The aches and pains that come with pregnancy can take their toll on a mum-to-be. Some pregnant women will use alternative therapies while for others, a painkiller is the only way they can get relief.
Can you take Panadol while pregnant? Yes, Panadol is considered the safest painkiller for pregnant women. The active ingredient, paracetamol, has few side effects and they are usually limited to minor allergic reactions. Other over the counter painkillers can have dangerous consequences when taken while pregnant, so understanding the active ingredients in drugs keeps mums and bubs safe.
Some people think all over the counter painkillers are the same. While you can purchase them without prescription, they are quite different. Known as non-opioids, they are sold over the counter and include paracetamol and non-steroidal anti-inflammatory drugs (NSAID) such as aspirin and ibuprofen.
Paracetamol
The active ingredient in Panadol is paracetamol which is an analgesic and antipyretic. It’s thought to work by reducing the pain signals in the central nervous system. Paracetamol also reduces fever by reducing the production of prostaglandins in the brain.
The standard adult dose of paracetamol is 0.5-1g which equates to 1-2 tablets every 4-6 hours. The maximum dose for an adult is 4g (8 tablets) in a 24-hour period. Everyone should be careful not to overdose on paracetamol.
Is Panadol Safe in Pregnancy?
Panadol is the most common brand of paracetamol products in Australia. Doctors recommend Panadol as the safest choice for pregnant women. Side effects are rare and generally mild including:
Toxicity of the liver is the most dangerous side effect, usually caused by a double dose of paracetamol.
Marketing of Paracetamol
Paracetamol is the active ingredient in many medications. Dymadon®️, Panadol®️, Panamax®️, Tylenol®️ and Lemsip®️ are the Australian brand names for paracetamol. Drugs containing paracetamol and codeine include Panadeine Forte®️ and Panamax Co®️. Drugs containing paracetamol, codeine and doxylamine include Mersyndol®️, Mersyndol Forte®️ and Panalgesic®️.
Ibuprofen and Aspirin
Ibuprofen, which is chemically similar to Aspirin, reduces inflammation by blocking the production of prostaglandins, a natural chemical released by the body, which causes pain, fever and inflammation. Ibuprofen works by inhibiting COX-1 and COX-2, needed to produce prostaglandins. Because of its ability to reduce inflammation, it can cause hypertension and affect blood clotting.
Side effects of ibuprofen include:
Side effects can also be impacted by the users' size, weight, previous use and the combination of other drugs.
Sufferers of rheumatoid arthritis, osteoarthritis, post-surgery pain, period pain, muscular injury and fever are recommended to take ibuprofen because of its anti-inflammatory properties.
Anyone suffering from ulcers, blood disorders, heart disease, asthma, inflammatory bowel disease (IBD) and renal impairment should avoid ibuprofen.
Marketing of Ibuprofen
Ibuprofen is available in tablet, capsule, soluble powder, liquid and suppository form. In Australia, it is sold under the brand names Brufen®️, Nurofen®️ and Nurofen Plus®️.
If you are unsure which brand name contains paracetamol or ibuprofen, read the box for the active ingredient.
Ibuprofen and Links to Birth Defects
All pregnant women have a background risk of 3-5% chance of having a baby born with a congenital disability. However, taking ibuprofen during early pregnancy has been linked to higher risks of birth defects. If taken close to the time of conception, ibuprofen increases the risk of miscarriage.
A Canadian study found that women who had prescriptions for NSAIDs filled during the first three months of pregnancy were twice as likely to have a baby with any birth defect diagnosed in the first year and three times as likely to have a baby with a structural defect. These include cleft palate and an opening in the wall separating the left and right sides of the heart.
Why You May Experience Pain in Pregnancy
A woman’s body undergoes many changes throughout the nine months of pregnancy. Mild pain is a common side effect.
Back pain
While back pain can occur throughout pregnancy, it is usually worse in the late stages when the baby is heavier, and the centre of gravity moves forward, changing the posture. The pain can be sharp, jabbing or a dull ache on both sides of the lower abdomen and groin area.
Ligaments
Ligament pain is one of the most common complaints during pregnancy. Ligaments supporting the growing uterus stretch and thin during the second trimester of pregnancy.
Heartburn
The muscle relaxer hormone progesterone causes the stomach valve also to relax and allow acid into the oesophagus.
The Risks of Taking Painkillers During Pregnancy
Understanding the risks involved in taking painkillers during pregnancy are difficult as pregnant women are usually precluded from clinical trials. Therefore, research is undertaken to compare pregnant women who use and don’t use a drug.
Study Related to Increased Risk of Behavioural Problems in Children
A study of 7,000 pregnant women in Britain has found a link between the use of paracetamol during pregnancy and children with behavioural problems at the age of seven.
Published in the JAMA Paediatrics journal in 2016, the study asked women to record their use of paracetamol at 18 weeks and 32 weeks of pregnancy. The survey showed 53% of participants took the drug at 18 weeks and 42% took it at 32 weeks. When their children were seven, 5% of mothers reported their child had behavioural problems. Researchers found there was an increased risk of a behavioural problem if the drug was taken at 18 and 32 weeks and an increased risk of emotional problems if the drug was taken at 32 weeks.
An Australian specialist pharmacist and researcher said the results were not enough of a reason for pregnant women to stop taking paracetamol to treat pain and fever as the risk was minimal. The survey result amounts to one to two extra cases of behavioural problems in every 100 births linked to paracetamol.
The research also didn’t examine why the women were using paracetamol. There is some clinical and animal evidence that some infections at certain times during pregnancy can cause neurological disorders. It can be argued that these infections are to blame for the behavioural problems, not the drug. It is also not known if an untreated fever could cause more harm to a foetus. More research is needed to gain definitive answers.
An earlier Danish study tracking 64,000 women found a similar correlation between paracetamol use and ADHD-like behaviour and hyperkinetic disorders (a severe form of ADHD) in children. ADHD is one of the most common neurological conditions in the world and is characterised by inattention, hyperactivity, increased impulsivity, and motivational/emotional dysregulation.
Study Related to Reproductive Health
Research published in the Reproduction journal found male mice exposed to paracetamol in the womb were less likely to mate. The males had a smaller number of neurons in the brain connected to sexual behaviour. They were also found to be less aggressive, and had changed urinary marking patterns as adults.
The Danish researchers believe there is enough evidence to suggest pregnant women should limit their use of paracetamol. Their earlier study found prenatal exposure can cause developmental changes in reproductive organs in both rodents and humans.
Other OTC Medications to Avoid While Pregnant
It’s not just ibuprophen and aspirin that are the only over the counter medications and preparations you should avoid while pregnant. Steer clear of cold and flu tablets containing pseudo-ephedrine and phenylephrine, nicotine gum and patches, allergy and congestion relief containing chlorpheniramine, castor oil, migraine relief containing caffeine and cold and allergy relief containing brompheniramine
Alternatives to Painkillers During Pregnancy
If you experience pain during pregnancy, speak to your doctor. Sometimes a painkiller is the only remedy, but you can also try to gain relief from the following:
Stretching - see a physio who can tell you which stretches are safe for you to do during pregnancy.
Massage – a pregnancy-safe massage may assist in giving you relief.
Talking a Walk - some pregnant women feel better after light exercise.
Warm shower – the warm water may provide some temporary relief.
Heat pack – depending on the location of your pain, a microwavable heat pack may help.
Sleeping position – try sleeping on your left side and using a sleep aid pillow to support your abdomen.
Support belt – use a maternity belt to support the weight of your abdomen during the day.
Rest – take the weight off regularly by sitting or lying down.
Alternatives to Reduce Fever While Pregnant
Pregnant or not we are all at risk of fever. Our temperature is determined by our body’s thermoregulatory set-point which can increase when it encounters a threat of bacterial or viral infection. Colds, flu and gastroenteritis are the most common causes. While it is common to take paracetamol to reduce fever while pregnant, there are some alternatives you can try.
Cool cloths – placing a cold, wet cloth on your wrists, forehead or ankles can reduce fever.
Slightly warm bath – as the water slowly cools so does the body temperature
Keep up the fluids – fever can cause dehydration so drink plenty of water or herbal tea.
Rest – try not to do too much to give your body the best chance of recovery.
Impact of Medication on Different Stages of Pregnancy
Different stages of pregnancy are at higher risk of birth defects. During the first four weeks, there is minimal risk that any medicine can impact a foetus because organs haven’t started to form and there is no blood supply connecting mother and foetus.
Weeks four to ten is when the risk of defect caused by medications is greatest as a foetus’ limbs are beginning to develop and the heart divides into the cavities. During weeks 11-26 the risks decrease but pick up from weeks 27 to 40 as the foetal organs start to function. The organs are immature and inefficient at medication and nutrient elimination.
However, there can be more harm done to a foetus if their mother stops taking some medications while pregnant. Antidepressants, asthma inhalers and anticonvulsant medications are continued by most mothers through pregnancy to ensure a healthy baby.
Where to Find Information About Taking Medication During Pregnancy
The Therapeutic Goods Administration (TGA) regulates any therapeutic goods that are supplied, imported, manufactured, exported and advertised in Australia. The Administration is responsible for conducting pre-market assessment and post-market monitoring of therapeutic goods.
The NPS Medicine Line (1300 MEDICINE) is staffed by registered nurses who can answer queries about prescription drugs, over the counter medicines and complementary therapies.
All medications have a category. Category A medications are the preferred option as large numbers of pregnant women have taken them without any proven increase in the frequency of malformations or harmful effects on the foetus. For more information, see the Australian Categorisation System for Prescribing Medicines in Pregnancy.
Remember to read all labels, packaging and information sheets before taking any medication, particularly when pregnant. If you are unsure if a medication is safe, call the Medicine Line, ask a pharmacist or your doctor.