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Many over-the-counter and prescription medications are safe to take during pregnancy. The following list of over-the-counter medications can safely be used to treat many common problems you may encounter during your pregnancy. However, if you ever have any questions regarding the safety of a medication, please don’t hesitate to call your provider’s office.

Western Colorado Physicians Group: (970) 241-6011

Family Physicians of Western Colorado: (970) 245-1220.

Headaches/Pain/Fever: Tylenol and Extra Strength Tylenol.
➤ DO NOT TAKE Motrin, Ibuprofen, Aleve, Aspirin or Naprosyn in pregnancy.

Heartburn: Rolaids or Tums should be tried first. Others that may be used are Maalox, Mylanta, Zantac, Pepcid, Prilosec or Prevacid.
➤ DO NOT USE Pepto-Bismol in pregnancy.

Seasonal Allergies: Benadryl, Zyrtec, Flonase, Claritin or Allegra.

Sore Throat: Most lozenges and sprays can be used. Salt water gargle.

Congestion/Runny nose: Nasal saline rinse, Flonase, Tylenol and Benadryl – Use caution when taking medication containing Phenylpropanolamine as it can elevate blood pressure.

Cough: Robitussin, Robitussin DM, Mucinex

Insomnia: Tylenol PM, Unisom or Benadryl

Constipation: Colace, fiber supplements, Miralax
* Note: Generics may be substituted for brand names in the suggested medications above.

Cold and Flu:
As far as it is known, the medications listed below do not cause any harmful effects during pregnancy. They are frequently used in pregnancy, but formal studies are generally not conducted using pregnant women. Cold and flu symptoms usually last ~ 7- 10 days regardless of treatments. Since these illnesses are frequently viral, antibiotics are not effective. Taking ineffective medication may result in risk without benefit. It may also result in resistant strains of bacteria.

Home remedies:
1. Increase fluid intake.
2. Use a humidifier.
3. Zinc. Controlled studies have shown taking Zinc will cut the time of your flu in half and taking Zinc when not ill will reduce the number of illnesses by half. Take 100mg per day when sick and 50mg per day to prevent illness. Zinc can be taken in pill form or by lozenges. 4. Get plenty of rest.
5. Eat a healthy, well-balanced diet.
6. Avoid caffeine.
7. Afrin nasal spray. Prolonged use can cause dependency.

When to call your doctor:

• Fever over 101 degrees
• Symptoms for greater than 7 days that do not appear to be improving.
• Difficulty breathing (not including a stuffy nose)
• Coughing up blood or rusty sputum

Discover more about your growing family with prenatal genetic screening through Natera.

Learn more: natera.com

A lot’s gonna change. You’ve got this! Learn more and get connected with your free personal nurse through the Nurse-Family Partnership.

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Phone: 970-248-6900

Eating healthy during pregnancy will benefit you and your baby. Eat a balanced diet with no more than 30% of your calories from fat and avoid simple sugars. Reducing your salt intake and drinking plenty of water will help reduce swelling. Try to drink at least 8 glasses of water a day. This can help reduce constipation and can prevent pre-term labor. Eat plenty of fruits and vegetables and avoiding sweets and starchy foods. Limit your caffeine intake to less than 200 milligrams per day.

You need to make sure you get enough protein by eating lean meats, eggs, legumes and fish. However, fish consumption should be limited to 12 ounces per week of store bought fish, including shellfish, or 6 ounces of fresh-caught fish. There are certain fish you should avoid because of their high mercury content. These fish include tilefish, swordfish, king mackerel and shark. For more information, visit ewg.org You should limit your cheese intake to pasteurized cheeses only and avoid soft imported cheeses. Also, avoid cold hot dogs and cold lunch meats and uncooked smoked seafood. These foods may carry a bacteria called Listeria that could be harmful.

Make sure you get between 1200-1500 mg of calcium per day. Skim milk and leafy greens are a good source of calcium but if you can’t get enough from food, taking a calcium supplement is sometimes necessary. A good goal for your pregnancy diet is to eat foods that are high in nutrition, like
fruits and vegetables. Avoid foods that are empty calories like sweets and sodas. Don’t attempt a weight loss diet without discussing it with your doctor.

Taking a prenatal vitamin is usually recommended for all pregnant and breastfeeding women. Over-the-counter prenatal vitamins are essentially the
same as prescription prenatal vitamins. Folic acid reduces the risk of neural tube defects and if possible should be taken three months before a woman becomes pregnant. Sometimes vitamins can make nausea worse. If taking prenatal vitamins makes you too nauseated, try to at least take some folic acid instead. Folic acid can be found in orange juice and fortified cereals.

Treatment
Reducing the size of meals and eating more frequently can prevent nausea because sometimes an empty stomach can trigger it. Eating bland foods that are low in sugar but high in carbohydrates and protein can also help. Sometimes sucking on something that causes frequent swallowing like ice chips or sunflower seeds can also lessen nausea.

While some over-the-counter remedies such as Ginger, Vitamin B6, and Acupressure can offer some relief, sometimes prescriptions are necessary to
control nausea. These can include Antihistamines, Dopamine antagonists and Serotonin antagonists.

Talk to your doctor before taking any medications during pregnancy.

You probably know that when you are pregnant, you share everything with your baby. That means when you get vaccines, you aren’t just protecting yourself-you are giving your baby some early protection too. You should get a flu shot and whooping cough vaccine (also called Tdap) during each pregnancy to help protect yourself and your baby.

Whooping Cough Vaccine
Whooping cough (or pertussis) can be serious for anyone, but for your newborn, it can be life-threatening. Up to 20 babies die each year in the United States due to whooping cough. About half of babies younger than 1 year old who get whooping cough need treatment in the hospital. The younger the baby is when he or she gets whooping cough, the more likely he or she will need to be treated in a hospital. It may be hard for you to know if your baby has whooping cough because many babies with this disease don’t cough at all. Instead, it can cause them to stop breathing and turn blue.

When you get the whooping cough vaccine during your pregnancy, your body will create protective antibodies and pass some of them to your baby before birth. These antibodies will provide your baby some short-term, early protection against whooping cough.
Learn more at www.cdc.gov/pertussis/pregnant/.

Flu Vaccine
Changes in your immune, heart, and lung functions during pregnancy make you more likely to get seriously ill from the flu. Catching the flu also
increases your chances for serious problems for your developing baby, including premature labor and delivery. Get the flu shot if you are pregnant during flu season- it’s the best way to protect yourself and your baby for several months after birth from flu-related complications.

Flu seasons vary in their timing from season to season, but CDC recommends getting vaccinated by the end of October, if possible. This timing helps protect you before flu activity begins to increase. Find more on how to prevent the flu by visiting www.cdc.gov/flu/.

Keep Protecting Your Baby after Pregnancy
Your ob-gyn or midwife may recommend you receive some vaccines right after giving birth. Postpartum vaccination will help protect you from getting sick and you will pass some antibodies to your baby through your breastmilk. Vaccination after pregnancy is especially important if you did not receive certain vaccines before or during your pregnancy.

Your baby will also start to get his or her own vaccines to protect against serious childhood diseases. You can learn more about CDC’s recommended immunization schedule for children and the diseases vaccines can prevent at www.cdc.gov.

Even before becoming pregnant, make sure you are up to date on all your vaccines. This will help protect you and your child from serious diseases. For example, rubella is a contagious disease that can be very dangerous if you get it while you are pregnant. In fact, it can cause a miscarriage or serious birth defects. The best protection against rubella is MMR (measles-mumps-rubella) vaccine, but if you aren’t up to date, you’ll need it before you get pregnant.

Keep in mind that many diseases rarely seen in the United States are still common in other parts of the world. Talk to your ob-gyn or midwife about vaccines if you are planning international travel during your pregnancy. More information is available at www.cdc.gov/travel.

Marijuana in breast milk was first described in 1982, about the same time as the first long-term studies of marijuana use in pregnancy were beginning. Those studies were limited in scope, and marijuana has changed a lot since then. THC was about 4% per joint. Today, it’s more than 20%.
“After we legalized marijuana here in Colorado, there were questions about what happens if someone were positive when they gave birth,” says pediatrician Maya Bunik, MD, MPH. “Some hospitals were testing urine and recommending that mothers pump and dump for two weeks, but this was all based on a hunch. The truth is we don’t know enough yet, and there aren’t any recommendations for the interim.

Studies on the effects of THC in adolescents,” she adds, ” have found that kids have long-term issues with cognitive function, executive function, attention issues, depression and anxiety. Until we have more research, we should be cautious and assume that it can affect infants the same way.”

From 2016 to 2019, with funding from the Centers for Disease Control and Prevention and the Colorado Health Department, Children’s Colorado neonatologist Erica Wymore, MD, MPH, led a prospective, observational pharmacokinetic study of participants with prenatal marijuana use who had delivered their babies and intended to breastfeed. Dr. Bunik was a senior principal investigator along with five additional researchers.

Study participants were frequent marijuana users, daily or several times a week. Notably, inclusion criteria stipulated abstention from marijuana for six weeks. After providing substance use patterns, participants were asked to provide plasma, breast milk and urine samples 2 to 5 times per week over the six-week period.

The team tested approximately 12 metabolites across 402 plasma-milk samples. All participants had detectable THC in their breast milk through the entirety of the six weeks, with trace amounts of other metabolites.

“It’s not surprising that we detected THC in the breast milk,” Dr. Bunik says, “given that it’s a lipophilic substance and lives in fatty tissue. But it lasts much longer than we thought it would. I think we had hoped to prove a shorter duration of exposure to the psychoactive component.”
Importantly, THC was more concentrated in breast milk than in plasma or urine, which suggests those testing sources aren’t as reliable a foundation for breastfeeding recommendations. Even more surprising was the range of THC concentration in breast milk. Some participants had very small amounts, and some had 10 t o 100 times higher, which is likely related to patterns of marijuana use, a person’s BMI or their metabolism.

Notably, the criteria to abstain from marijuana for six weeks was a hurdle for researchers and participants. Over the length of the study, researchers screened nearly 400 participants. One hundred and five participants were eligible with only 25 making the commitment to abstain from marijuana use. After testing the samples, the researchers found only 7 of the participants were able to truly abstain.

“If THC is indeed dangerous for infants, and we posit that it is, we learned just how difficult it was for these mothers to stop,” says Dr. Wymore. “That’s concerning, and the issue is being delayed until the delivery hospitalization. We should be proactive about safe breastfeeding long before people have a baby and get to that point.”

“It also points to the fact that we’re not doing enough as a prenatal community to help address stress in other ways,” adds Dr. Bunik. “There’s a huge opportunity here. Some individuals use marijuana for nausea, relaxation, sleep and so on. If our goal is safe breastfeeding and we don’t yet know how marijuana affects infants, what can we recommend now while we learn more? Could we be connecting patients to support groups? Should we be addressing the fact that if they’ve had a history of anxiety and depression that it may be more pronounced by the pregnancy and postpartum stage? It’s not enough to say you shouldn’t use marijuana. We should develop standard alternative options.”

At the time of the study, the Colorado Multiple Institutional Review Board advised against the research team testing infants due to potential ramifications such as mandatory reporting related to a federally illegal substance. If they were to recreate the study today, the team says they would store the samples from the infants and work to deidentify them later for analysis of infant metabolism.

Transportation was also a notable concern. “It’s one thing for participants to come twice a week when the baby is in their belly, but having an infant makes it much harder. At about the midpoint we realized a drop-off in recruitment, and we started having a designated taxi service that would pick them up,” says Dr. Bunik.

The team also recently submitted an addendum to the Review Board requesting to recontact study participants for longitudinal work, and they plan to include that in future study criteria from the outset. “It’s critical that we have better data on quantification of marijuana exposure and what those outcomes are for school-age children,” Dr. Wymore says.

Perhaps one of the most fascinating takeaways for the team came up when they presented the data at an international conference in Amsterdam. A researcher from Amsterdam was incredulous that U.S. researchers would want to study smoking marijuana and breastfeeding.

“In their country, it’s been legal for nearly 30 years,” says Dr. Bunik. “The conference attendee queries, ‘We smoke recreationally, but everybody knows that as soon as someone is pregnant, you don’t smoke around them from the start of pregnancy until after they’re done breastfeeding. So why are you needing to prove this?’ and that to me is really interesting – that commonsense approach in a country where they are accustomed to using marijuana very freely.”

“And that’s what we want to impress with this research,” adds Dr. Wymore. “The culture of legalization does not equate with safety. We’re talking about the most vulnerable patient population, and there’s a lot we don’t know about the effects. Until we do, we should be treating it like we do alcohol and cigarettes.”