When pregnant, you're still susceptible to all the usual illnesses that the general population faces. And pregnancy itself can give rise to health conditions that require treatment.

But many women have concerns about using medications during pregnancy. Should you avoid all medications? Which medications are safe? What if you're already taking a drug to treat an ongoing health condition? Should you stay on it?

As a general rule, it's best to use caution and avoid use of medications during pregnancy. Some drugs can cause an early miscarriage or harm the developing fetus. Exposure to drugs is thought to account for 2 percent to 3 percent of birth defects. Very few drugs have been proved to be completely safe in pregnancy, but many have been found to be safe enough that their benefits outweigh any tiny, unknown risk. Before you take any medicine — prescription or over-the-counter — check with your health care provider for specific advice based on your health history and the medication in question. A pharmacist also can provide general guidelines.

If you have a health condition that requires regular medication, or were taking a medicine regularly before getting pregnant, your health care provider will evaluate whether it's safest for you to continue taking the medication, discontinue it or switch to a different medication that poses less risk to you and your baby. A medication that was important for your health before pregnancy most likely will be important during pregnancy, too. It's always best to outline a plan regarding medications when you anticipate becoming pregnant.

Below is a guide to the risks for pregnant women regarding some commonly used medications.

Acne medications. Don't take any medications for acne without your health care provider's advice. Some drugs used to treat acne can harm a fetus. These include:

• Isotretinoin (Accutane). This acne medication, taken orally, is known to cause birth defects such as hydrocephalus, cardiac abnormalities and ear defects. Women who take Accutane must wait at least three months after stopping use of the drug before becoming pregnant.

• Hormonal therapy. Hormones, including estrogen and the anti-andro-gens spironolactone and flutamide, are sometimes used to treat acne, but shouldn't be taken during pregnancy.

• Tetracyclines. These antibiotic medications are often used to treat acne. They may cause slowed bone growth and discolored teeth in babies as well as severe liver disease in expectant mothers. They shouldn't be used during pregnancy.

Allergy medications. Allergy remedies include antihistamines, decon-gestants, nasal sprays and allergy shots. During pregnancy, avoid most antihistamines and decongestants unless your health care provider recommends them. Your health care provider can help you select medications that minimize the risk to your baby.

Steroid and nonsteroid nasal sprays are generally safe to use during pregnancy, although if you use them, do so with a health care provider's supervision. Allergy shots are safe for pregnant women who were already receiving them before they got pregnant, although most caregivers don't start them during pregnancy. (See also Allergies.)

Antacids and acid blockers. Antacids are generally safe when taken as directed, but their side effects might be bothersome. Sodium, a common ingredient in antacids, can worsen swelling and water retention. Other possible side effects are diarrhea and constipation. Because antacids can reduce your absorption of other medications and vitamins, take them at least an hour apart from other medications or vitamins.

Acid blockers, both histamine (H-2) blockers and proton pump inhibitors, are considered safe to use under a health care provider's supervision. H-2 blockers include cimetidine (Tagamet), famotidine (Pepcid) and ranitidine (Zantac). Proton pump inhibitors include esomeprazole magnesium (Nexium) and omeprazole (Prilosec). (See also Heartburn.)

Antibiotics. If you get a bacterial infection, such as a sinus infection or strep throat, your health care provider may prescribe an antibiotic. Most antibiotics, including penicillin, are safe to use during pregnancy, but the exceptions are serious. Always make your health care provider aware of your pregnancy when an antibiotic is to be prescribed.

Anticoagulants. Anticoagulants decrease the clotting ability of blood and help prevent harmful clots from forming in the blood vessels.

• Heparin. Heparin is the medication of choice for pregnant women who require an anticoagulant medication. Heparin may be prescribed for women who have a hereditary clotting disorder or who are at risk of developing blood clots while pregnant. Because heparin doesn't cross the placenta, it's safe to use during pregnancy and doesn't harm the fetus.

Heparin is administered by injection. The treatment must be stopped briefly at the time of delivery to prevent excessive blood loss. Management of heparin treatment is a job for an experienced obstetrician.

• Low molecular weight heparins. New, low molecular weight heparins (dalteparin, enoxaparin) also are safe in pregnancy and have some advantages. However, they're extremely expensive.

• Warfarin. Warfarin (Coumadin) is another anticlotting drug, but it has been shown to cause birth defects and is not used during pregnancy.

If you've had blood clots or are at risk of developing them, your health care provider will determine what the best course of treatment is for you.

Antidepressants and mood stabilizers. Women who are using medications for depression, anxiety and other mood disorders may need to change their use of these drugs during pregnancy. If you were taking any antidepressant or other psychiatric medication before becoming pregnant, talk to your health care provider about whether you should keep taking it. Medications used for these conditions include the following:

• Tricyclic antidepressants. Use of this family of drugs during pregnancy causes concern. More effective medications are now available, so there's rarely a need to consider using this group of drugs during pregnancy.

• Selective serotonin reuptake inhibitors (SSRIs). Multiple studies have evaluated use of fluoxetine (Prozac, Sarafem), sertraline (Zoloft) and paroxetine (Paxil) during pregnancy and haven't found evidence of increased risk of birth defects. The effect these medications may have on the unborn child's future behavior is unknown. These drugs usually should be continued if they were prescribed for serious depression.

• Other antidepressants. Bupropion (Wellbutrin) hasn't been shown to cause birth defects. However, its future effect on children and adults exposed during their mother's pregnancy is unknown. Bupropion is also sold as a stop-smoking aid under the name Zyban.

• Mood stabilizers. Lithium (Lithobid), valproic acid (Depakene) and carbamazepine (Tegretol) are used to treat bipolar disorder. If used during pregnancy, they may harm the developing fetus. If you're using any of these drugs and want to become pregnant, first talk to your health care provider or a perinatal specialist about their risks and benefits. Lithium and valproic acid are strongly linked to birth defects.

Cold medications. A wide variety of medications, including dozens of types of decongestants, cough syrups and nasal sprays, are marketed to treat the symptoms of the common cold. Most of these drugs have at least some concern attached with their use in pregnancy. The medicines may relieve signs and symptoms, but they don't cure or shorten the illness. If you're pregnant, the best treatment plan for a cold includes rest, fluids, increased humidity and time. Often you and your health care provider can find an approach to your cold that minimizes risk to your pregnancy. (See also Colds.)

Laxatives. Constipation is a common aggravation of pregnancy. Nonprescription laxatives are generally safe, but check with your health care provider for a recommendation. Overuse of laxatives can cause diarrhea and a degree of dependence. It's best to try to prevent constipation. (See also Constipation.)

Pain relievers

• Acetaminophen. This nonaspirin medication is sold under various brand names, including Tylenol. In recommended doses, it's considered safe to use during pregnancy. In addition to relieving pain, acetaminophen can lower a fever.

• Aspirin. Avoid taking aspirin when you're pregnant, unless your health care provider specifically recommends it. Maternal use of aspirin has been associated with some birth defects and bleeding problems in the mother or infant.

• Ibuprofren and other nonsteroidal anti-inflammatory drugs (NSAIDs). Ibuprofen (Advil, Motrin, others), indomethacin (Indocin), ketoprofen (Orudis) and other NSAIDs should be used during pregnancy only under a physician's direction, as they could pose risks to the fetus.

• Narcotics. Some pain relievers combine acetaminophen with a narcotic medication such as codeine or oxycodone. Brand names include Tylenol with Codeine, Darvocet, Vicodin and Percocet. Oxycodone medications have not been linked with birth defects, but they have high addiction potential and may cause withdrawal or other problems in the infant if used for many days in the last weeks before delivery. These medications are never appropriate for noncancer chronic pain, due to their addictive potential.

For pain relief, you might also consider nonpharmaceutical alternatives. For example, if you have a headache, try resting, avoiding light and using a cool pack on your head. For sore muscles or aches caused by arthritis, try a warm bath or massage.

For more specific information about medications used to treat other conditions, see Headaches; Herbal medications; Morning sickness.

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