Download Medications in Pregnancy and Breastfeeding

M edications in Pregnancy and Breastfeeding
Little information is available on the effects of most drugs on the human fetus. Avoiding
all medications is ideal, but if you need medications during pregnancy keep the following
points in mind:
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Avoid use of drugs in the first trimester (prior to 12 weeks) whenever possible.
Use non-pharmacologic remedies if possible.
Use only medications that are essential to the health of the mother.
Choose the lowest effective dose for the shortest period of time.
Benefits should outweigh the risks.
Many if these medications are available in generic form, so check with your
pharmacist.
Always check with the office if you have questions about medications.
Do not take Pepto-Bismol; Alka seltzer, Goody powders; aspirin, Advil (ibuprofen), Aleve
(naproxen), Orudis (ketoprofen), or other NSAIDS (anti-inflammatories); Nyquil or any
other medications that contain alcohol.
Influenza Vaccines
The American College of Obstetricians and Gynecologists, the American Academy of
Family Physicians, and the Centers for disease control and prevention advise flu
vaccination for pregnant women. Pregnancy places women at an increased risk of
pulmonary complications related to the flu and vaccination is the single best way to protect
women and their babies. Both the seasonal flu vaccine and the swine flu (H1N1) vaccine
are recommended for essentially all pregnant women. Both are safe to administer in any
trimester and can be given at the same time. Pregnant women should get the flu shot, not
the nasal spray version of the vaccine. More information will be provided to you as we
approach flu season.
TDaP Vaccine
The American College of Obstetricians and Gynecologists and the Centers for Disease
Control and advise the TDaP vaccine with each pregnancy. This will be offered to you
between 27 weeks and 36 weeks of gestation. This vaccine is an effective and safe way
to protest you and your baby from serious illness and complications from pertussis. The
TDaP vaccine should be administered during each pregnancy. More information will be
provided to you as you approach your 27th week.
Medications approved during preg nancy (H ang this on y our refrig erator f or q uick reference) Headaches,aches,and pains
Tylenol (acetaminophen)
Colds
Sudafed (pseudoephedrine)
Tylenol cold
Saline nasal spray/drops
Mucinex
Cough,sore,throat
Robitussin or Robitussin DM
Cough lozenges
Chloraseptic spray or lozenges
Allergies
Allegra
Benadryl
Claritin
Tavist
Chlor-Trimeton
Zyrtec
Indigestion
Tums
Rolaids
Maalox
Mylanta
Zantac
Diarrhea
Imodium AD
Kaopectate
Constipation
Metamucil
Citrucel
Fibercon
Colace
Senokot
Milk of Magnesia
Miralax
Hemorrhoids
Anusol
Preparation H
Tucks or Witch Hazel Pads
Vaginal yeast
Monistat-7
Gyne-Lotrimin
Lice
Rid
Pronto
R&C
Common Nutrition problems in pregnancy
Heartburn
• Eat small, frequent meals (6 small meals per day)
• Eat slowly, chew your food
• Stay upright for at least 45 minutes after eating
• Sleep propped up on pillows
• Avoid fried, spicy, or greasy foods
• Limit fluids with meals. Instead, drink liquids 30 minutes after meals
• Avoid caffeine
• Avoid carbonated drinks
• Avoid gas producing foods (onions, garlic, broccoli, cabbage,
etc.)
• Avoid acidic foods (citrus, coffee, lemon, etc.)
• Avoid peppermint and spearmint
• Avoid using straws
• Limit conversation at mealtime
• Avoid bending at the waist to pick something up; instead bend at
the knees.
Constipation
• Increase your fluids- especially fruit juice and water
• Increase your activity
• Increase your fiber (fresh and dried fruit, bran products, veggies,
beans, and peas)
Nausea & Vomiting
• Take your prenatal vitamin after lunch or before bed
• Eat small, frequent meals
• Try dry foods high in carbohydrates (crackers, dry cereal, graham
crackers)
• Try cold foods (they give fewer odors than hot foods)
• Drink liquids between meals, not with meals
• Suck on ice chips
• Avoid greasy foods
• Avoid strong odors, get plenty of fresh air
• Sit and rest after eating
• Eat something every 2-3 hours
• Try sour foods (lemonade, sour candies, etc.)
Special Nutritional Concerns in Pregnancy
Alcohol Consumption
Alcohol is not recommended in any amount in pregnancy. Babies born to women who consume
alcohol can be born with fetal alcohol syndrome (FAS), a combination of facial abnormalities,
growth retardation, and mental retardation. Even casual intake has been associated with higher rates
of miscarriages and low birth weight babies.
Artificial Sweeteners
Saccharin (Sweet n’ Low), Aspartame (Equal, Nutrasweet or Nutra-Taste), Acesufame K (sweet
One and Sunette), and Sucralose (Splenda) are all available in commercially made food items and
sold separately for home use.
Saccharin crosses the placenta during pregnancy and may be cleared more slowly by a developing
fetus, so small amounts are recommended in pregnancy. The other sweeteners mentioned either pass
through the mother undigested or do not cross the placental barrier. Studies conducted on animals
and in humans have suggested that these are safe to use in pregnancy. Use of these sweeteners in
moderation (2 servings per day) is still recommended.
Caffeine and Herbal Teas
Human studies relating to caffeine and pregnancy are limited. Some studies have indicated a
possible increase in fertility problems, pregnancy complications, birth defects, lower birth weights,
fetal growth retardation, and miscarriage from caffeine consumption. As a result, it is recommended
that caffeine be limited in pregnancy.
Herbal teas are not subject to any safety testing and should be limited to no more then 16 ounces a
day (or less) in pregnancy. Teas made lobelia, sassafras, coltsfoot, comfrey and pennyroyal should
be avoided completely as they have been shown to have harmful side effects. Herbal teas made
from rosehips, mint, lemon, and fruit trees are though to be safe.
Nicotine
Women who smoke while pregnant are more likely to go into pre-term labor, suffer miscarriages,
and have lower birth weight babies and their babies have an increases risk of dying of SIDS Sudden
infant death syndrome). Research indicates that second hand smoke can be detrimental to your
developing baby as well. It is recommended that you quit smoking while you are pregnant.
Food safety in pregnancy
When you are pregnant, you are at higher risk for food borne illness or “food poisoning”. Certain
foods should be avoided during your pregnancy. Additional foods, although they do not cause food
born illness, should also be limited when you are pregnant or breastfeeding.
Foods to avoid in pregnancy:
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Raw or undercooked eggs
Caesar salad dressing, soft boiled eggs, meringue pies, hollandaise sauce
Raw dairy products
Unpasteurized (or “raw”) milk or cheese (brie, feta, blue, camembert, queso fresco blanco,
gorgonzola, etc.)
Refrigerated or deli pates, meat spreads, smoked seafood (salmon, lox, trout)
Can also be labeled “nova-style”, “lox”, “kippered” or “jerky”
Raw or rare meat
Raw or uncooked shellfish
Raw fish (sushi)
Deli meats/ lunch meats, hot dogs- unless they are heated until they are steaming
Raw sprouts (alfalfa sprouts, etc.)
Foods safe to eat in pregnancy:
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Hard cheeses, mozzarella, cheese spreads, cream cheese, cottage cheese
Canned meat pates or meat spreads
Canned smoked seafood
Foods to avoid while pregnant, breastfeeding, or anticipating another pregnancy:
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Shark
Swordfish
Tilefish
King Mackerel
**Due to the risk of mercury contamination, these fish should be avoided in pregnancy
or breastfeeding. **
Brought to you by the Registered Dietitians at Novant Health WomanCare
Jennifer F. Greenly and Sandi Hamilton
(336) 765-5470
Foods to limit while pregnant, breastfeeding or anticipating another pregnancy:
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Fish in general should be limited to 12 ounces total per week due to mercury levels
Locally caught fish : limited to 6 ounces per week, with no other fish consumption
that week
Tuna : no more than 6 ounces of tuna per. Week; canned chunk white tuna is fine;
tuna steaks contain higher levels of mercury and should be limited or avoided.
Recent studies show that fish should not be avoided in pregnancy strictly due to the
risk of mercury contamination. The omega-3 fatty acids provided by fish and seafood
appear to have a beneficial on cognitive later in life.
Keeping food safe:
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Wash hands and surfaces often
Separate raw, cooked and ready to eat foods when shopping, preparing and storing
Cooks foods thoroughly and to a safe temperature
Refrigerate perishable foods promptly
Keep cold foods cold and hot foods hot
When in doubt, throw it out!
Brought to you by the Registered Dietitians at Novant Health WomanCare
Jennifer F. Greenly and Sandi Hamilton
(336) 765-5470
H erbal Products N ot recommended i n Preg nancy or Breastfeeding Many herbal products have not been evaluated for their safety in pregnancy and
breastfeeding. Some supplements are known to have adverse effects in pregnancy, such as
starting uterine contractions. Products taken by a breastfeeding mother have the potential
to be passed to the baby in breast milk. Please check with your healthcare provider before
beginning any herbal or botanical supplements. This list may not represent all of the
herbal products unsafe for pregnancy or breastfeeding.
Agnus Castus
Aloe
Angelica
Apricot Kernal
Asafoetida
Aristolchia
Avens
Blue Flag
Bogbean
Boldo
Boneset
Borage
Broom
Buchu
Buckhorn
Burdock
Calamus
Calendula
Chamomile, (German or Roman)
Chaparral
Cohosh, (Black or Blue)
Cola
Colstfoot
Comfrey
Cottonroot
Cornsilk
Crotalara
Damiana
Devil's Claw
Dong Quai
Dogbane
Ephedra
Eucalyptus
Eupatorium
Fenugreek
Feverfew
Foxglove
Franfula
Fucus
Gentian
Germander
Finseng
Golden Seal
Ground Ivy
Grounsel
Guarana
Hawthorne
Heliotropium
Hops
Horehound
Horsetail
Hydorcotyle
Jamaica Dogwood
Juniper
Liferoot
Licorice
Lobelia
Mandrake
Mate
Male Fern
Meadowsweet
Melliot
Mistletoe
Motherwort
Myrrh
Nettle
Osha
Passionflower
Pennyroyal
Petasites
Plantain
Pleurisy root
Podohyllium
Pokeroot
Poplar
Prickly Ash
Pulsatilla
Queen's Delight
Ragwort
Raspberry
Red Clover
Rhubarb
Rue
Sassafrass
Scullcap
Shepard's Purse
Skunk Cabbage
Stephania
Squill
St. John's Wort
Tansy
Tonka Bean
Uva-Ursi
Vervain
Wild Carrot
Willow
Wormwood
Yarrow
Yellow Duck
Yohimbe
Prenatal Vitamins and Omega-3
Supplements
Some women are more sensitive to prenatal vitamins and may experience slight nausea or
constipation from prenatal vitamins. There are tips at the bottom of page 2 to help with these side
effects.
You may use any brand of prenatal vitamin of your choosing. Feel free to bring your
vitamins with you to any appointment if you have questions or concerns regarding
quality.
Iron: 30mg/day. Foods high in iron should be included in the prenatal diet. In addition, you may be
advised to start taking an oral, low-dose iron supplement. Do not take iron supplements unless
directed to do so by your provider. Strict vegetarians need to make special efforts to get
adequate iron in their diet. Sources: eggs, lean red meat, liver, beans, fortified cereals, leafy
greens.
Folate: 400 to 800 mcg/day. Although adequate folate intake is easily achieved with dietary
sources, supplementation is recommended to reduce the risk of neural tube defects associated with
intakes less than 400 mcg per. Day. For women who have a child with a neural tube defect,
supplementation of up to 4g per. day is recommended. Sources: dark leafy green vegetables, citrus
fruits, beans and other legumes, wheat bran, pork, poultry and shellfish.
Calcium: 1500 mg/day. Most prenatal vitamins contain limited amounts (200-250 mg) of calcium.
By including 3-4 servings of calcium-rich foods per. day, requirements can be met. If dietary intake
is low, a separate calcium supplement should be taken. Since calcium and iron compete for
absorption, they are best taken at separate times. Sources: low-fat dairy, enriched soy products,
fortified juices, and leafy greens.
* If you begin to experience leg cramps during pregnancy a calcium supplement that contains
magnesium would be recommended to ease the frequency/intensity of cramping.*
Omega-3 fatty acids: This nutrient is not found in your standard prenatal vitamin. These are fats
that are essential to human health; but cannot be manufactured by your body. Current research is
inconclusive as to whether or not dietary supplements provide the same health benefit as eating
foods high in omega-3 fatty acids. The FDA has not established a minimum daily value nor has it
approved health statements associated with omega-3 fatty acid supplementation and pregnancy.
Omega-3 fatty acids come primarily from fish oils (EPA and DHA) and plant oils (ALA). Choose
high-fat, cold- water fish such as salmon, mackerel, halibut, sardines, and herring over supplements.
Plant sources of omega-3 fats include flaxseeds/oil, canola oil, soybeans/oil, pumpkin seeds/oil,
walnuts/oil, however, your body is inefficient at converting plant oils (ALA) into the omega-3
powerhouse DHA, so it is theorized that you will get more benefit from the omega-3 fats coming
from animal versus plant sources. Also widely available at the grocery store are omega-3 enriched
eggs (found with the regular eggs). If you choose to take an Omega-3 supplement, make sure it
is mercury free and contains between 200-300mg of DHA, such as Expecta Lipil. Omega- 3
fatty acid supplements should be used cautiously by people who bruise easily, have a bleeding
disorder, or who take blood-thinning medications. Please discuss this with your provider
before starting an omega-3 supplement.
Constipation: Prenatal vitamins contain increased amounts of minerals that may contribute to
constipation. Dietary changes such as more water, exercise and fiber may help. In addition, you may
benefit from an over-the-counter stool softener such as Docusate Sodium (Colace).
Nausea: Many women complain of nausea after taking their prenatal vitamin. Try taking vitamins
with a meal or just before with a light snack.
*If you have continued nausea/vomiting with no relief from light snacks, taking prenatal at recommended
times, and or other recommended techniques, please discuss this issue with your provider. Medications
may need to be prescribed to ease nausea and or vomiting.*