prescribed, then the amount your baby will receive through your breast milk should not be of concern as it will be far less than an infant dose of that same medicine; and 2) avoid using extra strength or time-released versions of the medicine you need to take because these will stay in your body longer and therefore have a greater chance of being in your breast milk.
Breastfeeding women should avoid aspirin and products containing aspirin (this includes Pepto Bismal taken for an upset stomach), as well as products containing naproxen (Aleve). In contrast, acetominophen (Tylenol) and ibuprofin (Motrin, Advil) are not known to have any negative effects on nursing babies. 8
Breastfeeding women should not take any contraceptives (birth control) containing estrogen, although progestin is fine. (Regular and very frequent breastfeeding reduces but does not eliminate the chances of getting pregnant.)
Postpartum depression, which lasts longer and is more serious than the “baby blues,” can affect a mother’s ability to care for her newborn. New mothers who suffer from depression and want to breastfeed their baby should first try psychotherapy or “talk therapy.” Cognitive behavioral therapy is especially effective for depression. If cognitive behavioral therapy doesn’t start to help reduce the depression within eight weeks and the woman is continuing to breastfeed, she should talk to her doctor about which antidepressant medication poses the fewest risks to her nursing baby. Medications such as Zoloft and Paxil, both of which are SSRIs (selective serotonin reuptake inhibitors), are considered somewhat safer than other SSRIs and other antidepressants, because only very low levels are found in breast milk.9 It’s important to remember, though, that no studies have looked at what health problems, if any, a person whose mother took antidepressants while breastfeeding might develop.
The older a medication is, the more likely we are to know if there are negative effects on a breastfeeding baby.
How to Learn More
To learn more about medications that might affect mothers and their children during pregnancy or breastfeeding and to find National Pregnancy Exposure Registries where you have the opportunity to help other pregnant or breastfeeding moms, please view the links listed below provided by the FDA’s Office of Women’s Health.
Click on the link above to get to the section of the FDA website where you can find a list of studies that include pregnant women who are taking medicines or getting vaccines. You can join by health problem (such as autoimmune diseases or cancer) or by medicine (the list includes medicines for diabetes, migraines and many other conditions).
Click on the link above or you can call OTIS’ toll-free hotline at (866) 626-6847 (8:30am to 3:30pm EST). OTIS provides free medical consultation about prenatal exposures to drugs, medications, and chemicals. OTIS has centers throughout the U.S. and in Canada that provide these consultations and also conduct studies on the effect that drugs, medications, chemicals, and other exposures may have on the fetus. The Website publishes fact sheets on various exposures of concern, including medications.
Click on the link above to visit LactMed, a database of drugs and other chemicals which breastfeeding mothers may be exposed to. Lactmed is part of the Toxicology Data Network (TOXNET® and NIH’s National Library of Medicine(NLM). The database includes relatively technical information about the levels of such substances in breast milk and infant blood, and the possible adverse effects on the nursing infant.
1 U.S. Department of Health and Human Service, Food and Drug Administration. (2010). Medicine and Pregnancy. Retrieved from http://www.fda.gov/ForConsumers/ByAudience/ForWomen/ucm118567.htm
2 Black, R, and Hill, A. (2003). Over-the-counter medications in pregnancy. American Family Physician, 67(12), Retrieved from http://www.aafp.org/afp/2003/0615/p2517.html
3 Mahadevan, U, and Kane, S. (2006). American gastroenterological association institute medical position statement on the use of gastrointestinal medications in pregnancy. Gastroenterology, 131. Retrieved from http://www.sciencedirect.com/science/article/pii/S001650850600864X
4 Black, R, and Hill, A. (2003). Over-the-counter medications in pregnancy. American Family Physician, 67(12), Retrieved from http://www.aafp.org/afp/2003/0615/p2517.html
5 CDC. Accutane-Exposed Pregnancies-California, 1999. MMWR 2000; 49(02);28-31 Retrieved from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm4902a2.htm
6 U.S. Department of Health and Human Servce, Food and Drug Administration. (2011). Topamax (topiramate): label change – risk for development of cleft lip and/or cleft palate in newborns Retrieved from http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm245777.htm
7 Spencer, J, Gonzales III, L, and Barnhart, D. (2001). Medications in the breast-feeding mother. American Family Physician, 64(1), Retrieved from http://www.aafp.org/afp/2001/0701/p119.html
8 American Academy of Pediatrics, Committee on Drugs. (2001).The Transfer of Drugs and Other Chemicals into Human Milk. Pediatrics, 108(3): 776-789. http://aappolicy.aappublications.org/cgi/content/full/pediatrics;108/3/776
9 Academy of Breastfeeding Medicine Protocol Committee. ABM clinical protocol #18: Use of antidepressants in nursing mothers. Breastfeed Med 2008 Mar;3(1):44-52. http://www.guidelines.gov/content.aspx?id=13409