Starting or expanding your family is a very exciting time. Women must remember that anything they eat or medication that they take has the potential to come into contact with their unborn child. In some cases, such as when flu or pertussis vaccines are given, this exposure is very beneficial. In other cases, there may be potential for harm.

During the first trimester, the fetus is most susceptible to harm. Medications such as pain relievers may be necessary during later trimesters or during delivery, but are not normally used in the beginning of pregnancy.

All medications are classified by the Food and Drug Administration (FDA) into pregnancy categories A, B, C, D, X or N. These categories do not take into consideration possible causes for birth defects and this classification system is not a replacement for clinical judgment. Generally, medications that are classified as X are NEVER used in pregnancy. The table here lists several common medications and their respective pregnancy categories.

Common Illnesses

About half of all women who become pregnant will experience nausea or vomiting. Prescription medications used to treat morning sickness are metoclopramide, ondansatron, and antihistamines. There is a new FDA-approved prescription medication called Diclegis, which is a combination of doxylamine (active ingredient in Unisom) and pyridoxine (form of vitamin B6). Supplements such as ginger and vitamin B are also commonly used, however the FDA does not regulate these.

Women who are pregnant are also more susceptible to catching a cold or the flu. During the 2013-2014 flu season, two pregnant Arkansans died due to complications caused by the flu. The best prevention is to get the flu shot, which is safe and effective during pregnancy.

Most obstetricians recommend avoiding all medications during the first 12 weeks of pregnancy. Saline nasal drops or spray for loosening mucus, nasal strips, or gargling with salt-water for a sore throat or cough can be used anytime during pregnancy. Several over-the-counter medications can also be used to alleviate cold or flu symptoms in pregnancy, including Tylenol for headache or aches and pains, antihistamines such as Claritin for stuffy nose, or Robitussin for cough. Check the labels of cough syrups to ensure they do not contain alcohol, and speak with your pharmacist or physician before taking any over-the-counter medications.

Pregnancy Categories Definition per Food and Drug Administration Drugs in this category
Category A Adequate and well-controlled studies have failed to demonstrate a risk to the fetus in the first trimester of pregnancy (and there is no evidence of risk in later trimesters). Diglegis
Category B Animal reproduction studies have failed to demonstrate a risk to the fetus and there are no adequate and well-controlled studies in pregnant women. Acetaminophen (Tylenol), penicillin, azithromycin (Z-Pack), metoclopramide (Reglan)
Category C Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks. Promethazine, aspirin, caffeine, fluconazole (Diflucan)
Category D There is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience or studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks. Tetracycline, alprazolam (Xanax)
Category X Studies in animals or humans have demonstrated fetal abnormalities and/or there is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience, and the risks involved in use of the drug in pregnant women clearly outweigh potential benefits. Alcohol, most statin medications (Lipitor, Crestor), Accutane
Category N FDA has not classified the drug.


Source: FDA.gov. These categories are defined by the Food and Drug Administration (FDA).

Recommended Vaccines

In October 2012, the Centers for Disease Control and Prevention recommended that women receive the tetanus/diphtheria/acellular pertussis, or Tdap, vaccine during each pregnancy between 27 and 36 weeks. This recommendation is in response to the recent spike in pertussis cases around the US. In 2012, the number of reported pertussis cases was the highest it has been since before the development of the vaccine.

In recent years, up to 1,450 infants have been hospitalized due to pertussis and about 10 to 20 die each year. Most of the deaths are in infants too young to be vaccinated with the childhood pertussis vaccine (DTaP). To protect these infants, everyone who may come into contact with the baby should also receive a Tdap vaccination.

Stay healthy during your pregnancy by having regular obstetric care visits, getting recommended immunizations, and preventing or treating illnesses. Remember, your pharmacist is an accessible healthcare provider who can help on weekends or after physician offices are closed.

Eric Crumbaugh, Pharm.D., is Director of Clinical Programs for the Arkansas Pharmacists Association. Eric and his wife Jennifer, also a pharmacist, have a 2-year-old daughter, Olivia Grace. They live in Benton.