Safe medicine during pregnancy: how to check before you take anything

You can take some medicines during pregnancy, and the safe way to choose them is to check each one first. That goes for creams and herbal tonics too. For pain or fever, HSA says paracetamol remains the recommended treatment in pregnancy when used as directed. HealthHub says to avoid ibuprofen. For anything else, ask a pharmacist or your doctor first.

How to check a medicine in pregnancy, step by step

1. Tell every doctor, dentist and pharmacist you're pregnant. HealthHub's medicine leaflets ask you to tell them, and to mention any supplements or herbal remedies you use.
2. Keep taking prescribed medicine until you've talked to your doctor. SingHealth says coming off medicine that keeps you well would put your baby at risk.
3. Ask a pharmacist before you buy anything over the counter. HSA says Pharmacy-Only medicines come with a pharmacist's advice on precautions and drug interactions, while General Sale List medicines can be bought from any shop, so take those to a pharmacy counter too.
4. Read the active ingredients, not just the brand name. HealthHub warns that paracetamol is often mixed into other medicines, and the NHS says cold remedies may already contain pseudoephedrine, which it doesn't recommend in pregnancy.
5. Use paracetamol for pain or fever as the label directs, but not the versions with added caffeine, which KKH doctors writing for Families for Life say to avoid.
6. Skip ibuprofen unless a doctor prescribes it. HealthHub says it should be avoided in pregnant women.
7. Treat herbs and TCM as medicine. SingHealth's TCM guide says Chinese medicine should only be used on your doctor's advice, so run each one past your gynae.
8. Buy from a pharmacy or a shop with a real presence in Singapore. HSA once found a potent steroid in a skin cream sold online as safe for pregnant women.
9. Keep a list of everything you take, with a photo of each label. Bring it to your first gynae visit and every check-up after; KKH asks anyone on regular medicine to talk to their doctor.

Common complaints: what's generally OK and what to ask about first

Here's what Singapore's hospitals and HSA say about the medicines people reach for most. Doses always come from the label or your doctor.

Cold and flu medicines get more detail in flu while pregnant. Heartburn has its own guide at heartburn during pregnancy, and nausea medicines are covered in morning sickness remedies.

Why the first months need the most care

SingHealth asks you to talk to your GP or obstetrician before taking any medicine, especially in the first few months, when your baby's organs are developing. Certain drugs are known to affect that. So early pregnancy is when checking matters most.

Most medicines do reach your baby. The UK's bumps leaflets (best use of medicines in pregnancy) say most cross the placenta, and for many that isn't a problem. Checking sorts out the few that are.

On long-term medicine, such as for thyroid or epilepsy? SingHealth says the best time to review it is when you're planning a baby. Already pregnant? Keep taking it until you've spoken to your doctor, and book that talk soon. Our guides to thyroid problems in pregnancy and antidepressants in pregnancy go further, and the first trimester checklist covers the other early jobs.

Paracetamol, ibuprofen and aspirin

HSA says paracetamol remains the recommended treatment for pain or fever in pregnant women when used as directed. It says there's no conclusive scientific evidence that paracetamol causes autism, and its own safety monitoring hasn't found a concern. Follow the label or your doctor. HSA's general rule is the lowest effective dose for the shortest time you need it.

Treating a fever looks after your baby too. HSA says untreated fever or pain during pregnancy can pose risks to the unborn child.

Ibuprofen is different. HealthHub says to avoid it in pregnancy. In the UK, bumps says it isn't advised unless a doctor prescribes it, especially from 20 weeks, when it can reduce the fluid around your baby. Taken before 20 weeks, bumps says, it's unlikely to harm your baby. If you took some before you knew, mention it at your next visit.

Aspirin is a special case. HealthHub notes that some women are started on aspirin in pregnancy to help prevent pre-eclampsia. If your gynae prescribed it, don't stop without speaking to them. For pain or fever, HealthHub asks you to clear aspirin with your healthcare professional first.

Herbs, TCM and products bought online

SingHealth's guide to TCM in pregnancy says Chinese medicine should only be used on your doctor's advice. Used wrongly, herbs can cause miscarriage or harm the baby. Some are strictly prohibited during pregnancy. Seeing a TCM practitioner? Tell them you're pregnant, and look them up on TCMPB's online register, which lists practitioners with a valid practising certificate.

Take the same care with products bought online or passed on by relatives. HSA tested a skin cream that claimed to be steroid-free and safe for pregnant women. It contained clobetasol propionate, a potent steroid that HSA says should only be prescribed by doctors.

Be wary of anything that promises miracles or no side effects, HSA says, even from well-meaning friends. Online, buy only from reputable pharmacies or shops with an established presence in Singapore.

Prenatal vitamins have their own guide. Confinement herbs and tonics after the birth are in medicine safe while breastfeeding, and hair dye and household sprays are in cleaning products while pregnant.

If you've already taken something

Call your gynae's clinic or a pharmacist. Tell them what you took and when, and keep the pack. Say how many weeks pregnant you are. Bumps notes that miscarriage and birth defects carry a background risk in every pregnancy, whether medication is taken or not.

Two cases need a quicker call. Bumps asks you to tell your doctor or midwife as soon as possible if you took ibuprofen after 20 weeks without medical supervision. And if you've used a product HSA flagged for hidden steroids, HSA says to see a doctor as soon as possible. Stopping steroids suddenly can cause problems of its own.

When to see a doctor

See a doctor, or call your gynae's clinic, if you have any of these:

• A temperature of 37.5 degrees C or more, taken at the mouth or ear. HealthHub counts that as a fever and lists pregnancy as a reason to see a doctor for one.
• Pain or fever that paracetamol doesn't control. Bumps says to ask your doctor before taking ibuprofen or any other anti-inflammatory.
• Heartburn that won't go away. KKH says it can sometimes be a sign of something more serious, such as pre-eclampsia.
• Vaginal bleeding, tummy pain, a severe headache or changes in your vision. KKH lists these, with fever, as medical concerns to come in for.
• You took ibuprofen after 20 weeks without a doctor's advice (bumps), or used a product HSA has warned about.

KKH asks you to go to its Urgent O&G Centre (Basement 1, Women's Tower) if you're under 22 weeks, or its Delivery Suite (Level 2, Women's Tower) from 22 weeks. Booked at another hospital? Use its own delivery suite or emergency route; our guide to premature labour signs lists SGH's. For a life-threatening emergency, such as breathlessness or excessive bleeding, MOH says to call 995.

Frequently asked questions

What is safe medicine during pregnancy in Singapore?

Paracetamol is the one Singapore sources name for pain or fever. HSA says it remains the recommended treatment in pregnancy when used as directed. Check most other medicines with your pharmacist or gynae first, because SingHealth says certain drugs can affect your baby's development.

Can I take paracetamol while pregnant?

Yes. HSA says paracetamol remains the recommended treatment for pain or fever in pregnancy, used as the label or your doctor directs. It also says there's no conclusive evidence that it causes autism. KKH doctors suggest skipping products with added caffeine.

Which medicines to avoid in pregnancy?

HealthHub says to avoid ibuprofen. KKH doctors writing for Families for Life say to stay away from sleeping pills and over-the-counter slimming pills. The NHS doesn't recommend the decongestant pseudoephedrine. SingHealth says herbs and TCM need your doctor's advice first.

Who can I ask about safe medicine in pregnancy in Singapore?

Start with any pharmacist at a retail pharmacy. HSA says Pharmacy-Only medicines come with a pharmacist's advice on precautions and interactions. For minor problems such as flu, SingHealth says your GP or polyclinic doctor can advise, and your gynae's clinic can take questions between check-ups.

I took medicine before I knew I was pregnant. What now?

Tell your gynae or GP what you took and when, and keep the pack. Bumps notes that miscarriage and birth defects carry a background risk whether medication is taken or not. Don't stop a prescribed medicine on your own: SingHealth says coming off medicine that keeps you well would put your baby at risk.

Is it safe to use TCM or herbal remedies while pregnant?

Only with your doctor's advice, SingHealth says. Some herbs are strictly prohibited in pregnancy, and others can cause miscarriage if used wrongly. If you see a TCM practitioner, check they're on TCMPB's register and tell them you're pregnant.