Pregnancy is tough for a lot of reasons, not the least of which is balancing your own medical needs with trying to provide the best environment for your baby.
It’s important to be mindful about what you put in your body because your baby is exposed to everything you consume. But you’re still a human being who may need to take medication for short-term or chronic illnesses.
“When we are pregnant, we naturally want to do what’s best for our child,” says UNC Health maternal-fetal medicine specialist Ebony B. Carter, MD, MPH. “A key part of my role as a high-risk OB-GYN is helping parents understand that maintaining their own health—including managing chronic conditions and addressing medical concerns—is essential to supporting a healthy pregnancy.”
Dr. Carter offers this advice for thinking about medication during pregnancy.
Safe Drugs During Pregnancy: What Doctors Know
If you’re pregnant or planning a pregnancy, your OB-GYN can give you a list of over-the-counter medications considered safe during pregnancy. They can help you determine if any long-term prescription medications need to be adjusted or changed.
Typically, your doctor will advise that you take the fewest medications needed at the lowest effective dose to manage your symptoms or underlying condition.
It’s always a risk-benefit analysis, Dr. Carter says. Is the condition the drug is treating more problematic for mother and baby than possible side effects from the drug itself?
Antidepressants are a good example: Untreated depression is associated with pregnancy risks, such as preterm birth and low birth weight. For women who need a selective serotonin reuptake inhibitor—the most commonly used class of antidepressants—to control depression during pregnancy, the benefits of taking the medication likely exceed the risks, Dr. Carter says.
It’s impossible to say any medication is 100 percent safe during pregnancy because pregnant women are typically excluded from clinical trials of medications, but doctors have observational studies and clinical experience to rely on when giving guidance.
Tylenol and Pregnancy
Pregnancy is often a time of aches and pains, and your immune system is weakened, which may lead to more viral infections such as colds and the flu. You’re even more likely to hurt yourself, because hormones that loosen your ligaments and muscles can lead to instability.
Pregnant women have long been told that if they need a pain reliever or fever reducer, they should take acetaminophen, or Tylenol, and never ibuprofen. Sold as Motrin, Advil and other brand names, ibuprofen can cause premature closure of a baby’s ductus arteriosus (a critical blood vessel) and reduce amniotic fluid levels, particularly in the third trimester.
Tylenol is still considered safe by OB-GYNs, Dr. Carter says, despite headlines about an association between mothers taking Tylenol and their children having an increased risk of autism. It’s much more likely that the underlying reason for needing the Tylenol (a mother’s pain, fever or infection) is linked to neurodevelopmental differences than the Tylenol itself, she says.
“While there was a slight increase in the risk of autism in some of the early observational studies of Tylenol in pregnancy, patients who took Tylenol were also more likely to have infections, chronic pain, ADHD and a mental health diagnosis,” Dr. Carter says.
A 2024 study of nearly 2.5 million children provides reliable data, Dr. Carter says.
“When they compared sibling pairs with the same parents—one exposed to Tylenol during pregnancy and the other not—there was no difference in autism, ADHD or intellectual disability. This provides high-quality, compelling evidence of the safety of Tylenol during pregnancy.”
Dr. Carter is concerned that if pregnant women are afraid to take Tylenol for fevers or headaches, they will choose a medication that’s less safe or just suffer through the fever. Untreated fevers in pregnancy are associated with an increased risk of neurodevelopmental problems in the baby.
“My entire job is to manage risk,” she says. “Among the options, taking Tylenol when you need it in the lowest dose you need is the least risky option for you and your baby. Women should have no guilt in making this choice because it is—by far—the safest of options.”
What to Do If You’re Pregnant and Concerned About Medication
Making decisions about medication during pregnancy is tricky, but you’re not on your own. Ask your OB-GYN for help and support in making the best decision for you and your baby.
You can even start this conversation before you’re pregnant. Dr. Carter consults with couples planning to conceive to talk about medications and management of chronic diseases.
For some drugs, such as retinol (used for acne and wrinkles) and ACE inhibitors (high blood pressure and kidney disease), alternatives must be found because they are known to be unsafe during pregnancy. Your OB-GYN can talk to your prescribing doctor to figure out a plan.
If you’re already pregnant and concerned about a medication, don’t stop suddenly. Instead, reach out immediately to your OB-GYN to get advice on what to do next.
Most of all, remember you’re doing your best for your baby.
The vast majority of the time, when something goes wrong during pregnancy, it had nothing to do with what the mother did or didn’t do, including what medications she took, Dr. Carter says.
“I see pregnant people beating themselves up for having to take a medication or having a complication during pregnancy, and it’s devastating,” Dr. Carter says. “There is no need to blame, shame or feel guilty when we’re all trying to do our best to have a healthy pregnancy, and sometimes that requires Tylenol, an antidepressant or a surgery. Pregnant women have medical needs too and failure to care for the mom is not beneficial to the baby.”
If you have questions about pregnancy, ask your doctor or find one near you.