Medications to Avoid While Pregnant: Safety Warnings and Safe Alternatives

When you're pregnant, every pill, drop, or spray feels like a decision that could change your baby’s life. You might take a pain reliever for a headache, an antihistamine for allergies, or even an antibiotic for a stubborn infection-thinking it’s harmless. But some common medications carry hidden risks that can affect your baby’s development, even before you know you’re pregnant. The truth is, not all drugs are created equal when you’re expecting. Some can cause birth defects, preterm birth, or long-term developmental issues. Knowing what to avoid-and what’s safe instead-can make all the difference.

NSAIDs: The Hidden Danger After 20 Weeks

Ibuprofen (Advil, Motrin), naproxen (Aleve), and other NSAIDs are staples in most medicine cabinets. But if you’re pregnant and past week 20, these drugs can quietly harm your baby’s kidneys. The FDA issued a clear warning in October 2020: NSAIDs can cause fetal kidney problems, leading to low amniotic fluid (oligohydramnios), which may result in lung underdevelopment or limb contractures. This isn’t a rare side effect-it’s a documented risk backed by multiple studies showing a 1.5 to 2 times higher chance of complications when taken after 20 weeks.

Even aspirin, often thought of as safe in low doses for preventing preeclampsia, should only be taken under medical supervision. At higher doses, it increases bleeding risks and can delay labor. If you need pain relief after the first trimester, skip the NSAIDs entirely. There are safer options.

Acetaminophen: The New Controversy

For decades, acetaminophen (Tylenol) was the go-to for fever and pain during pregnancy. It’s still listed as the safest choice by many doctors. But in September 2025, the FDA issued a Notice to Physicians that changed everything. New data from a 2021 JAMA Pediatrics study of 95,000 mother-child pairs showed a 28.6% higher risk of ADHD and a 20.4% higher risk of autism spectrum disorder in children whose mothers used acetaminophen for extended periods during pregnancy.

Does that mean you can’t use it? Not exactly. The FDA isn’t saying to stop completely. They’re urging caution. Short-term use for a high fever or severe headache is still considered acceptable. But using it daily for weeks-like for chronic back pain or recurring migraines-raises red flags. The key is dose and duration. Stick to the lowest effective dose (325-650 mg), and never exceed 3,000 mg per day. If you’re taking it more than a few days a week, talk to your provider. Untreated fever above 102°F is actually more dangerous than short-term acetaminophen use, since high body temperature increases the risk of neural tube defects by over 8 times.

Antibiotics That Can Harm Your Baby

Not all antibiotics are safe during pregnancy. Tetracyclines like doxycycline can permanently stain your baby’s teeth and weaken developing bones. Fluoroquinolones like ciprofloxacin have been linked to a 1.9-fold increase in musculoskeletal problems in animal studies and are avoided unless absolutely necessary. These drugs are typically off-limits throughout pregnancy.

On the flip side, penicillins (like amoxicillin), cephalosporins (like cephalexin), and clindamycin are well-studied and considered safe. If you have an infection, don’t avoid treatment-just make sure your provider knows you’re pregnant. Many infections, if left untreated, pose a far greater threat to your baby than the right antibiotic.

High Blood Pressure Medications: Stop Immediately

If you’re on ACE inhibitors (lisinopril, enalapril) or ARBs (valsartan, losartan) for high blood pressure, stopping them as soon as you know you’re pregnant isn’t optional-it’s critical. These drugs interfere with fetal kidney development and can cause life-threatening complications: fetal kidney failure, low amniotic fluid, underdeveloped lungs, and even stillbirth. Studies show a 30-50% risk of severe outcomes when these drugs are used during pregnancy.

The fix? Switch to methyldopa or labetalol before conception, or as soon as possible after a positive pregnancy test. Both are well-established, safe options for managing hypertension during pregnancy. Don’t wait for your next appointment-contact your doctor right away if you’re taking any blood pressure medication and find out you’re pregnant.

Acne and Seizure Medications: High-Risk, High-Consequence

Isotretinoin (Accutane), the powerful acne treatment, is one of the most dangerous drugs during pregnancy. It carries a greater than 25% risk of severe birth defects-including missing ears, heart problems, and brain malformations. The FDA’s iPLEDGE program requires strict contraception for women taking it, but accidental exposure still happens. If you’re planning pregnancy, stop isotretinoin at least one month before trying to conceive, and use two forms of birth control while on it.

For epilepsy, valproic acid (Depakote) is another high-risk drug. Studies show it causes major congenital malformations in 10.7% of exposed pregnancies-nearly four times higher than the general population’s 2.8%. The alternatives? Lamotrigine and levetiracetam. Both are much safer, with malformation rates around 2-3%. If you have epilepsy and are considering pregnancy, talk to your neurologist at least six months ahead of time. Switching medications takes planning and monitoring.

Safer Alternatives for Common Pregnancy Complaints

You don’t have to suffer through pregnancy discomforts without help. Here’s what’s safe:

• Pain and fever: Acetaminophen (Tylenol), 325-650 mg every 4-6 hours, not exceeding 3,000 mg daily. Use only when needed.
• Allergies: Loratadine (Claritin), cetirizine (Zyrtec), and fexofenadine (Allegra) are all Category B and have been studied in over 2,000 pregnancies with no increased risk of birth defects.
• Nasal congestion: Saline nasal sprays are first-line. If you need more, pseudoephedrine (Sudafed) is okay after the first trimester-no more than 120 mg daily. Avoid it if you have high blood pressure.
• Constipation: Start with fiber (25-30 grams daily) and water. If you need help, docusate sodium (Colace) or polyethylene glycol (Miralax) are both Category B and safe for long-term use.
• Heartburn: Calcium carbonate (Tums) and magnesium hydroxide (Milk of Magnesia) are safe short-term options. Avoid bismuth subsalicylate (Pepto-Bismol) because it contains salicylates.

What About Antidepressants?

Depression during pregnancy is real-and treating it matters. Stopping antidepressants suddenly can increase the risk of relapse by 20-25%, which raises your chances of preterm birth by 64% and low birth weight by 73%.

Paroxetine (Paxil) is the only SSRI linked to a slightly higher risk of heart defects (1.5-2% absolute risk). Other SSRIs like sertraline and citalopram are considered safer options. The biggest risk isn’t the medication-it’s untreated depression. Work with your psychiatrist and OB-GYN to find the lowest effective dose. Never stop cold turkey.

Preconception Planning: The Best Protection

The most effective way to avoid risky medications isn’t to guess what’s safe during pregnancy-it’s to review your meds before you even get pregnant. If you’re on chronic medications for epilepsy, high blood pressure, depression, or autoimmune conditions, talk to your doctor at least 3-6 months before trying to conceive.

For example, women on warfarin (Coumadin) should switch to enoxaparin (Lovenox) before pregnancy. Warfarin crosses the placenta and can cause fetal warfarin syndrome-facial deformities and bone problems. Enoxaparin doesn’t cross the placenta, making it the standard of care.

Keep a full list of everything you take: prescriptions, over-the-counter meds, vitamins, herbal supplements, and even CBD products. Many women don’t realize that some herbal teas or supplements can be harmful. Chamomile, for example, may stimulate contractions. Saw palmetto can affect hormone levels.

Where to Get Reliable Information

Not all online sources are trustworthy. Avoid blogs, social media advice, or anecdotal stories. Instead, use these trusted resources:

• MotherToBaby: A free service run by the Organization of Teratology Information Specialists. They offer expert advice via phone, chat, or email. Their fact sheets have been accessed over 2.3 million times a year.
• FDA Pregnancy and Lactation Labeling Rule (PLLR): This replaced the old A-X categories with detailed, narrative risk summaries. You can search for any drug on the FDA website.
• ACOG and CDC: Their guidelines are updated regularly and based on the latest evidence.

And remember: if you’ve already taken a medication you’re now worried about, don’t panic. Most exposures don’t lead to problems. The goal isn’t perfection-it’s awareness and action. Call MotherToBaby or your provider. They’ve heard it all before.

What’s Changing in 2025-2026

The landscape is shifting fast. The FDA’s 2025 warning on acetaminophen marks a turning point. The CDC updated its pregnancy medication page to include a prominent caution about long-term use. The NIH is funding a $15 million project to find non-drug pain relief options for pregnant women. And the multinational ABC Study-tracking 50,000 pregnant women and their children until age 10-is expected to release its first major findings by the end of 2025.

What does this mean for you? Be prepared for changing advice. What’s considered safe today might be reconsidered tomorrow. That’s why staying in touch with your care team is more important than ever. Don’t rely on old information. Ask questions. Keep updating your medication list. And don’t feel guilty if you’ve taken something you now know might be risky. The goal is to do better moving forward.