Medicine concerns during pregnancy

Date Updated: 11/19/2024

During pregnancy, you may need medicines to treat current or new health conditions. When it comes to medicine use during pregnancy, there are many considerations. In some cases, stopping a medicine during pregnancy may be more harmful than taking it. Many medicines have little to no impact on the fetus during pregnancy. However, certain medicines can cross the placenta, the temporary organ that develops during pregnancy, and increase the risk for health problems including pregnancy complications such as birth defects or pregnancy loss. It is important that you talk to your healthcare team before starting, stopping or changing medicines during pregnancy.

How medicines can affect pregnancy

How medicines affect you and your baby depends on several factors. These include:

How far along your pregnancy is.
The strength and dose of the medicine.
How easily the medicine can pass through the placenta.
Genetic factors that affect your body's response to the medicine.
Your overall health.

The way a medicine impacts a pregnancy depends on the medicine itself. There are several ways medicines can affect the fetus, including:

No effect. Many medicines don't have any impact on pregnancy.
Direct impact. Some medicines affect the fetus directly, causing damage, birth defects or death.
Indirect impact. Some medicines indirectly affect the fetus. For example, some medicines lower the parent's blood pressure, which can reduce blood flow to the placenta.
Altering the function of the placenta. Some medicines affect how the placenta functions. This can lead to reduced oxygen and nutrient supply to the fetus and cause an underweight or underdeveloped baby.
Causing muscle contractions of the uterus. Some medicines cause muscles in the uterus to contract forcefully. These contractions can harm the fetus or trigger preterm birth.

Some medicines can stay in the body after you stop taking them and may cause birth defects. Ask your healthcare professional how long any medicines you take will stay in your body.

How pregnancy can affect medicines

Pregnancy may change the way your body uses and responds to certain medicines.
Changes in the medicine dose or additional monitoring may be necessary.

The use of any over-the-counter medicines, supplements, nonprescribed use of medicines or nicotine, cannabis, or other substances during pregnancy should be discussed with your healthcare professional.

Amphetamines

Amphetamines are stimulants that speed up the messages between the brain and body. Some amphetamines such as dextroamphetamine (Adderall XR, Dexedrine Spansule) are prescribed to treat medical conditions such as attention deficit hyperactivity disorder (ADHD), narcolepsy and depression. Other amphetamines are illegal and highly addictive. This includes methamphetamine, also known as meth.

Meth use during pregnancy has been linked to miscarriage, low birth weight, preterm birth, separation of the placenta from the uterus, known as placental abruption, as well as a high blood pressure condition called preeclampsia. Babies who are exposed to meth in the womb may experience withdrawal symptoms after birth that may include jitteriness, drowsiness and trouble breathing. Prenatal exposure to methamphetamine also has been linked to brain development issues in children.

Due to serious health consequences, it's recommended to avoid methamphetamine use. For prescribed amphetamine medicines, discuss the benefits and risks of continuing use during pregnancy with your healthcare professional.

Benzodiazepines

Benzodiazepines are sedatives used to treat conditions such as anxiety, insomnia, alcohol withdrawal and seizures. They also may be used during a procedure or surgery as a part of anesthesia care. Benzodiazepines have sedative and hypnotic effects on the body which reduce anxiety and relax the muscles. As a result, benzodiazepines are often misused and can be addictive.

Studies have shown that benzodiazepine use during pregnancy is unlikely to cause birth defects but may increase the risk of miscarriage, preterm birth and low birth weight. When used regularly during the third trimester, babies are at risk for withdrawal. Symptoms of withdrawal may include:

Changes in muscle tone.
Diarrhea.
Drowsiness.
Irritability and restlessness.
Low body temperature.
Poor feeding.
Tremor.
Trouble breathing.
Vomiting.

Discuss the benefits and risks of taking a benzodiazepine during pregnancy with your healthcare professional.

Gabapentinoids

Gabapentinoids are medicines used to treat seizures and nerve pain. Gabapentinoids include gabapentin (Neurontin) and pregabalin (Lyrica).

Some studies have found that when used during pregnancy, gabapentinoids may cause a slightly higher risk of heart defects in babies. They also may be linked to preterm birth and low birth weight.

If you are taking a gabapentinoid during pregnancy, your healthcare professional may recommend that you increase your folic acid intake.

More research is needed to more clearly understand the effects of gabapentinoid use during pregnancy. Discuss the benefits and risks with your healthcare professional.

Opioids

Opioids are medicines used to relieve pain. They may come from the poppy plant or can be man-made. Opioids travel through the blood and attach to receptors in the brain. This blocks pain messages and can boost feelings of pleasure. However, using opioids often can lead to dependence and addiction.

During pregnancy, opioids cross the placenta. Exposure in the womb can lead to fetal dependence and can cause withdrawal symptoms in the baby after birth, also known as neonatal abstinence syndrome. Symptoms of neonatal abstinence syndrome in the baby may include:

Diarrhea.
Fever and blotchy skin.
Frequent yawning.
High-pitched crying.
Jitters.
Rapid breathing.
Seizures.
Tremors.

While opioids rarely cause birth defects, they may increase the risk of miscarriage, stillbirth, poor fetal growth and preterm delivery.

Discuss the benefits and risks of continuing an opioid during pregnancy with your healthcare professional.

Medicines used to treat opioid use disorder

People who take opioids over a long period of time are at risk of developing opioid use disorder. Opioid use disorder is described as having cravings to use opioids, inability to control the use of opioids, and continued use despite having negative health and life-related consequences.

In some people, opioids can boost feelings of pleasure and create a sense of well-being. Once those feelings wear off, a person may take more opioids to get those feelings again. Over time, these individuals may need to take larger quantities to get the same feelings. This is how dependence starts. Opioid use disorder can lead to serious health problems, including overdose and death.

During pregnancy, medicines are available to treat opioid use disorder. These medicines are safe to use during pregnancy and breastfeeding and have been shown to improve outcomes both for patients and their babies through increased prenatal care and by reducing the risk of overdose and death.

For those with opioid use disorder during pregnancy, it's recommended to start these medicines as early as possible and continue use throughout pregnancy, after birth and beyond. Medicines for opioid use disorder carry a risk for neonatal abstinence syndrome, a condition where babies go through withdrawal after birth from substances they were exposed to in the womb. However, this risk is lower than in those babies exposed to nonprescribed opioids such as fentanyl or heroin and is generally less severe and for a shorter time. Medicines used may include:

Methadone. Methadone is a long-acting opioid that reduces the effects of other opioids and reduces cravings and withdrawal symptoms. It is a preferred medicine for the treatment of opioid use disorder in pregnancy and helps individuals achieve and maintain recovery. Methadone is not associated with birth defects and is prescribed by a certified opioid treatment program.
Due to the effects of pregnancy, it is common for people to need their methadone dose increased or split into two separate doses during pregnancy.
Buprenorphine.Buprenorphine has some effects of opioids but also blocks other effects of opioids. It reduces cravings and withdrawal symptoms. It is a preferred medicine for the treatment of opioid use disorder in pregnancy and helps individuals achieve and maintain recovery. Buprenorphine is not associated with birth defects.

Discuss medicines for the treatment of opioid use disorder with your healthcare professional to decide which option is best for you.

Triptans for migraines

Triptans are medicines used to treat headaches and migraines. They may be taken by mouth in a pill form, in a nasal spray or by injection. Recent research has found that taking triptans for migraines during pregnancy is safe. Sumatriptan is the preferred medicine because it has the most safety data for use in pregnancy.

Discuss the benefits and risks of continuing a triptan during pregnancy with your healthcare professional.

Selective serotonin reuptake inhibitors

Selective serotonin reuptake inhibitors (SSRIs) are medicines commonly used to treat depression and anxiety. They are considered the first line treatment for depression and anxiety during pregnancy and after birth.

SSRI use in the first trimester carries a low risk of birth defects and little to no risk for miscarriage. These medicines may be associated with a small risk of high blood pressure disorders in pregnancy such as preeclampsia, as well as preterm birth.

Untreated and undertreated mental health conditions are associated with poor outcomes for pregnant and postpartum people. In general, stopping effective medicines for mental health during pregnancy or the postpartum period increases the risk of relapse and is not recommended.

For people who have been treated with success with an antidepressant in the past, that antidepressant is often recommended as the first choice. For those starting a medicine for the first time during pregnancy or if previous medicines were unsuccessful, sertraline (Zoloft) is typically the preferred medicine due to reassuring safety data.

Discuss the benefits and risks of starting or continuing an SSRI during pregnancy with your healthcare professional.

Cannabis

Cannabis is a broad term that describes products or chemical compounds that come from the cannabis plant species. It is commonly known as marijuana or weed. Cannabis is legal in much of the United States and use may be medical or recreational.

Whether medical or recreational, cannabis use during pregnancy should be avoided. Cannabis use increases the risk of gestational diabetes, gestational hypertension and preeclampsia. Use also may increase the risk of placental abruption, a condition where the placenta separates from the uterus too early.

Cannabis crosses the placenta and has been linked to higher rates of low birth weight, preterm birth and need for admission to the neonatal intensive care unit.

Nicotine replacements

Tobacco use during pregnancy can lead to many complications. Healthcare professionals advise quitting all forms of nicotine during pregnancy. The use of therapy may be enough for some. For those who have trouble quitting, nicotine replacement therapy (NRT) may be an option. The use of patches, gum, lozenges and other forms of nicotine may help people who smoke quit.

All in all, nicotine replacement therapy is considered safer than smoking because NRT has fewer toxins. Nicotine replacement products provide smaller amounts of nicotine in a slower-release form. This decreases cravings and makes quitting easier.

More research is needed to fully understand the effects of NRT use during pregnancy. It is generally recommended to use the lowest effective dose. Discuss the risks and benefits of the different forms of NRT with your healthcare professional to decide what is right for you.

Questions to ask your healthcare professional

Will I need to change my medicines if I want to get pregnant or if I find out I'm pregnant?
How might this medicine affect my pregnancy?
Are there medicines and supplements I should avoid?
Will I need to take more or less of my medicine?
Can I keep taking this medicine when I start breastfeeding?
What medicines should I take when I am pregnant?