There is an in-depth episode on the Safety of Tylenol (Acetaminophen) and Other OTC Medications During Pregnancy. Acetaminophen is an over-the-counter analgesic for pain relief and an antipyretic, which reduces fever. Acetaminophen is also known by the brand names Tylenol, Paracetamol, and Panadol. That episode covers the recently raised concerns about prenatal acetaminophen use and neurodevelopmental disorders like autism spectrum disorder. If you haven’t listened to that one yet, it provides important background on how this controversy started and what the evidence says. After that episode aired, I received numerous emails from listeners who had additional questions. Let’s take a look at some follow-up questions to navigate some specific scenarios and make an informed choice about acetaminophen.

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I Have Been Taking Tylenol During Pregnancy. Should I Be Worried?

“My doctor had told me it was safe to take Tylenol during pregnancy, so without even thinking twice, I’ve taken it a few times for headaches. Should I be concerned about the few times I’ve taken it?”

It is entirely understandable to feel concerned. When you took Tylenol for headaches, you had every reason to believe it was safe, especially since your doctor recommended it. There are a few key points to consider. First, you cannot change the past, and worrying about something that has already happened will not benefit you or your baby. Second, you made the best decision possible with the information available at the time. This is a fantastic lesson in parenting because this is exactly what parenting is. As you learn more, your approach may change. Now that you have more information, you can use it to guide your choices moving forward.

The short answer is no, you should not be worried. Now that you have more knowledge, you can navigate the decision to take acetaminophen with more information. If you have an occasional mild headache, you may choose to ride it out without medication. If you get persistent, severe headaches or migraines, you may need to discuss treatment options with your doctor.

Weighing the Risks of a Fever vs. the Risks of Tylenol

My doctor said that treating a fever with Tylenol is safer than letting the fever run high during pregnancy, but I still feel nervous about taking any medication. Are there any ways to bring down a fever without medication?

A fever is defined as a body temperature of 100.4°F (38°C) or higher. Your body’s temperature is regulated by a set point in the hypothalamus. When your immune system releases certain chemicals in response to infection, it raises that set point, causing a fever. Once your temperature rises, the only way to bring it back down is to let the fever run its course or take an antipyretic (a fever-reducing medication). Antipyretics, such as acetaminophen, work by blocking the production of prostaglandins, which are the chemical messengers that tell the hypothalamus to increase body temperature.

A high fever can be dangerous during pregnancy, but there are no universally agreed-upon guidelines for what temperature or duration is considered harmful. Because so much depends on when the fever occurs and how high it gets, it is best to monitor your symptoms closely. Take your temperature and record both the reading and the time. Also note any other symptoms, like a cough, congestion, or body aches.

If you do develop a fever, it is important to rest, stay hydrated, and take it easy. You can also use comfort measures to cool down, such as applying a cool, damp washcloth to your forehead, taking a lukewarm bath or shower, and wearing light, breathable clothing. These methods help your body release heat through the skin, which can make you feel better, but they do not lower your body’s set point the way medication does.

Because fever can pose risks during pregnancy, you should contact your doctor or midwife if you develop one. They can help you weight the risks to decide whether it is better to take a medication like Tylenol or allow the fever to resolve on its own, depending on your temperature, symptoms, and overall health.

Cold Medicines Without Acetaminophen

I’ve been sick with a cold and noticed almost every medication I find has acetaminophen in it. Since I’m trying to avoid it during pregnancy, what cold medicines or remedies would be safe alternatives?

You are right to notice that acetaminophen shows up in a lot of over-the-counter cold medicines. Even when you avoid that ingredient, others, like decongestants or cough suppressants, come with their own set of risks and unknowns. Let’s break down the most common types of cold medicine ingredients so you can make an informed choice.

Cough Medicines

A cough is your body’s reaction to irritants or secretions in your respiratory system. Expectorants, also known as mucolytics, are medications that thin mucus, making it easier to cough up phlegm from your lungs. The most common active ingredient in expectorants is guaifenesin. Cough suppressants, also known as antitussives, block the cough reflex. The most common suppressant is dextromethorphan, commonly noted by the letters D.M. after a brand name like Robitussin D.M. Cough suppressants can be useful when coughing keeps you awake. Otherwise, you may opt for an expectorant.

Unfortunately, ACOG does not have specific guidelines for cough medicines. Many sources cite both dextromethorphan and guaifenesin as generally safe during pregnancy. There is a study that found possible associations between using these in the first trimester and an increased risks of some birth defects, but we really need more research. Recommendations may vary by provider, with some suggesting avoiding these in the first trimester.

Antihistamines

Antihistamines are common in allergy medicines and may also be in cold medicines because they can help with congestion, a runny nose, and sneezing. ACOG does have specific guidelines for antihistamines to treat allergies, but not specifically for cold medicines.

Antihistamines are not miracle drugs for colds. A Cochrane review looked at 18 studies with 4,342 participants and found that antihistamines tended to help in the first day or two of a cold and had no significant effect after that. Unfortunately, this review did not include any studies that included pregnant mothers. There are many different types of antihistamines and trying to dig into each one included in each type of medicine is very confusing. As a result, if you are considering taking a cold medication that includes an antihistamine, it is best to run it by your doctor or midwife first.

Decongestants  

Decongestants narrow your blood vessels, which can help with congestion and a stuffy nose. The most common decongestants are pseudoephedrine and phenylephrine, commonly seen in medicines like Sudafed.

According to ACOG, pseudoephedrine has been linked to a small risk of abdominal wall birth defects and is not advised during the first 3 months of pregnancy. A study showed a small increased risk of an endocardial cushion defect (heart defect) with the use of phenylephrine. To put “small” into perspective, endocardial cushion defects occur in about 0.34 per 1,000 live births. Even if phenylephrine exposure increased the risk 8-fold, the absolute risk of having an affected child would be about 2.7 per 1,000 live births. It can help put statistics into perspective, but there is still a lot we do not know about decongestant use during pregnancy and the risks to a baby.

Summarizing Cold Medicines

There are many cold medicines that do not contain acetaminophen. However, other ingredients used to treat cough and congestion come with their own concerns. The safest option is to skip cold medicine altogether, which removes any potential risk to your baby. Some expecting parents prefer this approach, especially during the first trimester when development is most sensitive.

Of course, the trade-off is that cold medicine can help you feel better while your body fights off an illness. If you decide to take one, aim for the lowest effective dose for the shortest possible time. Choose medicines that target only the specific symptoms you have, and avoid extra-strength or combination products that include ingredients you may not need. Depending on your symptoms, you may decide that rest, fluids, and comfort measures are enough. But if your symptoms are significant and you feel like you need medication, check with your doctor or midwife before taking it so they can help you choose the safest option.

Acetaminophen and Breastfeeding

I was told to use Tylenol for pain after delivery, but I’m worried about passing medication to my baby through breast milk. Is it okay to take Tylenol while breastfeeding?

After you have your baby, you may have pain from afterpains, which are contractions your uterus has as it is shrinking back to prepregnancy size. They usually subside within about a week. You may also have pain from a vaginal tear or laceration as it heals.

ACOG states ibuprofen is usually the first preferred step because little of it passes through breastmilk. And that acetaminophen is also safe to take while breastfeeding. Fortunately, there is a fantastic resource for information on the safety of medications and breastfeeding. The LactMed database provides evidence-based information about how medications and other chemicals can affect breast milk and nursing infants. This database is updated regularly as new research becomes available. Each entry includes how much of a drug passes into breast milk, possible effects on a breastfed baby, effects on milk production, and recommended alternatives or safer options. If you would like to read more about using acetaminophen or ibuprofen while breastfeeding, check out these links:

• LactMed Acetaminophen
• LactMed Ibuprofen

Once your baby arrives, the questions about medication safety don’t stop, especially when it comes to managing fevers or pain.

Acetaminophen and Children

I watched the video of Trump talking about Tylenol, and he mentioned that you shouldn’t give a child Tylenol every time they have a shot. I thought it was standard to give children Tylenol before vaccines to avoid a fever, and that is what I have always done with my oldest. Is Tylenol dangerous for kids?

A fever is part of the body’s immune response to fight infection or illness. With any vaccine the goal is to have an immune reaction for it to be effective. A fever is one of the most common side effects of every vaccine. In the past it was common practice for parents to give children acetaminophen before a vaccine to reduce the instances of fever. This use is prophylactic, meaning preventative.

There is research that prophylactic use of acetaminophen may actually blunt the immune response to the vaccines. As a result, it is no longer recommended.

The American Academy of Pediatrics states that Acetaminophen is safe for children when taken, or dosed, correctly and under the guidance of a child’s pediatrician. Children younger than 12 weeks of age should not be given acetaminophen unless instructed by their pediatrician. The AAP does state that an oral analgesic (which would include acetaminophen) may be used for the treatment of fever and local discomfort following immunization. The bottom line is that you should monitor symptoms and treat if necessary, not give acetaminophen in advance.

There is Always Nuance

Like any pregnancy-related topic, there is always nuance. All you can do is make the best decision with the information you have. In light of the recent attention on potential risks of acetaminophen, you may want to be more strategic about how often or when you use it, or avoid it. There is a difference between taking it for minor aches and pains and taking it for a high fever. Your doctor or midwife can be an excellent resource to help you navigate when it makes sense to treat symptoms with acetaminophen and when you may want to let symptoms run their course.

Ideally, you are healthy throughout your pregnancy and have no need to treat a cold, flu, or fever. There are separate episodes on supporting and boosting your immune system during pregnancy. Basic things like eating well, getting enough sleep, and staying hydrated go a long way. Also, making sure you are taking a high-quality prenatal vitamin is essential. Simple actions to avoid illnesses, like frequent hand washing and being mindful about not touching your face, may also limit your risks.

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The Pregnancy Survival Kit from 8 Sheep Organics includes a set of four handcrafted products that help with common pregnancy pains like pregnancy insomnia, restless legs, lower back and hip pains, leg cramps, swollen and achy legs and feet, and stretch marks. All 8 Sheep products come with a 100-day Happiness Guarantee. You can try it completely risk-free for 100 days! Click here to save 10%.