Pain Medication While Pregnant: What's Safe?

Consult a Doctor Before Taking Any Pain Meds

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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.

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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.

Some OTC and prescription painkillers increase the likelihood of pregnancy complications or birth defects.


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.

Generally, up until 20 weeks gestation, ibuprofen and naproxen are considered safe 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.

Acetylsalicylic acid, the active ingredient in aspirin, works by inhibiting several chemical processes in the body to block pain and inflammation and inhibits blood clotting. However, it should not be taken by expectant mothers (except for those at high risk for preeclampsia), particularly in high doses, because it can cause serious problems for both the mother and the fetus.

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.

Ibuprofen and naproxen are generally considered safe during the first 20 weeks of pregnancy, but they are not recommended during the final half of pregnancy because they increase the risk of fetal kidney problems and bleeding during delivery.

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.

There is no evidence that any level of narcotic use during pregnancy is safe, and there's much research to suggest serious risks. Risks to the fetus include miscarriage, stillbirth, or premature delivery. At birth, the baby is also at increased risk of low birth weight (below 5.5 pounds), breathing difficulties, and extreme drowsiness, which can lead to feeding problems.

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.

13 Sources
Verywell Family uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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Additional Reading

By Naveed Saleh, MD, MS
Naveed Saleh, MD, MS, is a medical writer and editor covering new treatments and trending health news.