Pregnancy can be an emotional and uncertain time.  What should you eat or not eat? What medications can you take, if any? You want to do the right thing – after all, there are two of you that you now need to worry about!  

Aspirin has been one medication that pregnant women have been advised to avoid. But new research reveals that “baby” aspirin may be beneficial in some circumstances.

"In general, we recommend pregnant women minimize their exposure to medications as much as possible," says Neil Hamill, MD, Nebraska Medicine obstetrician-gynecologist. "But baby aspirin may have some benefits to women at risk for preeclampsia."

During pregnancy, women undergo alterations in their immune systems that may be associated with pregnancy issues like preeclampsia, pre-term labor, first-trimester pregnancy losses and growth restriction.

"Over the years, we have been trying to determine how we can improve pregnancy outcomes associated with these changes," says Dr. Hamill. "We've looked at things like antioxidants, calcium supplements and low-dose aspirin. While we've not seen any outcomes changes in some of these other pregnancy problems, we have seen that baby aspirin may decrease the incidence of preeclampsia in women with risk factors."  

Risk factors for preeclampsia include high blood pressure, diabetes, small vascular diseases like lupus and a history of preeclampsia. 

Baby aspirin should be taken under a doctor's recommendation and watchful eye, notes Dr. Hamill. 

"While baby aspirin is relatively safe, it can still change how the platelets function, making them less likely to stick together. Even in these very low doses, it can cause ulcers in some women as well as bleeding problems," he says. "The bottom line, if you don't need it, don't take it."

What about acetaminophen (Tylenol)?

Another over-the-counter medication that has been getting attention lately includes acetaminophen. 

A small study funded by the National Institutes of Health (NIH) found that exposure to acetaminophen in the womb may increase a child's risk for attention deficit/hyperactivity disorder and autism spectrum disorder by up to nearly 3%. 

"It should be noted that this was a small study so we can't be sure that there is a true causal and effect," says Dr. Hamill. "More research needs to be done."

"Determining what kinds of medications are safe to take during pregnancy has been a problem for years because there's just not a lot of reproductive data out there, and it is difficult to study," says Dr. Hamill. "The effect of anything in the fetus is a longitudinal process." 

This means that arriving at a definite cause and effect is difficult because we are looking at observations that fluctuate up and down over time for each individual, and it is the amount of fluctuation that is the focus of the study.

"If you are having problems during pregnancy that require pain relief, using over-the-counter pain relievers like acetaminophen – for two to three days – is usually acceptable," explains Dr. Hamill. "Some types of pain may be better treated with nonsteroidal anti-inflammatory drugs (NSAID). Like aspirin, NSAIDs can alter platelet function and after 32 weeks, it is believed that it could increase the risk of narrowing or closure of a fetal blood vessel called the ductus arteriosus."

For this reason, NSAIDs should only be used under a doctor’s direction and avoided after 32 weeks of gestation. 

Most women will be given a list of medications considered safe during pregnancy from their provider. 

Non-medication options, such as heat therapy or topical treatment, are acceptable and carry fewer risks. However, if you continue to need pain relief after three days, it's a good idea to talk to your doctor. At that point, you should have your doctor address the problem that is causing you to need medications.

Whenever you are in doubt, talk to your doctor for advice, says Dr. Hamill.