For the majority of analgesics available excepting acetaminophen and the NSAIDs, and to a lesser extent certain opioids , good prospective clinical trials documenting pharmacokinetic changes do not exist. More research is needed in both the scientific and clinical community to understand the risks and benefits of analgesic use in pregnancy, particularly as prevalence is rising.
Keywords: Addiction; metabolism; neonatal abstinence syndrome; obstetrics; pain; teratogenesis.. As the cold and flu season arrives, the RCOG review also found that it is important to ensure that women are aware that many over-the-counter remedies for coughs and colds may contain paracetamol, and if taken alongside paracetamol may lead to accidental overdose. In a bid to avoid flu, the RCOG continues to encourage pregnant women to have the flu jab. Earlier this week, Public Health England urged pregnant women to have the flu jab, after a fall in take-up compared to this time last year.
Dr Dina Bisson, Consultant Obstetrician and lead author of the review, said:. Many women may develop headaches, lower back pain and pelvic pain during pregnancy and breastfeeding, while others may have chronic conditions, where pain management is necessary. But if pain relief drugs are required, it is important that doctors and midwives are able to advise on appropriate medication and hopefully this review will be helpful. Flu can occasionally be serious for pregnant women as it increases risk of complications, such as bronchitis, a chest infection that can develop into pneumonia.
The best way to avoid getting this is to have the flu vaccination. Women who are pregnant should be reassured that current evidence shows the flu vaccine is safe to use. We strongly advise women to talk to a pharmacist, GP, obstetrician or midwife before taking any medications, including those that can be bought over-the-counter. It found:. For more information about pain relief during pregnancy, after childbirth and breastfeeding, please visit NHS Choices.
However, at high doses, antacids containing calcium can cause milk-alkali syndrome, 54 and antacids with aluminum can cause neurotoxicity. Selective histamine H 2 blockers have been used in all trimesters with no known teratogenic effects. In a meta-analysis of 2, women taking H 2 blockers, the OR for congenital malformations was 1. Proton pump inhibitors recently became available OTC. Although concerns have been raised about the potential teratogenicity of omeprazole Prilosec , multiple large cohort studies have demonstrated its safety when taken before conception and during the first trimester.
Proton pump inhibitors and H 2 blockers are considered safe in pregnancy. Diarrhea and constipation are common during pregnancy. Products containing bismuth, mineral oil, and castor oil should be avoided.
Bismuth itself is safe, but it has the same risks as aspirin when combined with salicylate. Although the American Gastroenterological Association considers loperamide to be low risk, it should be avoided when possible until further information is available. Considered safe in pregnancy; magnesium may cause tocolysis in late pregnancy, but this is not a risk with over-the-counter preparations. Simethicone available as a single agent and contained in multiple combination antacids.
Sodium salicylate is not thought to suppress platelet function like the salicylate moiety found in aspirin; however, given the concerns over potential fetal toxicity from chronic salicylate exposure, avoidance in the latter half of pregnancy may be prudent.
Data Sources : We searched PubMed, UpToDate, the National Guideline Clearinghouse, and the Cochrane database using the terms over-the-counter, medicine, and pregnancy; herbals and pregnancy; and individual drug names in combination with pregnancy.
Search dates: February to July , July The authors thank pharmacist Stephanie Owens for querying the Clinical Pharmacology database. The opinions herein are those of the authors. Already a member or subscriber? Log in. Interested in AAFP membership?
Learn more. Reprints are not available from the authors. Medication use during pregnancy, with particular focus on prescription drugs: — Am J Obstet Gynecol. Labeling and prescription drug advertising; content and format for labeling for human prescription drugs.
Federal Register. Food and Drug Administration. Summary of proposed rule on pregnancy and lactation labeling. Accessed June 28, Use of over-the-counter medications during pregnancy.
Fetal safety of drugs used in the treatment of allergic rhinitis: a critical review. Drug Saf. The safety of asthma and allergy medications during pregnancy. J Allergy Clin Immunol. Pregnancy outcome following first trimester exposure to antihistamines: meta-analysis. Am J Perinatol. Use of antihistamine medications during early pregnancy and isolated major malformations. Weber-Schoendorfer C, Schaefer C. The safety of cetirizine during pregnancy.
Reprod Toxicol. Philadelphia, Pa. Placental transfer and fetal metabolic effects of phenylephrine and ephedrine during spinal anesthesia for cesarean delivery. Werler MM. Teratogen update: pseudoephedrine. Physicians' Desk Reference. Accessed July 27, Clinical Pharmacology.
National Library of Medicine. Daily Med. Association of sympathomimetic drugs with malformations. Vet Hum Toxicol. Case-control study of a gastroschisis cluster in Nevada. Arch Pediatr Adolesc Med. Maternal medication use and risks of gastroschisis and small intestinal atresia.
Am J Epidemiol. Maternal medications and environmental exposures as risk factors for gastroschisis. A case control study to examine the pharmacological factors underlying ventricular septal defects in the North of England. Eur J Clin Pharmacol. Ferencz C, et al. The Baltimore-Washington Infant Study, — Armonk, NY: Futura Publishing; Use of oral decongestants during pregnancy and delivery outcome. Decongestant use during pregnancy and its association with preterm delivery.
Clinical inquiries. Is guaifenesin safe during pregnancy? J Fam Pract. The safety of dextromethorphan in pregnancy: results of a controlled study. What over-the-counter preparations are pregnant women taking? A literature review. J Adv Nurs. A review of the literature on the effects of acetaminophen on pregnancy outcome.
Case-control analysis of maternal prenatal analgesic use and cardiovascular malformations: Baltimore- Washington Infant Study [published ahead of print March 27, ]. Accessed August 7, Paracetamol in pregnancy and the risk of wheezing in offspring: a systematic review and meta-analysis. Clin Exp Allergy.
Acetaminophen use during pregnancy: effects on risk for congenital abnormalities. Maternal use of acetaminophen, ibuprofen, and acetylsalicylic acid during pregnancy and risk of cryptorchidism.
Acetaminophen use during pregnancy, behavioral problems, and hyperkinetic disorders. JAMA Pediatr. Acetaminophen in pregnancy and future risk of ADHD in offspring. Can Fam Physician. Acetaminophen use in pregnancy and risk of birth defects: findings from the National Birth Defects Prevention Study.
Obstet Gynecol. Aspirin and reproductive outcomes. Obstet Gynecol Surv. Aspirin consumption during the first trimester of pregnancy and congenital anomalies: a meta-analysis.
Periconceptional over-the-counter nonsteroidal anti-inflammatory drug exposure and risk for spontaneous abortion. Nonsteroidal anti-inflammatory drugs in early pregnancy. Herbal use before and during pregnancy.
Dietary supplements. Accessed July 30, Conover EA. Over-the-counter products: nonprescription medications, nutraceuticals, and herbal agents. Clin Obstet Gynecol. Evaluating the safety of St. John's Wort in human pregnancy. Pregnancy outcome following gestational exposure to echinacea: a prospective controlled study. Arch Intern Med.
0コメント