Medications to Avoid While Pregnant: Safety Warnings and Safe Alternatives

When you’re pregnant, every choice you make feels bigger. That cold you’ve been fighting? The headache that won’t quit? The heartburn keeping you up at night? It’s natural to reach for something to feel better-but what’s safe? And what could actually hurt your baby? The truth is, medications to avoid during pregnancy aren’t always obvious. Some are in your medicine cabinet right now.

What’s Really Dangerous During Pregnancy?

Not all drugs are created equal when you’re carrying a baby. Some are harmless. Others can cause serious, lifelong problems. The biggest red flags come from drugs that cross the placenta and interfere with how your baby’s organs form-especially in the first trimester, when everything is building from scratch.

NSAIDs like ibuprofen and naproxen are common painkillers, but they’re not safe after 20 weeks. The FDA issued a warning in 2020 after studies showed they can cause fetal kidney damage and dangerously low amniotic fluid. That means even if you took Advil last month for a headache, you need to stop now if you’re past 20 weeks. Aspirin is also risky unless it’s prescribed in low doses (60-150 mg) for preeclampsia prevention.

ACE inhibitors and ARBs-medications like lisinopril or valsartan-are used for high blood pressure. But they’re absolute no-gos during pregnancy. They can cause kidney failure in the baby, low amniotic fluid, and even death. If you’re on one and planning pregnancy-or already pregnant-talk to your doctor immediately. There are safer blood pressure meds, like labetalol or methyldopa.

Isotretinoin (Accutane) for acne is one of the most dangerous drugs you can take while pregnant. It doesn’t just raise the risk of birth defects-it causes them. Studies show more than 25% of babies exposed to isotretinoin in early pregnancy develop severe problems: missing ears, heart defects, brain abnormalities. If you’re taking this, you need to use two forms of birth control and confirm you’re not pregnant before starting. Even one pill can be enough.

Valproic acid, used for epilepsy and bipolar disorder, carries a 10.7% risk of major birth defects-more than three times the normal rate. Babies exposed may have spina bifida, cleft palate, or developmental delays. If you have epilepsy and are planning pregnancy, switching to lamotrigine or levetiracetam before conception can drop that risk to around 2.2%.

Tetracycline antibiotics (like doxycycline) stain developing teeth and weaken bones. Fluoroquinolones (like ciprofloxacin) are linked to joint and muscle problems in babies. These should be avoided unless there’s no other option for a life-threatening infection.

The Acetaminophen Debate: Still Safe or Not?

For years, acetaminophen (Tylenol) was the go-to for fever and pain during pregnancy. It’s still listed as the safest option by ACOG and the American Academy of Family Physicians. But in September 2025, the FDA issued a new notice to doctors: use it only when necessary.

Why the change? A 2021 study of 95,000 children found that moms who took acetaminophen for long periods during pregnancy had a 28.6% higher chance of having a child with ADHD and a 20.4% higher chance of autism spectrum disorder. The risk was strongest when it was used for more than 28 days total.

Here’s the catch: the FDA doesn’t say acetaminophen causes these conditions. They say the evidence is strong enough to recommend caution. And they’re not alone. The CDC now advises pregnant women to “consider avoiding” it as a precaution.

So what do you do? If you have a fever of 102°F or higher, don’t wait. High fever itself raises the risk of neural tube defects by over eight times. In that case, taking acetaminophen is safer than not taking it. But for a mild headache or occasional back pain? Try a warm bath, gentle massage, or rest first. Use acetaminophen only if you really need it-and never more than 3,000 mg a day.

Safe Alternatives for Common Pregnancy Symptoms

You don’t have to suffer. There are safe, effective ways to manage everyday discomforts without risking your baby’s health.

• Pain and fever: Acetaminophen (Tylenol) at 325-650 mg every 4-6 hours, max 3,000 mg daily. Avoid NSAIDs after 20 weeks.
• Allergies: Loratadine (Claritin), cetirizine (Zyrtec), or fexofenadine (Allegra) are all Category B and have been studied in thousands of pregnancies with no increased risk of birth defects.
• Nasal congestion: Start with saline sprays or steam. If you need more, pseudoephedrine (Sudafed) is okay after the first trimester-no more than 120 mg a day. But avoid it if you have high blood pressure.
• Constipation: Eat more fiber (25-30 grams a day), drink water, and move your body. If you need help, docusate sodium (Colace) or polyethylene glycol (Miralax) are both safe and well-studied.
• Heartburn: Eat smaller meals, avoid spicy or fatty foods, and don’t lie down right after eating. Calcium-based antacids like Tums are fine. Avoid those with sodium bicarbonate or magnesium trisilicate.

Antidepressants: The Hard Choice

If you have depression or anxiety, stopping your meds during pregnancy can be just as risky as staying on them. Untreated depression increases the chance of preterm birth by 64% and low birth weight by 73%.

Some antidepressants carry risks. Paroxetine (Paxil) is linked to a slightly higher chance of heart defects. SSRIs overall may raise the risk of persistent pulmonary hypertension in newborns (PPHN), from 1-2 per 1,000 to 5-6 per 1,000.

But here’s the real math: if you stop your meds, there’s a 20-25% chance your depression will come back hard-and that can affect your ability to eat, sleep, care for yourself, and bond with your baby after birth.

The best move? Talk to your doctor before you get pregnant. If you’re already pregnant and doing well on an SSRI like sertraline or citalopram, staying on it is often safer than switching. Never stop cold turkey.

What About Supplements and Herbal Products?

Just because something is “natural” doesn’t mean it’s safe. Many herbal supplements aren’t tested for pregnancy safety.

Avoid:

• Black cohosh (linked to premature labor)
• Blue cohosh (can cause fetal heart damage)
• High-dose vitamin A (over 10,000 IU/day-can cause birth defects)
• Essential oils like rosemary, sage, or pennyroyal (can trigger contractions)

Stick to prenatal vitamins with folic acid (at least 400 mcg), iron, and DHA. If you’re considering any supplement-even ginger for nausea-ask your provider first.

How to Stay Safe: Practical Steps

You don’t need to guess. Here’s how to protect yourself and your baby:

• Make a list of every medication you take-prescription, OTC, herbal, vitamins. Bring it to every appointment.
• Ask your doctor or pharmacist: “Is this safe in pregnancy?” Don’t assume it is.
• Use MotherToBaby (free service run by experts). They answer over 100,000 questions a year and have fact sheets on over 500 medications.
• Check the FDA’s Pregnancy and Lactation Labeling Rule (PLLR) for updated info on any drug you’re taking.
• If you’ve already taken something risky, don’t panic. Most exposures don’t lead to problems. Call MotherToBaby or your OB-GYN right away.

What’s Changing in 2026?

The rules aren’t set in stone. In 2026, ACOG is updating its guidelines to reflect the new acetaminophen data. Meanwhile, the NIH is funding a $15 million study to find non-drug ways to manage pain in pregnancy-like acupuncture, physical therapy, and mindfulness.

The biggest long-term project? The ABC Study-tracking 50,000 pregnant women across 15 countries to see if acetaminophen really affects brain development. Results won’t be ready until late 2025, but they could change everything.

Until then, the message is simple: don’t avoid medicine when you need it. But don’t take it when you don’t. Be informed. Be cautious. And talk to your provider-every time.