If You Get Sick During the Pregnancy

Taking medications during pregnancy

HERE'S A PARENTING PEARL that we've found to be true: TAKE GOOD CARE OF YOURSELF SO YOU CAN TAKE GOOD CARE OF YOUR BABY. This advice applies already in pregnancy, but even mothers who pay close attention to their health do get sick at times.

If you get sick while pregnant you will naturally be concerned about your baby. The worry is twofold: Will your illness harm your baby? And will any medications you take harm your baby?

There is good news in answer to both questions. The great majority of illnesses in the pregnant mother, if properly treated, do not harm baby, and the great majority of medicines that pregnant mothers need to take do not harm their babies. Nevertheless, you don't have a blank prescription to take any medication you see on the drugstore shelf. You must consult your doctor first. Most medications are safe, some are safe with reservations, and a few are definitely unsafe.

Your fears about taking medicine during your pregnancy can work to your and your baby's advantage - and disadvantage. Wanting to avoid medicines forces you to practice preventive medicine (you minimize your exposure to infectious diseases, pollutants, and allergens and you eat well) and learn about safe alternatives to taking drugs. But your fears about taking medicine may also cloud your reason. Sometimes not taking the medicine is riskier than taking it. Getting mother healthy again may be what's best for baby. Sometimes the effects of the disease on mother and baby are worse than the effects of the drug. Sometimes waiting too long to get proper medical care requires the mother to take a stronger drug for a longer time with more side effects; this might have been avoided with earlier medical intervention. Consider these dos and don'ts when taking medicines while pregnant:

• Do take the medicine in the exact dosage and for the length of time your doctor recommends. Taking more is not better and is often worse.
  
  
• Don't take a lower dose than your doctor prescribes without consulting your doctor. The lower dose may do you no good, yet baby may still get the effects of the drug.
  
  
• Don't read the PDR (Physician's Desk Reference). The information in the PDR about drugs during pregnancy is there to protect the manufacturer rather than to inform the consumer. The warnings are needlessly scary and are often based upon research in which huge doses of a drug are given to experimental animals; the research may have little application to humans. Oftentimes there is very little broad-based research available about using a drug during pregnancy, so it's safer for the manufacturer just to advise women not to take any of the medicine while pregnant. (With this advice on the record, the manufacturer is at less risk of a lawsuit.)
  
  
• Don't take medicines, even over-the-counter ones, without consulting with your doctor.
  
  
• Don't take over-the-counter remedies that contain several drugs unless advised by your doctor (e.g., cold remedies may contain mixtures of antihistamines, deconges-tants, aspirin, etc.). Because mixtures are difficult to study, it is hard for researchers or doctors to provide reliable information about the safety of the combined drug.

Do consider safer alternatives to medicines. For example, if you're treating a cold, what alternatives are there to taking the medicine?

Don't panic if you've taken a drug that you later read may be unsafe. Odds are greatly on your baby's side that no harm was done. Very few drugs taken as a one-time dose will harm your baby. Most drugs must be taken for extended periods or in large doses to produce harmful effects.

Do compromise. While some medications pose some risks to baby, a sick mom is not good for baby either. For example, depriving yourself of oxygen because your breathing passages are clogged or letting yourself get dehydrated from vomiting and diarrhea would be risky for baby. You would be better off taking medicines for these conditions. For example, if your nasal passages are so clogged you can't breathe, one dose of a decongestant spray, such as Afrin, for a day or two, has been shown not to have any harmful effects on the fetuses who were studied.

Do think about the effect of the drug on your baby. Because your baby's liver and kidneys are immature, he cannot eliminate the drug as you can, so the drug may stay in baby's system longer and at a higher level.

Don't use medicines if you are trying to conceive, especially in the first month. The first month of fetal organ development is a high-risk period for the effects of drugs. The "flu" you're experiencing may turn out to be early pregnancy nausea.

If you are already taking physician-approved medications while pregnant, check with your doctor before taking an additional drug. Also, when your doctor gives you a prescription for a new medication, be sure to tell him or her about any other medications you are taking. Certain drugs may be safe if taken individually but not in combination with others.

Common illnesses during pregnancy

During pregnancy the discomforts of common illnesses are magnified. You're already tired, your nutrition may be marginal (at least in the early months), and your energy reserves are already devoted to growing a baby. Being sick upsets an already tenuous balance. The following are the most common illnesses mothers experience while pregnant, along with safe treatment regimens that will work for most pregnant mothers most of the time.

Nasal Congestion and Sinusitis

The mucous membranes in the nasal passages of the sinuses often swell and become congested during pregnancy, probably due to the same hormones that cause vaginal membranes to become congested. Some women feel they have a persistent "cold" or sniffles throughout pregnancy. Women who are already prone to allergic rhinitis, or hay fever, may find this nuisance worsens during pregnancy (others find that it improves). Because of the extra person and the extra tissues you are growing, the need for oxygen greatly increases during pregnancy. To meet these increased demands, pregnant women must inhale and exhale more air per breath. This requires clear nasal passages.

Because the sinuses are an extension of the nasal passages, nasal congestion can lead to sinusitis. Swollen nasal membranes trap secretions in the sinuses, and fluid that can't drain, like water in a stagnant pond, becomes infected. Signs that you may have developed a sinus infection are feeling fullness or pain in the sinuses, alongside the nose, or over the eyebrows; snotty nasal discharge; increasing tiredness; or the feeling that you have a cold that just won't go away.

Keeping nasal secretions thin and moving. Here are ways to keep your nasal secretions uncongested, and thus prevent them from being infected:

• Avoid unnecessary exposure to nasal allergens and pollutants, such as smog and cigarette smoke.
  
  
• Drink even more water each day.
  
  
• Flush your nasal passages with saltwater (or saline) nose drops several times a day. These are available without prescription, or you can make your own: 1/4 teaspoon of salt to 1 cup of water.
  
  
• Use a facial steamer (basically a hot-mist vaporizer attached to a face mask) to "steam clean" your nasal passages and sinuses. Treat your nasal passages to this steam treatment for ten to twenty minutes. (You can watch television or read a book at the same time.) Facial steamers are available in cosmetic departments, beauty supply stores, or in some pharmacies. You can make your own steamer by boiling water in a wide pot, removing the pot from the stove, and breathing the steam from the water with your head covered with a towel to form a steam tent. A long, warm shower is another way to loosen up nasal congestion.
  
  

Treating sinus infections. Sinus infections can be treated with decongestants or antihis-tamines.

Decongestants. In theory, medicines that constrict the blood vessels of the nose may enter the bloodstream and constrict the blood vessels of the uterus or placenta; therefore, decongestants should be used only under a doctor's supervision, and only in the dosage and frequency your doctor recommends. Women with decreased placental circulation should be particularly careful about taking any form of inhaled or oral decongestants. Some nasal sprays are safer than others, but don't use any except for saltwater (or saline) nasal spray without first consulting your doctor. If your nasal passages are so clogged that you feel miserable or have difficulty getting enough air, the benefits of decongestants to you, and therefore to your baby, far outweigh the risks. Many nasal decongestants are probably safe if used once a day for one or two days. Suggestions of a harmful effect of decongestants on a developing baby were based on situations in which these medications were used many times a day or for many days. In consultation with your doctor, consider the following nasal decongestants:

• Afrin (oxymetazoline) when used only twice a day and for a couple of days has not been shown to cause harmful effects on the developing baby.
  
  
• Inhaled nasal steroids (Vancenase, Be-conase) are in the "probably safe" category, especially when taken only a couple of times a day and for a short period of time. Best to stick with the lower-potency inhaled steroids unless advised by your doctor.
  
  
• Nasal or oral decongestants that contain the following compounds have been shown to be possibly harmful to the developing baby and should not be taken unless all other alternatives have been tried and your doctor judges that the benefits outweigh the risks: ephedrine, phenyl-propanolamine, Neo-Synephrine, phenylephrine. The main worry with these decongestants is that because they constrict the vessels in the airway passages, they may also constrict the blood vessels delivering blood to the baby
  
  

Antihistamines. Some antihistamines, such as chlorpheniramine and tripelennamine, are categorized as safe to take during pregnancy ("green light"; see page 396). Others are rec ommended only with reservation ("yellow light"), such as those containing brompheni-ramine, diphenhydramine, terfenadine, and clemastine. In a rare finding these were implicated in causing eye damage in premature infants if taken in the last two weeks of pregnancy. Unless you are certain your congestion is due to allergies and it is compromising your breathing, it's best to use the medical and nonmedical methods of clearing nasal passages listed above and avoid the anti-histamines in the yellow category.

Other medications. If you were taking allergy shots before becoming pregnant, your doctor may advise continuing these shots during your pregnancy, but because reactivity to these injections may change during pregnancy, your doctor may elect to change the dosage. It is unlikely that your doctor would advise starting allergy shots during a pregnancy.

Cromolyn (Intal) is safe to take during pregnancy. It is not a decongestant, a steroid, or an antihistamine, but rather a medication that when taken over a long period of time lessens nasal congestion due to allergies. It is especially helpful during seasonal allergic rhinitis or hay fever. It is not helpful during an acute attack of a stuffy nose.

Cough syrups should be taken with caution while pregnant and are best limited to nighttime use or to severe coughs. Avoid cough syrups that contain iodine or alcohol. Studies have shown no link between guaifen-esin and fetal defects. For annoying coughs, especially those that interfere with your sleep, treat yourself to a facial-steamer treatment before bedtime.

Asthma

Like most chronic allergic problems, asthma may get better for some women during pregnancy and worse for others. Because the airway is already working overtime during pregnancy (the amount of air you move with each breath increases), asthma can be particularly worrisome at this time. If your airway is compromised and you're not getting enough oxygen, your baby may not be getting enough oxygen either. So, for your health and your baby's health, it's particularly important to take care of asthma during pregnancy. Try these ways of managing your asthma:

• Early in your pregnancy (or, even better, when you are planning to conceive), consult your family physician or allergist and your obstetrician to review your current asthma management program. Determine what self-help regimens you can use and which medications you can take while you're pregnant. Depending on the frequency and severity of your asthma, it may be wise to repeat this consultation later in your pregnancy. Some medications cause different problems at different stages of pregnancy.
  
  
• Avoid unnecessary exposure to allergens, primarily cigarette smoke and other pollutants. Pay particular attention to your sleeping environment. You may need an air filter in your bedroom during your pregnancy, even though you may not have needed one before (a HEPA-type is the most effective).
  
  
• Keep your nasal passages and sinuses clear using the methods suggested on page 392. As veteran asthmatics know, keeping nasal passages and sinuses clear is one of the best preventive measures against asthma.
  
  
• Seek medical attention and treat your asthma early, before the attack escalates to compromise your breathing. While pregnant, many women find it's necessary to call the doctor earlier and to treat their asthma more aggressively than before they were pregnant.
  
  

Medications for asthma. If you have chronic asthma and are on a treatment regimen that has been working for you, do not stop or change your medication before checking with your doctor. Don't let the fear of taking medicine set you up for an asthma attack, which may be more harmful to your baby than the medication. Albuterol, the mainstay of asthma treatment, is the most common medication used in pocket inhalers and home nebulizers. Because albuterol can elevate the heart rate in mother and baby, raise maternal blood pressure, and cause changes in maternal and fetal blood sugar, it must be used exactly as prescribed by the physician. Even though albuterol is generally considered safe during pregnancy and is an example of a medication in which the benefits usually outweigh the risks, it still is in the "yellow light" category, meaning it needs to be used with caution. Cromolyn is in the "green light" (safe) category as a maintenance medication for chronic asthma. Epinephrine-containing products should be avoided unless recommended by your doctor; they are usually used only in severe asthmatic attacks. Despite the "yellow light" rating, inhaled steroids are considered safe for treating asthma as long as they are used under a physician's close supervision and in the dosage and frequency advised by the doctor.

Urinary Tract Infections (UTIs)

A full bladder competes for pelvic space with a growing uterus. Urinary tract, bladder, or kidney infections may result. Many women will have at least one episode sometime during their pregnancy The symptoms of a urinary tract infection (UTI) or bladder infection (cystitis) include painful urination, burning on urination, increased urgency and frequency of urination, lower abdominal or pelvic pain, and possibly blood in the urine. Sometimes the infection can spread upward into the kidneys (called "pyelonephritis"), causing severe back pain, fever, chills, rapid heart rate, vomiting, and a generally very ill feeling. Urinary tract infections are treated with a combination of self-help methods and medicine prescribed by your doctor. Here are ways to lessen your chances of getting a UTI.

• Drink extra fluids. Cranberry juice in particular is thought to kill bacteria in the urine.
  
  
• Don't hold on to your urine; go as soon as you feel the urge.
  
  
• Empty your bladder thoroughly at each urination by triple voiding: urinate once, wait about ten seconds, urinate again, and then a third time.
  
  
• Empty your bladder before and after intercourse.
  
  
• Wear loose-fitting underwear, panty hose, and slacks.
  
  
• Keep your regularly scheduled prenatal appointments, at which your doctor will routinely check your urine for signs of infection.
  
  
• If you suspect you have a bladder or kidney infection, have your urine checked immediately. Oftentimes, your doctor can detect a UTI immediately with routine urinalysis; sometimes an overnight culture is needed. Some women will grow bacteria in their urine even without symptoms (called "asymptomatic bacteriuria"), and this condition increases the chances of getting UTIs. To screen for this, your doctor may perform frequent urine cultures as part of your prenatal care. If you have a urinary tract infection, your doctor will prescribe an antibiotic that is safe for you to take while pregnant. The type and the duration of the antibiotic will depend upon the severity of your UTI and your stage of pregnancy. It's important to be vigilant about following your doctor's instructions in treating UTIs. Improperly treated UTIs increase the risk of having a problem pregnancy or premature delivery.
  
  

Intestinal Disorders

The intestinal flu can strike the already queasy stomach of pregnancy. An infection of the intestinal lining is called "gastroenteritis." It is recognized by the symptoms of nausea, vomiting, diarrhea, crampy lower abdominal pain, and often fever. While you don't have to worry that the infection affects your baby, the resulting loss of fluids and body salts (electrolytes) could cause you to become dehydrated, jeopardizing your health and that of your baby. So, your main goal if you have any intestinal disorder that causes vomiting and/or diarrhea is to keep yourself adequately hydrated.

• Go to bed and rest as many hours a day as you can.
  
  
• Prevent dehydration. Sip on fluids all day long. Small, frequent sips are best. You may need to drink an additional quart of fluids in addition to your already increased fluid intake. To be sure you're replenishing adequate electrolytes, try oral electrolyte solutions (Pedialyte, Resol, Rehydralyte, Ricelyte), available over the counter. Commercially available oral rehydration fluid has the proper balance of sugar and electrolytes to promote adequate absorption of fluids from inflamed intestines. Many homemade mixtures contain either too much sugar or not enough sodium. Too much sugar in the solution can actually increase the diarrhea. You can make your own solution: to 1 quart of juice (orange, grape, apple, or pineapple) add 2 teaspoons of table salt.
  
  
• Because of nausea and vomiting you may find it easier to retain fluids taken in the form of juice bars or ice chips.
  
  
• Unless you really can't keep them down, it's important to eat some solid foods; otherwise the diarrhea may worsen and your nutrition may be inadequate. Try these easy-on-the-intestines foods: rice, baked potatoes, bananas, and yellow vegetables.
  
  

Medications for vomiting. Some medicines to treat vomiting (called "antiemetics") are safe, some are not. Emetrol (basically a cola syrup) is a safe and sometimes helpful medication for nausea and vomiting. One tablespoon taken several times a day may relieve stomach upset. Phenothiazines (Compazine) and Trimethobenzamides (Tigan), despite the "yellow light" category, are generally considered safe for pregnancy, especially in the short term used for the treatment of occasional vomiting from gastrointestinal disorder or severe morning sickness.

Antidiarrheal medications. No antidiar-rheal medications (even those obtained over the counter) should be taken without your doctor's advice. Increased intestinal motility and consequent diarrhea is the body's natural way of getting rid of harmful bacteria and toxins in the intestines. Medicines that slow down intestinal motility or cause the infected material to remain longer in the intestines may actually be dangerous because they prolong the time the bacteria and toxins remain in the intestines. Unless there is severe discomfort or the woman is in danger of dehydration, most doctors suggest their patients not use antidiarrheals. The combination of kaolin and pectin (Kaopectate), even though it is safe to take during pregnancy, is not very helpful. Imodium A-D is a more effective antidiarrheal and is reported to be safe to take during pregnancy. Still, it may be better to allow the intestines to rid themselves of bacteria and toxins naturally, so we have put these two medications in the "yellow light," or caution, category. However, if your doctor feels that it would be better in your situation to slow down the diarrhea, Imodium A-D may be the best choice. Pepto-Bismol contains sa-licylate (similar to the drug found in aspirin), which may cause bleeding in mother and/or baby; Bismuth has been linked to birth defects in experimental animals. Neither of these medications is regarded as safe to take while pregnant.

If you are in danger of becoming dehydrated from vomiting and/or diarrhea, and your illness does not seem to be self-limiting, your doctor may choose to rehydrate you with an intravenous solution that can be administered over several hours while you are an outpatient in the doctor's office or in an emergency room. For many women, intravenous rehydration is the quickest way to prevent dehydration, and most report they feel better immediately after the treatment.

Medications for treatment of gastro-esophageal reflux or heartburn. Medications that block gastric acid secretion (called "H²-receptor antagonists"), such as Tagamet, Zantac, and Pepcid, seem to be safe to take while pregnant and fall into the "green light" category. However, even these medications should not be taken without a doctor's advice. Over-the-counter antacids, such as Turns, Mylanta, Mylecon, Milk of Magnesia, Maalox, and Rolaids, are all safe to take during pregnancy and are also in the "green light" category. Because it contains aspirin (see page 399), Alka-Seltzer is not safe to take during pregnancy, although Alka-Seltzer-brand compounds that do not contain aspirin are safe. Phenobarbital-containing antispasmodics (Donnatal) are in the "red light" category, since phenobarbital has been reported to harm fetal development.

Fever

During pregnancy, a woman's body temperature increases by approximately 1° anyway due to the hormones of pregnancy and also because of her stepped-up metabolism. High fever, however, is both uncomfortable for mother and potentially harmful to baby. Both animal experiments and studies in pregnant women have shown a statistical increase in spinal column abnormalities in mothers who had prolonged, elevated temperatures above 102° F (39° C) in the first trimester, especially between the third and fifth week of pregnancy. These studies looked at women whose body temperatures were elevated from extended hot tub exposure; the up-and-down fever pattern associated with most infections is less likely to harm baby Nevertheless, it's prudent to treat a fever aggressively while pregnant. Here are safe measures to lower fever:

• Dress for the temperature. Don't overdress or underdress yourself. Putting on too many clothes retains your body's heat; underdressing encourages shivering, which produces more heat. Wear lightweight, loose-fitting clothes that allow the air to circulate over your skin. Change your clothes frequently if you are perspiring profusely.
  
  
• Keep cool. Open a window, turn on the air conditioner, go outside. Cool, fresh air removes the heat from your body
  
  
• Drink lots of fluids. Sweating and fast breathing cause your body to lose fluids that need replacing. Carry around a water bottle and sip all day long.
  
  
• Feed the fever. The extra heat you produce burns up fuel that needs replacing with nutritious calories. Calorie-filled, cool smoothies combine the need for food and fluids.
  
  
• Take a cool dip. Soak in a lukewarm bath or shower that is cool enough not to be uncomfortable or make you shiver. Then step out of the tub while still wet and allow your body to cool as the water evaporates. Rubbing yourself vigorously with a towel increases the circulation to the skin and accelerates heat loss.
  
  

Medications for pain and fever. Aspirin is not the preferred fever-reducing medication to take while pregnant, because there are safer and equally effective alternatives. Don't worry if you have taken a couple of aspirin on a couple of occasions. This is unlikely to harm your baby. The main concern with aspirin is that prolonged high doses, especially in the third trimester, may cause bleeding in mother or baby (aspirin is an anticoagulant) or interfere with the normal onset of labor (aspirin inhibits prostaglandins). Obstetricians sometimes use low-dose aspirin to prevent pregnancy-induced hypertension, eclampsia, and other intrauterine problems. The jury is still out on whether prolonged use of aspirin in the first trimester is associated with congenital defects, but the evidence seems to favor no link between taking aspirin during the first trimester and congenital defects.

Ibuprofen (Motrin, Nuprin, Advil) is safer than aspirin during pregnancy, but it should be taken only with a doctor's advice. No studies link ibuprofen taken during the first and second trimesters with congenital defects, placing ibuprofen in the "green light" category for the first two trimesters. Ibuprofen does not have the anticoagulant effect of aspirin and is therefore unlikely to cause bleeding in mother or baby when taken in the third trimester. However, because, like aspirin, it also inhibits prostaglandins (natural hormones that influence labor), it must be used with caution during the third trimester. Because of its antiprostaglandin effect, ibuprofen can also interfere with the normal blood flow within the heart and blood vessels of the baby during the third trimester. These effects are likely to disappear when the drug is stopped, though, and have not been shown to harm baby. Thus, ibuprofen is considered an effective fever-lowering medication, safer than aspirin, and safe to take in the first two trimesters — but only under a doctor's supervision.

Acetaminophen is safe to take throughout all stages of pregnancy It is an effective fever-reducer and an analgesic for pain. Even though acetaminophen is in the "green light" category, if high doses are needed over a prolonged period of time, it should be taken under a doctor's supervision. (This is true of all medications.) Studies have shown that high doses of acetaminophen throughout pregnancy may be harmful to mother and baby. Acetaminophen, if used in the proper dosage and for the usual two-to-three-day illnesses associated with fever, is considered safe for both mother and baby.

Taking medications safely while pregnant

Green Light: Go Ahead

These medications, if used in the dosage and duration prescribed by your physician, have not been shown to be harmful for mother or baby.

Yellow Light: Use Caution!

Drugs in this category should be taken only when the physician decides that the health benefits to the mother (and usually, therefore, also to the baby) outweigh the potential risk to the baby. Most of the drugs in this category are available only with a prescription and should be taken only under the supervision of your doctor, and only in the dosage and duration prescribed. Some drugs are in this category because animal studies have shown potential risk to the fetus. Others should be used with caution because there are not enough human studies available to determine whether or not the drug is safe.

Red Light: Stop!

These drugs have been shown to pose a risk to the fetus and are recommended only when a safer alternative cannot be used or when mother's health is seriously in jeopardy.