Pregnancy can be such 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 of those meds that pregnant women have been advised to stay away from in the past. 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 Teresa Berg, 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. Berg. "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. Berg. "While baby aspirin is relatively innocuous, 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," she says. "The bottom line, if you don't need it, don't take it. For the average woman, you run the risk of complicating your life."

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. Berg. "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. Berg. "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 in moderation for two to three days, is usually acceptable," explains Dr. Berg. "Some types of pain may be better treated with non-steroidal anti-inflammatory drugs (NSAID). Like aspirin, NSAIDs can alter platelets 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 venosus."

These should be taken with physician direction and should not be used after 32 weeks of gestation. Most women will be given a list of medications felt to be safe by their provider during pregnancy. Alternative solutions like heat therapy or topical medications are acceptable and do not have the same level of concern because these are external. However, if you continue to need pain relief after three days, it's a good idea to talk to your doctor, advises Dr. Berg. 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. Berg.