Answers to Common Questions During Pregnancy

Although the ideal situation is to abstain from all medication throughout your pregnancy, this may not be realistic for you. Some medications can be safely taken in pregnancy. The following list is provided to make you more comfortable:

Aches - Many preventative measures can be taken to avoid muscle aches such as exercise, proper body mechanics, good posture, and frequent position changes. If "prevention" is too late, begin implementing the above techniques in addition to:

• Placing a heating pad to the affected area
• Taking a warm bath for no longer than twenty minutes at a time
• Relaxing in a pool creates a type of weightlessness and can relieve pressure
• Back support belts designed for pregnancy:
  • Available in maternity stores and provide relief for many women o
  • Example: Prenatal Cradle
  • Support varicosities (varicose veins) of the vulva with a V2 Supporter
• Two Tylenol extra strength or the generic equivalent, taken as directed

If these measures are not helpful, most women benefit from a consultation with a qualified physical therapist for individual therapy.

Bloating - Intestinal gas and bloating in pregnancy can often be managed by an over the counter remedy containing simethicone, such as Phazyme.

Congestion and runny nose - Saline nasal drops or Breathe-Right strips used as directed may provide relief of sinus symptoms. A humidifier may also help the symptoms.

Antihistamines such as Chlortrimeton, Benadryl, Zyrtec, and Claritin are not associated with any known problems in pregnant women. For allergies, Claritin and Zyrtec (or their generics loratadine and cetirizine) are best.

If your symptoms are more from a cold or flu, then the older antihistamines Chlortrimeton and Benadryl (chlorpheniramine or diphenhydramine) will relieve symptoms better but are known to cause more sleepiness than loratadine and cetirizine.

Decongestants in general should be avoided in pregnancy. A recent study showed some rare fetal birth defects associated with the first trimester use of Sudafed or phenylephrine, phenylpropanolamine, and psuedoephedrine. These can be found in combined medications such as DayQuil and NyQuil and should therefore be avoided in the first trimester. The use of the nasal spray oxymetazoline (Afrin) should be avoided in the first and second trimesters due to concerns about its association with fetal renal collecting system anomalies or kidney problems in the baby. Reference: Am J Epidemiol 2013:178(2):198-208.

Constipation - By increasing the amount of fiber in your diet, increasing your fluid intake, and maintaining as active a lifestyle as possible, you will decrease the occurrence of, or at least help in relieving, constipation. If you are without relief, you may take Colace and Dulcolax as directed.

Cough - Robitussin is often helpful in treating a minor cough, if necessary. Depending on the type of cough you have, increasing humidity with a cool mist vaporizer or taking a hot shower may provide some relief. Increasing fluids can also moisten your throat and thin secretions, which may be helpful as well. Non-medicated lozenges with glycerin or honey are helpful and safe.

Diarrhea - It is important to prevent dehydration and electrolyte imbalance when suffering from diarrhea by drinking enough water and Gatorade to make the color of your urine clear. A clear liquid diet, including items like jello and popsicles, is recommended. You can slowly return to a regular diet as symptoms disappear and if tolerated well. Imodium AD as directed is safe, however, be aware that constipation can be a side effect.

Fever- Tylenol extra strength as directed. If your temperature is 100.4° F or higher, please call the office.

Hemorrhoids - Preventative measures are to avoid straining when having a bowel movement through preventing constipation, spending the shortest time sitting on the toilet possible, avoiding lifting heavy objects, and to not stand in one position for extended periods of time. If prevention is too late, Anusol HC, Tucks, and Dermaplast spray used as directed should provide temporary relief. Tub baths with Epsom’s salt are often soothing.

Indigestion - Avoid foods that make your symptoms worse (often spicy or greasy foods), eat small frequent meals, and remain upright for at least 1 hour after eating. If you still have symptoms you can try Tums and Carafate. If you continue to have symptoms, call the office, but in general over the counter antacid medications (ex zantac or prilosec) are generally safe in pregnancy.

Insomnia - Avoid naps during the day if possible, exercise for at least 30 minutes a day in the late afternoon/evening, and take a warm shower before bed. Don't consume food or beverages that are high in sugar and caffeine after 5:00 PM and place a nightlight in the bathroom so you don’t need to turn the full light on when you use the bathroom. If lack of sleep continues to bother you, Benadryl taken occasionally can help.

Nausea - Eating food high in protein and complex carbohydrates while avoiding the ingestion (and the smell) of spicy or greasy food is a good start to preventing episode of nausea. Try to eat several small meals a day. Because a too empty or too full stomach can increase the nausea, try to keep your stomach about the same degree of fullness all day. A bedtime snack with meat or milk (protein) will sometimes help you avoid the morning nausea. Drink plenty of fluids between meals. Avoid extra stress and extreme fatigue. If nausea is inhibiting your activities of daily living, begin the day with crackers in bed. Proceed with other bland food such as dry toast, Cheerios, low salt pretzels, wheat/bran muffins, or ginger snaps until the nausea has subsided.

Other options include:

• "Sea bands" are acupressure wristbands worn to prevent motion sickness and effectively reduce nausea in some women.
• A variety of herbal remedies, often in the form of teas, including peppermint, spearmint, and ginger may reduce or even eliminate nausea.
• If you continue to have issues with nausea you can take the combination of unisom (doxylamine) and vitamin B6 to decrease symptoms. This is taken as 12.5 mg unisom tablet (25mg broken in half) before bed, and a 10 or 25 mg vitamin B6 tablet every 6 hours as needed.
• We can provide prescription medications for women in whom these methods are not helpful.
• We also are able to give IV fluids to women with severe nausea and vomiting in the office.

Hospitalization is required for only a few percent of pregnant women and is generally limited to those women who are unable to continue to drink liquids. Nausea without vomiting, while miserable, generally does not require hospitalization.

Sore Throat - Any over the counter throat lozenge especially dyclonine (Sucrets Maximum Strength) or Chloraseptic spray taken as directed may be soothing. Tylenol can also help the pain. Treating runny nose and congestion (refer to the congestion section above) will help with sore throat.

Leg Cramps - Calf cramps are very common in pregnancy, generally at night. If you have a cramp, stand up and stretch the calf muscle to help the cramp resolve. Daily stretching and good water intake can decrease the frequency of these cramps. If the cramps remain frequent with these measures you can take an over the counter magnesium supplement to decrease their frequency.

Leg Swelling - most pregnant women get some leg swelling during pregnancy, usually worse after standing for a long time. Compression stocking put on first thing in the morning can decrease leg swelling and also decrease discomfort with varicose veins.