Pregnancy and Medicines

Is it safe to take medicine during pregnancy?

Some medicines are safe to take during pregnancy, but many are not. If you're pregnant, check with your health care provider before taking any medicine. Some medicines can harm your developing fetus. This includes:

• Prescription drugs
• Over-the-counter medicines
• Herbs and supplements

Always talk to your provider before you stop or start any medicine. You may take medicine to treat a health problem you had before pregnancy. Not using the medicine that you need may be more harmful to you and your fetus than using the medicine. For example, many pregnant women take prescription medicines for health problems like diabetes, asthma, seizures, and heartburn. The decision about whether to take a certain medicine should depend on the risks and benefits that go with it. You and your provider should make this choice together.

If you're pregnant, you shouldn't take regular vitamins. They may have too much or too little of the vitamins you need. For example, everyone needs folic acid, a type of B vitamin. But if you're trying to get pregnant, it's really important. Getting enough folic acid before and during pregnancy can prevent birth defects of the brain or spine. During your prenatal care visits, your provider will talk about prenatal vitamins. These are a special kind of vitamin to take during pregnancy.

Food and Drug Administration

Prenatal Care

What is prenatal care?

Prenatal care is the health care you get while you are pregnant. It includes your checkups and prenatal testing. Typically, a health care provider specializing in the delivery of babies and the care of pregnant women, such as an obstetrician or a midwife, provides prenatal care.

Prenatal care can help keep you and your fetus healthy until you're ready to deliver your baby. It lets your provider spot health problems early. Early treatment can cure many problems and prevent others from developing.

Every prenatal visit offers you the chance to ask questions about having a healthy pregnancy and preparing for delivery. Talk to your provider about childbirth education classes for you and your partner to help you prepare for the birth of your baby.

Your provider will give you a schedule for your prenatal visits. Usually, visits during your pregnancy occur:

• Once a month for weeks 4 through 28
• Twice a month for weeks 28 through 36
• Weekly for week 36 until your baby is born

If you are over 35 years old or your pregnancy is high risk because of health problems like diabetes or high blood pressure, your provider will probably want to see you more often. You can also expect to see your provider more often as your due date gets closer.

During prenatal visits, your provider will check your health and carefully monitor your pregnancy until you deliver your baby.

Your first prenatal visit may take a little longer. Your provider will most likely:

• Ask about your health history, including prior pregnancies
• Ask about your family's health history
• Discuss any health conditions and risk factors that could affect you or your fetus
• Do a complete physical exam, including a pelvic exam and Pap test
• Review blood, urine, or other routine prenatal lab tests
• Check your blood pressure, height, and weight
• Discuss a healthy amount of weight gain, healthy eating, and prenatal vitamins
• Figure out your due date (when you are 40 weeks pregnant)

During most visits, your provider will most likely:

• Check your blood pressure and weight gain
• Measure your abdomen (belly) to check fetal growth once you begin to show
• Check the fetal heart rate
• Check your hands and feet for swelling
• Do routine prenatal tests

Depending on the stage of your pregnancy, you may have additional tests.

Always talk to your provider before you start or stop any medicine. Some medicines can harm your fetus. To help keep yourself and your fetus healthy, avoid substances that could be harmful, such as tobacco, alcohol, and drugs.

Dept. of Health and Human Services Office on Women's Health

Prenatal Testing

What is prenatal testing?

Prenatal testing provides information about the health of your fetus before the baby is born. Some routine tests during pregnancy also check your health. The prenatal test may use a sample of your blood, urine or fluid from your vagina, cervix, or rectum.

Since some health conditions can be treated before your baby is born, it's important to find them early. But even if they cannot be treated, it can still be helpful to know about the problem early on. This gives you time to learn about the condition and prepare for any challenges you may face after the baby is born.

At your first prenatal visit, your health care provider will test for various conditions, including problems with your blood, signs of infections, and whether you are immune to rubella (German measles) and chickenpox.

Throughout your pregnancy, your provider may recommend additional tests as well. Some tests are suggested for all women, such as screenings for gestational diabetes, Down syndrome, and HIV.

Your provider might offer other tests based on your:

• Age
• Personal or family medical history
• Ethnic background
• Results of routine tests

There are two types of tests:

• Screening tests check if you or your fetus may have certain health issues. They look at risk but do not diagnose problems. If your screening test result is abnormal, it does not mean that there is a problem. It means that more information is needed. Your provider can explain what the test results mean and possible next steps. You may need diagnostic testing.
• Diagnostic tests help determine whether you or your fetus have a certain health problem.

It is your choice whether to get prenatal tests. You and your provider can talk about the risks and benefits of the tests, as well as the type of information they can give you. Then you can decide which ones are right for you.

National Women's Health Information Center

Reflux in Children

What is reflux (GER) and GERD?

Gastroesophageal reflux (GER), often called reflux, occurs when food or stomach acid flows back from your child's stomach into the esophagus. The esophagus is the tube that carries food from your mouth to your stomach. This can sometimes cause irritation or a burning sensation. Occasional reflux is common and usually not a problem.

Gastroesophageal reflux disease (GERD) is a more serious and long-lasting type of reflux. GERD can cause repeated symptoms or damage to the lining of the esophagus. Having reflux two or more times a week may be a sign of GERD. Your child's health care provider may diagnose GERD if the reflux causes pain, feeding problems, or irritation of the esophagus.

A small muscle called the lower esophageal sphincter acts as a valve between the esophagus and stomach. When your child swallows, this muscle relaxes to let food pass from the esophagus to the stomach. This muscle normally stays closed, so the stomach contents and acid don't flow back into the esophagus. This muscle, along with the diaphragm (the large muscle between the chest and abdomen), usually prevents reflux. It's normal for children to have reflux occasionally.

In children who have GERD, the lower esophageal sphincter may be weak or relax when it shouldn't. That allows stomach contents into the esophagus. This can happen because of:

• A hiatal hernia, a condition in which the upper part of the stomach pushes up into the chest
• Increased pressure on the abdomen (belly) from being overweight or having obesity
• Certain medicines, such as some used to treat asthma, allergies, depression, or pain
• Smoking or exposure to secondhand smoke
• Previous surgery on the esophagus or upper abdomen
• Developmental delays or certain neurological conditions, such as cerebral palsy
• Lung conditions, such as cystic fibrosis

Many children have occasional reflux, especially after large meals or physical activity. GERD is less common, and most symptoms improve with time and lifestyle changes.

Symptoms may vary by age. Some children might not even notice reflux, while others may taste food or stomach acid in the back of their mouth.

In children, GERD can cause:

• Heartburn, a burning feeling in the chest or throat (more common in older children and teens)
• Bad breath
• Nausea or vomiting
• Trouble or pain when swallowing
• Cough, hoarseness, or breathing problems
• Wearing away of tooth enamel from stomach acid

Other conditions can cause similar symptoms. Talk to your child's provider if symptoms happen often or make eating, sleeping, or daily activities difficult.

In most cases, your child's provider can tell if it's reflux by learning about your child's symptoms and health history. Tests are usually needed only if symptoms don't get better with lifestyle changes or medicines, or if another health problem is suspected.

Common tests include:

• Upper GI series, which looks at the shape of your child's upper GI (gastrointestinal) tract. Your child will drink or eat a chalky-tasting liquid called barium. For young children, the barium is mixed in with a bottle or other food. Several x-rays are taken to track the barium as it goes through your child's esophagus and stomach.
• Esophageal pH and impedance monitoring, which measures the amount of acid or liquid in your child's esophagus. A thin flexible tube is placed through their nose into the stomach. The end of the tube in the esophagus measures when and how much acid comes up into the esophagus. The other end of the tube attaches to a monitor that records the measurements. Your child will wear the tube for 24 hours. They may need to stay in the hospital during the test.
• Upper gastrointestinal (GI) endoscopy and biopsy, which uses an endoscope, a long, flexible tube with a light and camera at the end of it. An endoscope is inserted down your child's esophagus, stomach, and first part of the small intestine. While looking at the pictures from the endoscope, tissue samples (biopsy) may be taken.

Simple lifestyle changes can often improve symptoms. Examples include:

• Maintaining a healthy weight.
• Eating smaller meals.
• Avoiding high-fat foods or other trigger foods that cause symptoms.
• Wearing loose-fitting clothing around the abdomen (belly).
• Staying upright for 3 hours after meals and avoiding slouching when sitting.
• Sleeping with the head of the bed raised 6 to 8 inches.

If lifestyle changes aren't enough, your provider may recommend medicine to reduce stomach acid. The medicines work by lowering the amount of acid your child's stomach makes. Some are available over-the-counter, while others need a prescription. Do not give your child any medicine unless your provider recommends it.

If symptoms don't get better or are severe, your provider may refer you to a doctor who treats stomach and digestion problems in children. In rare cases, surgery may be considered.

If GERD isn't treated, it can cause problems such as inflammation or scarring in the esophagus, changes in its lining (Barrett's esophagus), or make breathing problems, like asthma, worse.

NIH: National Institute of Diabetes and Digestive and Kidney Diseases

Reflux in Infants

What is reflux (GER) and GERD?

Gastroesophageal reflux (GER), often called reflux or spitting up, happens when food or milk comes back up from your baby's stomach into the esophagus. The esophagus is the tube that carries food from your mouth to your stomach. Reflux is very common in healthy babies. It usually starts to get better by 6 months of age and goes away by 12 months. Reflux that continues after 18 months is unusual.

Gastroesophageal reflux disease (GERD) is a more serious and long-lasting type of reflux. It can cause feeding problems, discomfort, or other symptoms that affect your baby's growth or sleep. Babies may have GERD if symptoms prevent them from feeding well or last longer than 12 to 14 months.

There is a muscle (the lower esophageal sphincter) that acts as a valve between the esophagus and stomach. When your baby swallows, this muscle relaxes to let food pass from the esophagus to the stomach. This muscle normally stays closed, so the stomach contents don't flow back into the esophagus.

In babies who have reflux, this muscle is not fully developed and lets the stomach contents back up the esophagus. This causes your baby to spit up (regurgitate). As your baby grows and the sphincter muscle fully develops, your baby should no longer spit up.

In babies who have GERD, the sphincter muscle becomes weak or relaxes when it shouldn't. This allows stomach contents to come up more often or cause irritation.

Reflux is very common in babies and usually goes away on its own. Most babies spit up several times a day during their first 3 months. They usually stop spitting up between the ages of 12 and 14 months.

GERD is less common. Babies may show symptoms, but they decrease with growth, with only a small number of babies affected by 12 months.

Babies are more likely to have reflux or GERD if they:

• Were born too early (premature)
• Have lung problems, such as cystic fibrosis
• Have conditions that affect the nervous system, such as cerebral palsy
• Have a hiatal hernia (when part of the stomach pushes up into the chest)
• Have had surgery on the esophagus

In babies, the main symptom of reflux and GERD is spitting up. GERD may also cause symptoms such as:

• Arching of the back, often during or right after eating
• Coughing
• Gagging or trouble swallowing
• Irritability or crying, especially after eating
• Poor eating or refusing to eat
• Not gaining enough weight or losing weight
• Wheezing or trouble breathing
• Forceful or frequent vomiting

Other conditions can cause similar symptoms. Contact your baby's health care provider if your baby has symptoms, especially if your baby isn't gaining weight.

In most cases, your provider diagnoses reflux by reviewing your baby's symptoms and medical history. Testing is only needed if symptoms don't get better with feeding changes or medicines, or if there are other health concerns.

Several tests can help your provider diagnose GERD. Sometimes more than one test may be ordered to get a diagnosis. Common tests include:

• Upper GI series, which looks at the shape of your baby's upper GI (gastrointestinal) tract. Your baby will drink or eat a chalky-tasting liquid called barium. The barium is mixed in with a bottle or other food. Several x-rays are taken to track the barium as it goes through your baby's esophagus and stomach.
• Esophageal pH or impedance monitoring, which measures the amount of acid or liquid in your baby's esophagus. A thin flexible tube is placed through your baby's nose into the stomach. The end of the tube in the esophagus measures when and how much acid comes up into the esophagus. The other end of the tube attaches to a monitor that records the measurements. Your baby will wear this for 24 hours, most likely in the hospital.
• Upper gastrointestinal (GI) endoscopy and biopsy, which uses an endoscope, a long, flexible tube with a light and camera at the end of it. An endoscope is inserted down your baby's esophagus, stomach, and first part of the small intestine. While looking at the pictures from the endoscope, tissue samples (biopsy) may be taken.

Simple feeding changes may help reduce your baby's reflux:

• Add rice cereal to your baby's bottle of formula or breastmilk. Check with your provider about how much to add. If the mixture is too thick, you can change the nipple size or cut a little "x" in the nipple to make the opening larger.
• Burp your baby after every 1 to 2 ounces of formula. If you breastfeed, burp your baby after nursing from each breast.
• Avoid overfeeding; give your baby the amount of formula or breast milk recommended.
• Hold your baby upright for 30 minutes after feedings.
• If you use formula and your provider thinks that your baby may be sensitive to milk protein, they may suggest switching to a different type of formula. Do not change formulas without talking to your provider.

If feeding changes do not help enough, your provider may recommend medicines to reduce stomach acid. Medicines aren't usually needed, and are only suggested if your baby still has regular GERD symptoms and:

• You have already tried some feeding changes
• Your baby has problems sleeping or feeding
• Your baby does not grow or gain weight properly

Acid-blocking medicines may be given for a short time to see if they help. You shouldn't give your baby any medicines unless your provider tells you to.

If medicines don't help and your baby still has severe symptoms, your provider might talk to you about surgery. Surgery is rarely needed for babies with GERD. It may be considered only if reflux causes serious breathing problems or if your baby isn't gaining enough weight.

NIH: National Institute of Diabetes and Digestive and Kidney Diseases