If you’re pregnant or planning to be, you could easily be confused about which medications are safe to take during this time. If you don’t think you can make it without your meds, you’re not alone. According to the Centers for Disease Control and Prevention (CDC), 90 percent of pregnant women take at least one medication at some point during their pregnancies and 70 percent take a prescription medication.

Even so, many drugs carry risks if taken during pregnancy. During the late 1950s and early 1960s, popular sedative thalidomide was prescribed for morning sickness, an unapproved medication, in pregnant women until it was revealed as the cause of severe birth defects in hundreds of babies. Since then, clinical research on pregnant women has been limited, and few large-scale trials have been conducted to determine what medications are safe to take during pregnancy. According to the CDC, fewer than 10 percent of drugs approved in the U.S. since 1980 have been researched well enough to determine birth defect risks.

For this reason, doctors often stress lifestyle interventions— such as adjusting your diet and daily habits— as the first line of treatment, just to be safe. When your sickness still won’t subside, here’s what to choose during pregnancy, or as you prepare for a pregnancy. 

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Vitamins and supplements

Spencer Richlin, M.D., fertility specialist at Reproductive Medicine Associates of Connecticut, urges all women who are pregnant or plan to be to stop taking vitamins and supplements until they can discuss them with their doctor. That goes for herbal and all-natural supplements, too.

There is one exception: a daily prenatal supplement with 800 micrograms of folic acid, which he recommends every pregnant woman take.

Over-the-counter drugs

If you use over-the-counter medications for every ache and sniffle, you’ll want to break that habit and adopt an ask-your-doctor policy.

Nonsteroidal anti-inflammatory drugs (NSAIDs), the class of meds that includes aspirin, ibuprofen (Motrin, Advil) and naproxen (Aleve), should not be taken during pregnancy. Especially if used in the third trimester, NSAIDs may increase the risks of birth defects and labor complications, according to a study in the journal of the American Academy of Family Physicians. 

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Acetaminophen is the main ingredient in Tylenol, which is not an NSAID. If you have pains during pregnancy, Tylenol is the safest bet, Richlin says. For any pain acetaminophen can’t handle, talk to your doctor about stronger options.

Not all discomfort is pain. Digestive problems during pregnancy, especially heartburn and constipation, are common. To avoid them in the first place, eat fewer fatty foods and increase your fiber and water intake.

If those steps don’t help and you still get heartburn while pregnant, chewing a stick of gum may help and antacids such as Tums and Mylanta are thought to be safe, though they haven’t been studied directly on pregnant women. For constipation, osmotic laxatives like MiraLAX and Dulcolax should be your first choice, according to guidelines published in the journal Alimentary Pharmacology & Therapeutics.

If you come down with a cold during your pregnancy, your best bet may be to tough it out. For congestion, it’s safe to gargle or snort salt water to clear your sinuses, but consult your physician if your symptoms become unbearable.

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Prescription medications

You may think your first order of business when you become pregnant is to go off all your meds, but talk to your doctor before doing that. Sometimes, it’s in your best interest to stay on your current medication, and sometimes your physician can switch you to a pregnancy-safe alternative.

“For example, take a woman with hypertension,” Richlin says. “She may normally be on an ACE inhibitor but during pregnancy her doctor should switch her to a beta blocker.” If you take a daily medication for any condition and want to get pregnant, talk to your doctor about the safest option for you.

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Not all women have the option to switch, and not all women respond well to the safest medication. Especially in the case of psychiatric illness such as depression or anxiety, stopping medication can lead to other habits, such as poor nutrition and substance use. Those habits could be a bigger risk to the baby than the presumed drug risk, according to the American College of Obstetricians and Gynecologists.

“It is imperative for the patient’s medical team to communicate and make a well-informed plan,” Richlin says. That includes the primary care doctor, OB/GYN, psychologist and any specialists you normally see.

In the end, “it’s a balancing act to meet the needs of the mother and baby,” Richlin says. It’s always in baby’s best interest to have a healthy, happy mom.