Take two aspirin?

Find out which OTC medications are safe during pregnancy.

You’re eight months pregnant, and with your uterus squeezing your stomach, you could really use an antacid. Is it safe to pop a Tums?

A prickly heat rash is sweeping like wildfire across your abdomen. Should you reach for the cortisone cream?

And what about the pounding headache, those achy legs and the nausea, constipation or sniffles that won’t go away? Are there any over-the-counter remedies you can swallow, swill, chew, spray or rub on that will not threaten your developing baby?

In a word, yes. Although any woman who is pregnant or planning to become pregnant in the near future should not take anything — even an aspirin — without first discussing it with her doctor, many nonprescription medications pose no known risks to mother or fetus. “Pregnancy is a time to be cautious, but avoiding everything is not appropriate,” says Lynn Martinez, program manager for the Pregnancy RiskLine in Salt Lake City, a referral organization for the Teratology Information Services hot line. “Though the benefit of using a medicine during pregnancy sometimes far outweighs any potential risk, some women are fearful of taking anything, even when it’s on doctor’s orders.”

But just because a medication is available without a prescription does not mean it is safe to take during pregnancy. (In fact, because of the potential risks, few drugs have been tested on pregnant women.) Experts say that where any drug is concerned, it is best to proceed with caution. “The basic rule is, if you don’t need to take a medication — prescription or over-the-counter — don’t take it,” says Karen Filkins, M.D., director of reproductive genetics in the Department of Obstetrics and Gynecology at the University of California, Los Angeles, Medical School. Still, we do know enough about the use of some remedies during pregnancy to give them a green light.

Safe bets

Pain relievers No serious risks from the moderate use of acetaminophen (Tylenol) have been found. But experts often warn against using aspirin, ibuprofen (Advil) and non-steroidal anti-inflammatories containing naproxen (Naprosyn).

Cold medicines Oral decongestants called pseudoephedrines (Sudafed) have been used safely during pregnancy to relieve sniffles and sneezing. Nasal sprays are usually not recommended, as their effects on fetal development have not been as well studied.

Antacids The antacid of choice, according to Martinez, is one containing calcium carbonate (Tums). If you want to use a different product, select one without sodium, since salt can cause fluid retention.

Laxatives John Larsen, M.D., professor of obstetrics and gynecology at The George Washington University Medical Center in Washington, D.C., tells his patients to drink a lot of water and use a fiber preparation such as oat bran or Metamucil. Stronger purgatives may cause severe cramping and become habit-forming.

Nausea remedies Although drugs can be prescribed for severe nausea, pregnant women’s milder upsets have been treated for decades with the over-the-counter antihistamine doxylamine. Found in some sleep aids, it also can be safely used to ease cold or allergy symptoms. Anti-nausea remedies such as cola syrup or other sugar compounds (including Emetrol) have been used for generations. If your doctor agrees, they can be a safe choice during pregnancy.

Creams Occasional use of topical hydrocortisone creams (Dermacort) seems to be safe for soothing annoying skin rashes. “No over-the-counter topical ointment or cream has been found to cause birth defects in humans,” Martinez says.

Even so, Filkins advises against casual daily use of these compounds. “Topical medications are absorbed by different women in varying degrees,” so it’s a good idea to ask your doctor first,” she says.

Strictly off-limits

Medications to be avoided at all costs are such known teratogens (agents that cause birth defects) as the acne drug isotretinoin (Accutane); repeated high doses of androgen hormones used to treat some cancers; and thalidomide, which has been used in the laboratory to treat AIDS, leprosy and even arthritis. Also avoid daily doses of aspirin or other blood thinners late in pregnancy, as well as alcohol and cigarettes.

Should you have a nervous stomach after reading this, Filkins offers this final bit of advice: “Go ahead. Take the Tums.”