Navigating medication and supplement use during pregnancy can feel overwhelming. While many options are safe, others can pose risks to your baby’s development. 

We spoke with Laura Rosenfield, M.D., an OB/GYN and physician on the medical staff at Texas Health Dallas and at Gynecological and Obstetrical Associates, a Texas Health Physicians Group practice, to help you better understand what to use with caution and what to avoid altogether.

How to Approach Medication Use in Pregnancy

“Each pregnancy is unique, and what’s safe for one person may not be for another,” says Rosenfield. “We weigh the benefits and risks carefully, especially during the first trimester.”

She notes that while many supplements and over-the-counter (OTC) medications are probably safe, data is limited.

“Very few randomized controlled trials have been performed on pregnant women, so we often extrapolate data from animal studies and clinical experience.”

For guidance, she refers to resources like the National Institutes of Health (NIH) and Hale’s Medications & Mothers’ Milk.

Over-the-Counter (OTC) Medications

Pain Relievers
When it comes to pain relief during pregnancy, acetaminophen (Tylenol) is widely considered the safest option.
“We often suggest Tylenol as being safe in pregnancy,” says  Rosenfield. However, she adds, “Prolonged or high-dose use may be linked to maternal liver dysfunction and jaundice in overdose situations. Use the lowest effective dose and avoid exceeding 4,000 mg per day.”

• Safe Option: Acetaminophen (Tylenol) for headaches, muscle aches, and fever. tick to the recommended dosage.
• Avoid: The FDA recommends avoiding nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil, Motrin), aspirin, and naproxen (Aleve), especially after 20 weeks gestation. Rosenfield notes these may pose risks to fetal circulation. “There’s some evidence they might be okay in small doses, but I’m not comfortable enough with the evidence to endorse their use.”

Cold and Allergy Medicines
If cold or allergy symptoms interfere with your daily life, some OTC options are safe during pregnancy. Rosenfield advises targeting specific symptoms rather than using combination medications.

• Safe Options:
• Loratadine (Claritin), cetirizine (Zyrtec), or diphenhydramine (Benadryl) for allergies
• Dextromethorphan (Robitussin) for cough
• Saline nasal spray, pseudoephedrine (Sudafed), and Mucinex for congestion
• Occasional use of Afrin, nasal steroids, or nasal antihistamines
• Avoid: Phenylephrine and Allegra (fexofenadine), especially early in pregnancy or if you have high blood pressure.

Heartburn Relief
Heartburn affects up to 80% of pregnant women due to hormonal changes and a growing uterus. Rosenfield recommends starting with lifestyle changes like eating smaller, more frequent meals and avoiding spicy or rich foods.

• Safe Options:
• Antacids like Tums or Rolaids (calcium carbonate-based)
• H2 blockers like famotidine (Pepcid AC)
• Prescription options like pantoprazole, if needed
• Avoid: Antacids containing sodium bicarbonate or magnesium trisilicate.

Constipation Medications
Constipation is another common issue during pregnancy caused by hormonal shifts. Lifestyle changes like increasing fiber intake and staying hydrated are first-line treatments.

• Safe Options:
• In severe cases, Rosenfield says a basic enema can work well without causing rebound constipation
• “Hydration, a high-fiber diet, and sometimes Miralax can go a long way,” she says.

Prescription Medications
Prescription medications can be more complex during pregnancy, but they’re not always off-limits.
“I never recommend stopping medications abruptly,” says Rosenfield. “Instead, I evaluate the safety of each drug and may adjust the dose or switch to a safer alternative. Many chronic condition medications can be continued with close monitoring.”

• Safe Options:
• Stool softeners like docusate sodium (Colace)
• Bulk-forming fiber supplements like psyllium (Metamucil)
• Non-stimulant laxatives like polyethylene glycol (Miralax)
• Antibiotics like penicillin or azithromycin for infections.
• Thyroid medications like levothyroxine for hypothyroidism.
• Low-dose aspirin (81 mg) under medical supervision for preeclampsia prevention.

Some prescription drugs — including the ones in this list — can cause birth defects in your baby. If you’re pregnant and taking any of these medicines, call your doctor immediately. You may need to stop taking it or switch to a different drug or dose that’s safe for your baby. 

• Captopril (Capoten®)
• Carbamazepine (Carbatrol®, Epitol®, Equetro®, Tegretol®)
• Codeine
• Enalapril (Vasotec®)
• Fluoxetine (Prozac®)
• Hydrocodone (Vicodin®)
• Isotretinoin (Accutane®, Amnesteem®, Claravis®, Sotret®)
• Morphine
• Oxycodone (OxyContin®, Percocet®)
• Paroxetine (Paxil®)
• Thalidomide (Thalomid®)
• Tramadol (ConZip®, Ryzolt®, Ultram®)
• Valproic acid (Depacon®, Depakene®, Depakote®, Stavzor®, Valproic®)
• Warfarin (Coumadin®, Jantoven®)

Supplements During Pregnancy

While prenatal vitamins are essential for fetal development, not all supplements are safe during pregnancy.
“Ideally, you should get most nutrients from a healthy diet, but there are key nutrients that may need to be supplemented,” Rosenfield says.

• Essential Supplements:
• Prenatal vitamins with folic acid (400–800 mcg daily) to prevent neural tube defects.
• Iron supplements if prescribed by your provider.
• Vitamin D if levels are low.
• Calcium
• Choline (450 mg/day): Supports fetal brain development. Most prenatal vitamins don’t include enough, so you may need a separate supplement or dietary sources like eggs and milk.
• DHA (350–450 mg/day): Crucial for fetal brain and eye development. Found in fatty fish or algae-based supplements for vegetarians.
• Supplements to Avoid:
• Herbal products like black cohosh, dong quai, St. John’s wort, ginseng, and licorice.
• High doses of Vitamin A due to the risk of birth defects.
• Full-body cleansing products marketed as “natural.”
• Certain essential oils, including sage and pennyroyal

“These can cause uterine contractions or affect fetal development,” Rosenfield says. “And since they’re not regulated, it’s hard to know what’s really in them.”
Additionally, you should be very careful about where you get your information from when it comes to researching anything regarding your pregnancy, no matter how well-meaning or convincing.
Some websites may say certain drugs are safe to take during pregnancy, but you should always check with your health care provider first. Because every woman’s body is different, what is safe for one woman may not be safe for you.

General Tips for Medication Safety

• Keep an Updated List: Bring a list of all medications and supplements you’re taking to every prenatal visit.
• Ask Questions: If you’re unsure about a medication’s safety, consult your OB/GYN or pharmacist.
• Use Moderation: Only take medications when absolutely necessary and at the lowest effective dose.
• Trust Reputable Sources: Stick to guidance from trusted organizations like ACOG or the FDA.

Final Thoughts

Navigating medication use during pregnancy can be overwhelming, but as Rosenfield says, “Less is more. If you’re eating a well-balanced diet, you’re likely getting what you need. But a good prenatal vitamin — with choline and DHA — is still a smart move.”

You’re bound to have a lot of questions throughout your pregnancy, so never hesitate to ask! Many OB offices have nurses available by phone or offer online portals for quick questions. If you’re unsure about a medication while at the pharmacy, check with the pharmacist — they can offer helpful guidance on what’s safe.

“Always ask before you take anything. Even natural products can carry risks,” she adds.

By staying informed and consulting with your doctor, you can ensure the best outcomes for both you and your baby.