Which over-the-counter medications and supplements are safe during pregnancy?

Many health complaints can arise during pregnancy due to the many weird and wonderful body changes that come with bringing life into the world. You'll want to be extra cautious during this period as many medicines can cross the placenta and reach the baby, potentially impacting its development.

Before taking any medicine, knowing which may be safe and unsafe to take during pregnancy is essential. This can depend on the stage of the pregnancy, and it's always best to speak to your doctor about any lifestyle changes you can implement to deal with the health issue before turning to medicine or supplements. Discuss with them anything to do with dosages as well as whether or not the medication is safe for your pregnancy stage, and your health.

The same goes for supplements and vitamins. Some of these, while considered natural, may not be safe. Then some are specifically formulated for pregnancy. You may have a condition for which you are already taking medication, so it's essential to discuss with your doctor whether you should continue. This will most likely involve debating the risks and benefits of doing so. Ask as many questions as possible about medicines you are considering taking.

In this article, we discuss some common medications and supplements people may consider taking while pregnant. We spoke to Liz Wilkes, a midwife of 28 years and Managing Director of My Midwives, about the general safety of these common remedies during pregnancy.

Panadol is a popular medicine people turn to for pain relief. During pregnancy, you can use Panadol to reduce fever and relieve headaches or other body aches and pains that come with carrying a growing baby. 

Wilkes says Panadol or paracetamol is the safest of all drugs in pregnancy. "It is the only true category A drug which means that there are no negative impacts on the baby. Of course, normal safety precautions and maximum drug dosages still apply."

Acid reflux occurs when the stomach acids that break down food in the stomach travel back up the oesophagus toward the mouth. It's one of the most common issues during pregnancy, as when the fetus grows, pressure can develop on nearby organs such as the stomach. Increased production of certain hormones, too, may slow digestion, causing a build-up of stomach acid. There also may be a slowing down in the movement of muscles of the oesophagus that allow for swallowing. 

Though usually mild, acid reflux can be uncomfortable and painful, with a burning sensation in the throat or chest. You can make lifestyle changes to reduce and prevent acid reflux, such as reducing the size of meals and avoiding lying down. However, you may also be tempted to turn to an antacid (like Gaviscon, Mylanta, Nexium) to help minimise symptoms.

Wilkes says, "Antacids are generally relatively safe in pregnancy, however, some have ingredients that can cause women concern, like magnesium oxide, which can impact uterine contractions.  Therefore it is potentially worth considering how much antacid is being consumed, as the combined total may have an impact.  Without individual consultation with your midwife, GP or other healthcare practitioners it may be difficult to identify your needs on your own. If you have concerns, please check with your GP. For most women, though, antacids are a necessary part of pregnancy to combat the genuine impact of reflux."

Ibuprofen is an active ingredient in the well-known medicine brand Nurofen. Like Panadol, it's a medicine people commonly turn to for temporary relief of headaches and pain from strains. The difference between the two, as the London Doctors Clinic Group explains, is that ibuprofen also aids in reducing inflammation.

"There are definite periods during pregnancy where it is better to avoid Nurofen," Wilkes explains. "Additionally, women with a history of asthma or respiratory conditions should use caution and seek advice before using Nurofen." If you're unsure, seek advice from your doctor or pharmacist about taking this medicine.

The Royal Women's Hospital medicines in pregnancy factsheet advises that ibuprofen should be avoided, especially after 30 weeks, due to the risk of harm to the baby.

Leg cramps are common during pregnancy, particularly during the night in the later stages. Magnesium may be a remedy to consider for leg cramps.

Wilkes explains that magnesium is also used for nervous irritability during pregnancy, apart from muscular aches. "It is quite safe, but as with everything, if you have concerns, you should speak to your care provider. Do not exceed the recommended daily dose without appropriate consultation."

During pregnancy, it is essential to get more sleep, particularly as the body gets tired. However, the ability to meet these sleep needs may be affected by the various body changes as you go through each stage of pregnancy. These changes can include waking up due to frequent trips to the toilet and discomfort from indigestion or other body aches.

Melatonin is a hormone that the brain releases in response to darkness and some people consider taking it in the form of a supplement to assist with achieving better sleep.

Wilkes says there is insufficient evidence to provide appropriate recommendations on melatonin. It would be best to speak to your doctor if you consider taking this supplement.

Constipation can be more common in pregnancy for a few reasons. These include a low-fibre diet, medications, and the increase in the production of the progesterone hormone, which slows the movement of food through the intestine.

It's best to prevent and treat constipation with a healthy, high-fibre diet, adequate water intake, and exercise. Metamucil is a dietary fibre supplement, which Wilkes says is entirely safe for use throughout pregnancy to combat the challenges of constipation and sluggish digestion. It is also critical to remember to increase fluids wherever constipation arises.

Movicol is a laxative in powder form. Wilkes explains, "It is safe in pregnancy and falls into a similar category to Metamucil. If constipation is causing serious concerns, it is always important to talk to your care provider."

The Vicks brand has a range of cold and flu products, well-known for its active ingredients of menthol, extracts of peppermint oil, camphor, and eucalyptus oil. Wilkes says, "You should use menthol products and anything absorbed by the skin cautiously during the first 12 weeks of pregnancy."

Health Direct’s website states that the Vicks Cough Syrup is generally considered safe during pregnancy if taken as directed.

That said, Vicks is reported by The Australian Pharmacist not to be effective at reducing nasal congestion, so you may want to discuss other options with your doctor or pharmacist.

If experiencing hayfever symptoms, Wilkes says, "Antihistamines fall into the category of drugs that should always be considered with a benefit versus risk approach. While generally in a category B class, which means no ill effects have been shown, it is always best to consider if there is any other alternative before taking them."

Urinary tract infections, an infection of the urinary system, are the most common bacterial infection in pregnant women, as noted by the Pregnancy, Birth and Baby website.

This increase in risk for urinary tract infections can be due to the different makeup of urine and changes in the immune system during pregnancy. As the pregnancy progresses, the pressure on the bladder increases, which can reduce the urine flow and lead to an infection.

The website further explains, "Having a UTI during pregnancy can increase your risk of developing high blood pressure. Your baby may be born early and smaller than usual. For this reason, even if you don't have any symptoms, it is important to treat a UTI as soon as possible."

Ural is in powder form, which reduces the acidity of urine to relieve the painful burning sensation that comes with UTIs. Wilkes advises, "It's recommended to consult a health professional before starting over-the-counter products such as Ural. Urinary symptoms can be indicative of serious issues."

Apart from drinking lots of water to flush out the urinary tract, your doctor may prescribe antibiotics that are safe for pregnancy to treat the UTI. 

Wilkes comments that antibiotics also fall into Category B drugs and are widely used by most women during pregnancy. "However, it is always essential to consider whether you need the antibiotic before using it. Where antibiotics are recommended, amoxicillin is widely used as a very safe option for a mother and baby.

The Royal Women's Hospital's website says antibiotics should only be used if an infection has been diagnosed, not for cold and flu. It also adds you should discuss the risks versus benefits of taking antibiotics with a doctor. An untreated infection can lead to serious health consequences for the mother and baby, including the potential for pre-term delivery.

Apart from speaking to your doctor, your midwife, or your maternal health nurse, you can contact the hospital you are having your prenatal appointments.

Apart from reading the medicine label packaging, you can look up the medicine's details on NPS Medicine Wise 

If you have questions about medicines, call the Medicines Line 1300 MEDICINE (1300 633 424) from anywhere in Australia.