OTC Medication Safety During Pregnancy: What to Ask First

When you’re pregnant, even a simple headache or stuffy nose can feel like a crisis. You want relief-fast. But you’re also terrified of doing something that might hurt your baby. That’s why so many women reach for an OTC medicine without thinking twice. And that’s exactly where the danger lies.

Not All OTC Medications Are Created Equal

You might assume that if a drug is sold over the counter, it’s safe. That’s a dangerous myth. The truth? Some OTC medications are fine. Others can raise your risk of miscarriage, birth defects, or long-term developmental issues. And the risks change depending on which trimester you’re in.

Acetaminophen (Tylenol) is still the go-to for pain and fever during pregnancy. It’s been studied more than any other OTC drug in pregnant women. The standard safe dose is 650-1,000 mg every 4-6 hours, with no more than 4,000 mg in 24 hours. Even in the first trimester, when the baby’s organs are forming, acetaminophen is considered the safest option-if used as directed.

But here’s the catch: new research is raising questions. A large study tracking 50,000 pregnancies is currently looking at whether long-term or high-dose acetaminophen use might be linked to attention or behavioral issues in children. The findings aren’t final yet, but they’re enough to make experts urge caution. Don’t take it longer than you need to. Don’t take more than you need to. And never use it as a daily crutch.

NSAIDs: Avoid After Week 20-And Be Careful Earlier

Ibuprofen (Advil, Motrin), naproxen (Aleve), and aspirin belong to a class called NSAIDs. These are common, cheap, and effective. But they’re not safe during pregnancy, especially later on.

The FDA issued a strong warning in 2020: NSAIDs can cause serious kidney problems in the developing baby after 20 weeks. That means reduced amniotic fluid, which can lead to lung underdevelopment and limb contractures. In rare cases, it can even cause heart failure.

But the risks don’t stop there. Studies show that using NSAIDs in the first trimester may increase the chance of miscarriage by up to 60%. That’s not a small number. Even a single dose of ibuprofen during early pregnancy can be risky if you’re already at risk for pregnancy loss.

Bottom line: Skip NSAIDs entirely unless your doctor says otherwise. And if you’ve already taken some, don’t panic-but do mention it at your next appointment.

Decongestants: The Hidden Danger

Pseudoephedrine (Sudafed) is a common decongestant. It’s in a lot of cold and sinus medicines. But if you take it in the first trimester, you’re increasing the risk of a rare but serious birth defect called gastroschisis-where the baby’s intestines develop outside the abdomen.

Research shows this risk goes up by more than double. That’s why most doctors tell pregnant women to avoid pseudoephedrine in the first 12 weeks. Even if you’re just taking it for three days, it’s not worth the gamble.

And here’s another trap: many cold medicines combine decongestants with pain relievers or cough suppressants. So if you grab a bottle labeled “Cold & Flu,” you might be getting pseudoephedrine without even knowing it. Always read the active ingredients. Look for “phenylephrine” too-it’s another decongestant with limited safety data in pregnancy.

Antihistamines: Which Ones Are Safe?

Allergies don’t take a break during pregnancy. But not all antihistamines are equal.

Loratadine (Claritin) and cetirizine (Zyrtec) are considered safe throughout pregnancy. Fexofenadine (Allegra) is now also included in this group, based on a 2022 study of over 12,000 pregnancies. These are second-generation antihistamines-they don’t cause drowsiness and have the best safety record.

Chlorpheniramine (found in some older allergy meds) is also considered acceptable, though it can make you sleepy. But diphenhydramine (Benadryl)? Use it sparingly. It’s not proven to cause birth defects, but it crosses the placenta easily and can affect fetal heart rate. Plus, it’s often in nighttime cold remedies. If you’re taking it to sleep, talk to your doctor about safer alternatives.

Heartburn and Diarrhea: Simple Fixes, Big Mistakes

Heartburn is almost guaranteed during pregnancy. Tums (calcium carbonate) is a great first choice. You can take up to 2,000 mg a day safely. Maalox, Mylanta, and Pepcid AC (famotidine) are also fine.

But don’t go overboard. Too much calcium can cause constipation or kidney stones. And never use antacids with aluminum unless your doctor says so-they can build up in your system.

For diarrhea, loperamide (Imodium) is okay if you don’t have a fever and you follow the package instructions. But if your diarrhea lasts more than two days, call your provider. It could be something like listeria or a stomach virus that needs treatment.

What You Should Ask Before Taking Anything

The real question isn’t “Is this safe?” The real question is: What do I need to ask before I take it?

Here are the five questions every pregnant woman should ask before reaching for an OTC bottle:

1. Is this medication absolutely necessary? Can I manage this with rest, hydration, saltwater gargles, or a humidifier?
2. What’s the lowest dose that will work? Don’t take two pills if one will do. Start low.
3. How long will I need it? A day or two? Fine. A week? Talk to your doctor.
4. Are there non-drug options? For headaches: cold compress, massage, deep breathing. For congestion: saline spray, steam, nasal strips. For heartburn: eat smaller meals, avoid spicy food, don’t lie down after eating.
5. Has my provider approved this exact product? Brand names matter. “Plain Robitussin” (just dextromethorphan) is safe. “Robitussin Multi-Symptom” contains phenylephrine and acetaminophen-avoid it.

The Biggest Mistake: Assuming “Natural” Means Safe

Herbal teas, ginger supplements, essential oils, and “natural” cold remedies are everywhere. But “natural” doesn’t mean safe. Some herbs like black cohosh, goldenseal, and pennyroyal can trigger contractions or miscarriage. Even chamomile and peppermint tea in large amounts can affect hormone levels.

There’s almost no regulation of herbal products. They don’t have to prove safety during pregnancy. So if you’re thinking about a supplement, ask your provider first-even if it’s on the shelf at the health food store.

What to Do If You’ve Already Taken Something

If you took ibuprofen last week for a headache? Don’t panic. One dose is unlikely to cause harm. But don’t ignore it either. Write it down: what you took, how much, when, and why.

Bring that list to your next prenatal visit. Most doctors will ask you about OTC use anyway. But if you’re worried, call your provider sooner. They can check for signs of complications and give you peace of mind.

And if you’re planning to get pregnant? Start this conversation now. Talk to your doctor about your current medications-even if they’re just for allergies, migraines, or acid reflux. Getting your meds sorted before conception is the best way to protect your future baby.

Keep a Medication Log

The CDC recommends keeping a full list of everything you take during pregnancy: prescription drugs, OTC meds, vitamins, herbs, and even topical creams. Include brand names, dosages, and how often you take them.

Many women don’t realize that even a daily multivitamin can interact with other supplements. And some cough syrups still contain alcohol-even if they say “alcohol-free.” Always check the inactive ingredients.

At your first prenatal visit, bring this list. It’s one of the most helpful things you can do. It helps your provider spot risks you didn’t even know about.

Final Thought: You’re Not Alone

You’re not careless for wanting to feel better. You’re human. But you’re also carrying a life that can’t speak for itself. That’s why asking the right questions matters more than ever.

There’s no perfect answer. No medication is 100% risk-free. But there are clear, evidence-based choices that minimize risk. Stick to acetaminophen. Avoid NSAIDs after week 20. Skip decongestants early on. Stick to proven antihistamines. And always, always check with your provider before taking anything new-even if it’s on the shelf next to the gum and mints.

Your baby’s health isn’t about avoiding all risk. It’s about making smart, informed choices. And that starts with asking the right questions before you swallow that pill.