Pain Medication While Pregnant: What's Safe?

Pregnancy and discomfort often go hand in hand. But when discomfort progresses to pain, many expectant parents wonder which medications they can safely use for relief. Luckily, safe painkiller options exist, particularly, acetaminophen, which is often the best option for pain relief during pregnancy.

But as with everything else during pregnancy, diligence (and careful timing) is necessary. So, discuss all medications that you take—including over-the-counter (OTC) drugs—with your OB-GYN.

Here's a breakdown of pain relievers, along with guidelines for those that are safe to use and those that should be avoided during pregnancy. Again, be sure to consult with your physician before taking any medication during pregnancy, whether OTC or prescription strength.

OTC Painkillers

Pain medications, also called analgesics, can be obtained either over the counter (OTC) or by prescription. Naturally, prescription-strength painkillers are usually more potent than OTCs, and they also tend to present more potential dangers to the developing fetus. OTC analgesics, however, are not risk-free.

Over-the-counter painkillers come in two categories (acetaminophen and NSAIDs), based on their active ingredient.

Acetaminophen

Acetaminophen, the active ingredient in Tylenol, is considered safe during pregnancy. Well researched by scientists, acetaminophen is used primarily for headaches, fever, aches, pains, and sore throat. It can be used during all three trimesters of pregnancy. Its use in pregnancy is widespread. For example, approximately 50% of pregnant women use it in the first trimester.

However, there are some concerns. Research has increasingly found an association between prenatal acetaminophen use and behavioral problems in childhood, including attention deficit hyperactivity disorder (ADHD). For example, a 2019 study found that babies exposed to high levels of acetaminophen in the womb had a higher risk of being diagnosed with autism and/or ADHD in childhood.

NSAIDs

Nonsteroidal anti-inflammatory drugs (NSAIDs) include aspirin, as well as Advil or Motrin (ibuprofen) and Aleve (naproxen). For the most part, aspirin is not recommended in pregnancy.

However, in the second half of pregnancy, all NSAIDs are contraindicated. The Food and Drug Administration (FDA) "recommends avoiding use of NSAIDs in pregnancy at 20 weeks or later because they can result in low amniotic fluid," as well as other complications for the fetus, including kidney problems. While these complications are rare, the consequences can be fatal.

Research indicates that low levels of amniotic fluid, a condition known as oligohydramnios, can be seen after just two days of NSAID use in pregnant women after 20 weeks gestation. Once the problem is detected and the medication is stopped, the volume of amniotic fluid usually returns to normal. However, when NSAID use continues, serious kidney, heart, and other developmental problems can occur.

Aspirin

Aspirin may be prescribed to treat certain other medical problems in pregnancy, such as preeclampsia. Studies have found that taking a daily low dose of aspirin after the 12th week of pregnancy provides safe and effective complication prevention for pregnant women at risk of preterm labor due to preeclampsia. Aspirin decreases the risk of deadly blood clots in these patients.

The benefits of taking aspirin must be weighed against the increased risk of major bleeding events (hemorrhage), as aspirin slows the ability of blood to form clots. This is of particular concern late term: If aspirin is taken a day or so before delivery, it can lead to heavy bleeding during labor.

Ibuprofen and Naproxen

Ibuprofen and naproxen are often considered safer NSAID options, as these medications have lower risk of gastrointestinal symptoms and other side effects. However, both of these medications should be used with caution during pregnancy.

CBD

Pregnant people should avoid using CBD during pregnancy and breastfeeding. According to the FDA, the "FDA strongly advises against the use of cannabidiol (CBD), tetrahydrocannabinol (THC), and marijuana in any form during pregnancy or while breastfeeding." The primary concerns about CBD are that many of these products are marketed with unsubstantiated claims and have not been rigorously tested for safety or efficacy in pregnant people.

Topical Products

Check with your doctor before using topical painkillers as some are considered safe for use during pregnancy, while others are not. Generally, topical products with menthol or lidocaine as their active ingredients are typically recommended. However, topical medications containing NSAIDs are usually not considered safe during pregnancy, as they have been linked to an increased risk of birth defects.

Prescription Painkillers

The more common prescription painkillers are categorized as opioids, which are derivatives of the poppy plant. All opioids are considered narcotics, which are controlled substances and illegal to use without a prescription.

Painkillers of this strength are typically used for intense pain resulting from injuries, surgery, dental work, or migraine headaches.

These prescription analgesics are available in several different forms and brand names, including:

• Codeine 
• OxyContin (oxycodone)
• Percocet (oxycodone and acetaminophen)
• Roxanol (morphine)
• Demerol (meperidine)
• Duragesic (fentanyl)
• Vicodin (hydrocodone and acetaminophen)

Opiates are potent drugs with adverse effects. Physicians allow the use of these drugs sporadically in pregnant patients when the benefits of the drug outweigh the potential risks.

A Word From Verywell

Remember to always discuss all prescription and over-the-counter pain medications that you're taking (or considering taking) with your OB-GYN before taking them. While there are safe painkiller options for pregnant people, some OTC and prescription analgesic medications can cause serious—even fatal—complications for your baby and yourself.