Safe Medications During Pregnancy: What You Can Take and What to Avoid

Author: Nnenna Chiloli, MBBS, MPH

Medical Reviewer:  Azuka Chinweokwu Ezeike, MBBS, FWACS, FMCOG, MSc (PH)

Highlights

• About 75-97% of pregnant women take at least 1 over the counter medication during their pregnancy. 
• Every medication carries the potential to affect the developing baby, depending on its type, dosage, and timing of exposure during pregnancy.
• The first trimester is the most sensitive period, as major organs are forming, but some drugs can pose risks throughout pregnancy.
• Common safe medications include paracetamol, penicillin, folic acid, pyridoxine, etc.
• High-risk medications such as isotretinoin, valproate, and some antibiotics like tetracyclines, can cause serious birth defects and should be avoided.
• Pregnant women should not self-medicate; always consult a healthcare provider.

Introduction

Pregnancy is a unique period in a woman’s life. Your body undergoes numerous changes throughout pregnancy and raises important questions about what is safe for you and your unborn baby. One of the most common concerns I hear from expectant mothers is: “Can I take paracetamol if I have a headache while pregnant?”. This uncertainty is understandable. You want to keep yourself healthy and safeguard your child at the same time. 

Evidence shows that approximately 50% of pregnant women took at least one medication during the first trimester, whether for nausea, pain relief, or managing chronic conditions like diabetes or depression, and treatment of infections [1]. 

The key is to work with your healthcare providers. They can help you make wise choices about which drug is safe and best for you.

This article will help you learn the basics of medication safety during pregnancy, identify some commonly used safe medications, drugs to avoid, and offer tips for choosing drugs during pregnancy.

Why Medication Safety Matters In Pregnancy

During pregnancy, nearly everything you consume, from food to medications, can potentially affect your developing baby [2]. Medication use is common in pregnancy, and research shows that 75-97% of pregnant women take at least 1 over the counter medication during their pregnancy. 

Taking medications while pregnant isn’t always a simple yes or no decision. It often requires weighing the benefits and risks. When you take a medication, it can result in any of the following:

• No problem for your baby and its development.

• Directly affects your baby, resulting in harm or aberrant growth that could cause birth abnormalities or even death.

• Alter the placenta’s function typically by narrowing the blood vessels, which cuts down on air and food for your baby. This can make your baby small and underdeveloped.

• Cause the muscles of your womb contract forcefully, indirectly injuring your baby by reducing its blood supply or triggering preterm labour and delivery.

• Stay in the body and have effects after they are stopped. For example, isotretinoin, a medication used to treat skin disorders, can cause birth defects if a woman becomes pregnant within 2 weeks after the drug is stopped.

On the other hand, while avoiding medications when pregnant may be desirable, it is often dangerous because some women enter pregnancy with medical conditions such as diabetes, depression, asthma, etc, that require ongoing and episodic treatment [3][4]. 

Also in pregnancy, a new medical problem can develop, and old ones can get worse, requiring treatment, which, if not done, can affect both the mother and baby [4]. Because of this, medication safety during pregnancy calls for careful thought and involves weighing the benefits and drawbacks.

The first trimester(weeks 1 to 12) of a pregnancy is a critical stage because your baby’s major organs are developing. During this period, the baby is more sensitive to the effects of certain drugs. In contrast, certain medications may be fine in the second or third trimester, depending on how they affect the baby’s growth and development, while others may be harmful throughout the entire pregnancy. 

Understanding FDA Pregnancy Drug Categories

Now that you understand why medication safety matters, let’s look at how drugs are classified during pregnancy. The U.S. Food and Drug Administration (FDA) once used a letter-based system, categories A, B, C, D, and X to describe the safety of medications during pregnancy [3].  Category A is the safest, and category X is contraindicated. Different categories and their examples are as follows:

However, a modern approach called the Pregnancy and Lactation Labelling Rule (PLLR) has replaced the letter categories since 2015 and provides more detailed narrative descriptions.

Safe Medications During Pregnancy

Although no drug is completely risk-free, even safe drugs should only be taken when absolutely necessary and at the lowest possible dosage. Common safe medications when used correctly are;

• Acetaminophen, also known as paracetamol. This drug is used to treat pain.
• For allergies, medications like Loratidine and cetirizine are generally safe.
• Penicillins and cephalosporins are trusted antibiotics often prescribed during pregnancy.
• Pyridoxine (Vitamin B6) can help ease morning sickness and nausea. 
• Prenatal vitamins such as folic acid help your baby’s brain and spinal development.
• If you have heartburn, Antacids may help, especially those that contain calcium carbonate.
• Some drugs are safe for long-term health conditions, a few are:

• Insulin for blood sugar in diabetes.
• Labetalol, a common choice for blood pressure when you are pregnant.
• Levothyroxine keeps thyroid levels right.
• Sertraline is sometimes used for sad feelings(depression) when it helps you and your baby more than it harms.

Medications To Avoid In Pregnancy

Some drugs can be bad for you when you are pregnant. It is best not to take them, but your doctor may say it’s okay if the good is more than the bad.  Among them are the following;

• Pain killers such as non-steroidal anti-inflammatory drugs( NSAIDS), e.g, Ibuprofen. This increases the risk of miscarriage when used in early pregnancy. When used in the third trimester, it can cause premature closure of important blood vessels in the baby’s heart and kidney problems.

• Antibiotics, including tetracyclines and their derivatives, e.g, minocycline, cause permanent tooth discolouration and effects on bone development. 

Fluoroquinolones, e.g, ciprofloxacin, can cause spontaneous abortion and also affect the baby’s bone and cartilage development [5].

• Anti-hypertensive drugs like Angiotensin converting enzyme (ACE) Inhibitors, e.g, lisinopril, enalapril. They are used for the treatment of high blood pressure. They can cause kidney problems and growth restriction in the developing baby.

• Anti-epileptic drugs such as valproate, topiramate, etc, can cause birth defects [6].

• Thyroid medications, such as methimazole.

• Isotretinoin, often prescribed for severe acne, is one of the riskiest medications in pregnancy. It can cause serious birth defects even when you stop it two weeks before conception.

• Herbal medication. Be careful with herbs. They may seem safe, but some can be a danger to you or the baby. 
• Warfarin, a drug used to stop blood clots. But it can make your baby bleed and also make it more likely to lose the baby.  

Practical Tips For Pregnant Women

Picking the right medication while pregnant can feel confusing. These simple habits will help you and your doctor make safer decisions.

• See your healthcare provider as soon as you know you are pregnant.
• Never take drugs on your own.
• Take your drugs just as your doctor says.
• Tell your doctor about all the medications you are taking. This includes herbs, alcohol, or tobacco.
• Don’t stop a prescribed drug suddenly without speaking to your doctor.
• Always check labels and keep an eye on pregnancy warnings and expiry dates.
• Be careful with the advice you find online. It can be wrong. Always ask your doctor or nurse.
• Report any concerning symptoms or side effects promptly.

Safe Self-care Practices for Common Pregnancy Symptoms

Here are a few common discomforts in pregnancy and how you can feel better before considering medication. They are often manageable with small lifestyle changes.

• Morning sickness: Try vitamin B6 (when advised by your doctor) and eat small, frequent meals.
• For heartburn, try eating smaller meals, avoid spicy foods, and consider calcium carbonate antacids if needed.
• Constipation: Increase fibre-rich foods, fluid intake, and gentle daily activity.
• For headaches, try rest, drink water, and apply a cold compress.

Seek medical help if you 

• Show signs of an allergic reaction (a rash, swelling, or breathing difficulty). 
• Think you took too much of a drug or think it’s an overdose.
• Get bad signs that may point to pregnancy complications or any unusual feelings.

Conclusion

Pregnancy is a period full of new experiences and choices. Before you take any medicine, always ask your doctor. With the right help, you will stay well and give your baby the best, safest start. Keep in mind, good care keeps both you and your baby safe.

References

1. Mansour O, Russo RG, Straub L, Bateman BT, Gray KJ, Huybrechts KF, et al. Prescription medication use during pregnancy in the United States from 2011 to 2020: trends and safety evidence. American Journal of Obstetrics and Gynecology [Internet]. 2024 Aug 1 [cited 2025 Oct 19];231(2):250.e1-250.e16. Available from: https://www.sciencedirect.com/science/article/pii/S0002937823021725
2. Lynch MM, Squiers LB, Kosa KM, Dolina S, Gard Read J, Broussard CS, et al. Making decisions about medication use during pregnancy: implications for communication strategies. Matern Child Health J [Internet]. 2018 Jan [cited 2025 Oct 20];22(1):92–100. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5764786/
3. Sachdeva P, Patel BG, Patel BK. Drug use in pregnancy: a point to ponder! Indian J Pharm Sci [Internet]. 2009 [cited 2025 Oct 19];71(1):1–7. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2810038/
4. Alema NM, Semagn G, Melesse S, Araya EM, Gebremedhin H, Demsie DG, et al. Patterns and determinants of prescribed drug use among pregnant women in Adigrat general hospital, northern Ethiopia: a cross-sectional study. BMC Pregnancy and Childbirth [Internet]. 2020 Oct 15 [cited 2025 Oct 20];20(1):624. Available from: https://doi.org/10.1186/s12884-020-03327-7
5. Xiang D chun, Xie W long, Cheng G ying, Yue M, Du X yi, Jiang J. Pregnancy-related adverse events and congenital disorders associated with fluoroquinolones: A real-world pharmacovigilance study of the FDA adverse event reporting system (Faers). Heliyon [Internet]. 2024 Sep 30 [cited 2025 Oct 20];10(18):e37547. Available from: https://www.sciencedirect.com/science/article/pii/S2405844024135785
6. Tomson T, Sha L, Chen L. Management of epilepsy in pregnancy: What we still need to learn. Epilepsy & Behavior Reports [Internet]. 2023 Jan 1 [cited 2025 Oct 20];24:100624. Available from: https://www.sciencedirect.com/science/article/pii/S2589986423000424

Disclaimer:
The information provided on this website is for general educational and informational purposes only. It is not intended to replace professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition

Published October 24, 2025