Medications to Be Wary of During Pregnancy

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Given how uncomfortable pregnancy can be — morning sickness, bloating, heartburn — expecting women don’t have a lot of options when it comes to relieving their symptoms.

During my pregnancy, I was hit with terrible congestion so I reached for my trusty Afrin nasal spray. However, a quick Internet search yielded multiple warnings about the seemingly harmless decongestant. “DO NOT TAKE AFRIN WHILE PREGNANT!” the headlines screamed. Turns out, the spray is classified as “Drug C,” which means there are no human studies on its safety.

The Food and Drug Administration’s 30-year-old drug guidelines for pregnant and breastfeeding women is dubbed the “ABC system,” for using letters of the alphabet to classify the safety of each medication. It has a long history of confusing consumers with murky, vague definitions, though.

Drugs like Afrin and Tylenol are dubbed Class C because animal studies may have shown adverse effects on a fetus, but there are no well-controlled studies in humans. Other drugs may be risky to fetuses, but the benefits of taking them could outweigh the risks if they prevent certain ailments, like asthma attacks. Because the classifications are so gray, in most cases, doctors are left to decide on a case-by-case basis.

Sometimes it’s hard to nail down how a drug is classified. For example, Ibuprofen is listed by a respected pharmaceutical journal as class X, meaning human and animal studies have shown fetal risk. On Drugs.com, it’s given a D. The FDA’s site clarifies that the OTC pain reliever is C before 30 weeks of pregnancy, and D after.

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With all this confusion, there’s good news: On Wednesday, the FDA announced it was abolishing the old system and replacing it with clearer guidelines scheduled to take effect in June 2015. The new system will classify drug risk into three parts: Pregnancy, lactation, and fertility and will require companies to provide comprehensive summaries of its product’s risk factors. What that means for you: No more frantic Internet searches at the drugstore.

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In the meantime, here are four drugs that you should be wary of taking if you’re expecting:

Accutane (class X - human and animal studies have shown fetal risk): If anyone doubts whether the skin-clearing wonder drug Accutane (also sold as, Amnesteem, Claravis, and Sotret) is safe to take during pregnancy, check the back of the package where there are multiple warnings along with images of pregnant women. While the pill is known to turn the blotchiest complexion into that of a dewy newborn, it can also cause severe, life-threatening birth defects. The risk is so high that in order to take the drug, women must undergo intense medical examinations. If approved, they agree to using two forms of birth control and taking regular pregnancy tests — even if they’ve had their tubes tied. The drug’s safety for breastfeeding women is currently unknown.

Ibuprofen (class D after 30 weeks of pregnancy): Most people have a bottle of the pain reliever Ibuprofen (brand names: Advil, Midol, Motrin) in their medicine cabinet to curb headaches and menstrual cramps. But the FDA recommends avoiding it after 30 weeks of pregnancy as it can increase the odds of miscarriage or birth defects. And according to Mother to Baby, a non-profit Organization of Teratology Information Specialists, taking Ibuprofen in the third trimester is particularly dangerous because it can cause high blood pressure in the fetus, reduce amniotic fluid (which leaves an unborn baby vulnerable to illness) and even inhibit labor.

Echinacea (class N - not classified): This flowering plant from the daisy family has a superhero rep for fighting the common cold, urinary tract infections, migraines, even gum disease. Some take it as a preemptive move, others wait until they feel symptoms. Either way, it’s off-limits to pregnant women. That’s because doctors are unsure whether echinacea is harmful to a fetus. On the one hand, a study of 206 women who took the herb periodically during pregnancy experienced no increase in miscarriage or birth defect risk. However, some preparations contain lead which can harm fetal brain development and there’s not enough research to warrant approval. A safe alternative: Chicken broth.

Pepto Bismol (class N): Hell hath no fury like a pregnant woman with heartburn. That painful burning feeling in the chest is not just the result of eating a spicy meal — it can strike at any moment, sometimes all day, every day. Unfortunately, the safety of the goopy, pink stuff isn’t known. An ingredient called salicylate in Pepto Bismol may be iffy for fetuses, especially in the third trimester. To prevent heartburn symptoms, eat less frequently or in small quantities or avoid eating before bed to prevent reflux.