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Accutane® See Isotretinoin.

Acetaminophen
Acetaminophen, also known as Anacin-3(r), Datril(r), Panadol(r), Tylenol(r), and Valorin(r), is an over-the-counter pain medication (see Pain relievers) and fever reducer. It is an ingredient in numerous cold and flu remedies (see Cough and cold suppressants).

Concerns: A scientific study noted a link between high (almost everyday) acetaminophen use in the third trimester of pregnancy and wheezing and asthma in children. There was no link with average or high use prior to 20 weeks of pregnancy.

Acetaminophen has been assigned a pregnancy risk factor category of B (see Appendix 1). Although controlled studies have not been performed on humans, there is no evidence that taking an occasional acetaminophen or two during pregnancy causes any problems. Further, a prolonged high fever in pregnancy could cause problems for the baby, so you should always try to bring a fever down with acetaminophen.

The bottom line: Acetaminophen is considered to be the safest pain reliever and fever reducer in pregnancy. It is viewed as the pain reliever of choice in pregnancy.

Acidophilus
Acidophilus is a nutritional supplement that contains the bacteria Lactobacillus acidophilus. Many people think that the bacteria aid in digestion and play a role in keeping our immune systems healthy. Acidophilus can be taken orally as a capsule or powder, or is present in some brands of yogurt (see Yogurt). It is also available as a vaginal suppository to treat yeast infections.

Concerns: Because acidophilus is categorized as a food supplement, it is not regulated by the U.S. Food and Drug Administration. Thus, there is no guarantee of the strength, purity, or safety of this product. If you are experiencing a pregnancy complication, you may want to avoid vaginal suppositories. It is a good idea to inform your health care provider if you are taking any nutritional supplements.

The bottom line: Some studies have observed beneficial digestive effects from taking acidophilus by mouth or using it in a vaginal suppository to treat vaginal yeast infections. Acidophilus may also aid in the treatment of chronic diarrhea; however, its usefulness in other conditions is unclear. Acidophilus appears to be safe in pregnancy.

Acrylic nails
Acrylic nails are artificial nails created by a liquid monomer and a powdered polymer that are combined to form an epoxy. The mixture is then shaped and applied over the natural nail or to a plastic tip that has been glued to the nail. The result is a strong, natural-looking nail that can last for several weeks.

Concerns: Because most manicurists find it necessary to wear face masks to avoid breathing in fumes, many pregnant women have concerns about having this treatment and about visiting salons where this treatment is performed. It is also known that some chemicals can be absorbed into the natural nail itself.

No studies have been performed that deal specifically with acrylic nails and pregnancy, but the U.S. Food and Drug Administration has deemed one ingredient used in acrylic nails, methyl-methacrylate (MMA), a health hazard due to the potential of allergic reactions and asthma exacerbations. Be sure to ask your salon if this chemical is used on the premises. Stay clear of any salon that still uses MMA, regardless of pregnancy status. The ingredient ethyl-methacrylate (EMA) is a safer alternative.

The bottom line: If you are worried, avoid the treatment outright while pregnant. Make every effort to limit potential effects by waiting until after the first trimester, when there is less risk to the development of the baby's organs; go to a well-ventilated salon; visit earlier in the day when there are less fumes; consider wearing a mask; and avoid getting chemicals on your skin.

Acupressure
Acupressure is a less invasive form of acupuncture (see Acupuncture) that uses thumb or finger pressure, in place of needles, to balance or correct the internal flow of energy. Acupressure has been used to decrease the symptoms of morning sickness, turn breech babies, and reduce labor pains. A typical session can last from 30 minutes to 1 hour.

Concerns: Several studies have looked at the effectiveness of acupressure to relieve or reduce symptoms related to morning sickness. Wristband acupressure has been shown to safely relieve or reduce the symptoms of morning sickness. This technique can be applied by a provider, by oneself, or through the use of elastic bands. Some acupoints are thought to help speed or induce labor, and reasonable care must be taken prior to being full term.

The bottom line: Based on recent scientific studies, acupressure does seem to have some usefulness during pregnancy, especially to control nausea. There is no scientific literature indicating that acupressure has been harmful to a pregnancy.

Acupuncture
Acupuncture is based on the traditional Chinese belief that health depends on a balanced flow of life energy, or qi (also spelled chi). To correct any imbalances, acupuncture needles are placed into acupoints, which act to correct the flow of qi and to redirect the flow of energy to affected areas. Traditional Chinese medicine has used acupuncture for thousands of years to reduce pain during childbirth. More recently, scientific studies have examined the usefulness of acupuncture for infertility, nausea, back pain, carpal tunnel syndrome, turning breech babies, postpartum depression, and the induction of labor.

Concerns: Most traditional western OB/GYNs have a limited knowledge of acupuncture and are not likely to recommend its use during pregnancy. Concerns over how it works and the safety of sticking needles into the body have contributed to recommendations to avoid acupuncture during pregnancy. Practitioners of acupuncture caution against overuse throughout pregnancy due to concerns about overstimulation of the fetus. They also suggest avoiding certain acupoints that may stimulate premature labor in the first and second trimesters.

The bottom line: Based on recent scientific studies, acupuncture does seem to have some usefulness during pregnancy, especially to control labor pain, back pain, and nausea, and to increase the success of in vitro fertilization. However, because some acupoints are thought to induce or help speed labor, reasonable care must be taken to avoid these acupoints prior to 37 weeks. There is no scientific literature indicating that acupuncture is harmful during pregnancy. Be sure you visit a licensed or certified acupuncturist. Requirements vary from state to state, but you can learn more through your state's medical board or health department.

Adderall®
Adderall® is a brand name of amphetamine (see Amphetamines).

Adrenaline Rush®
Adrenaline Rush® is a brand name of an energy drink (see Energy drinks).

Advantage®
Advantage® is a brand name of animal flea medication (see Flea and tick medications).

Advil®
Advil® is a brand name of ibuprofen (see Ibuprofen; Pain relievers).

Air conditioners
Air conditioners lower the air temperature in an enclosed area.
Concerns: Some people notice increased allergy symptoms when using air conditioners during the summer months, which is often due to nonfunctioning air filters. A simple way to avoid this is to maintain the unit properly. Replace filters according to the manufacturer's suggestions; some manufacturers recommend as often as once per month. Air conditioning can also exacerbate the dry skin you may experience during your pregnancy. To help with this condition, consider using a good moisturizer and humidifier.

There has also been some publicity about the association of Legionnaire's disease outbreaks with air conditioners. Legionnaire's disease is caused by a bacterium called Legionella pneumophila, which lives in warm-water environments, such as those found in air conditioners, plumbing systems, and humidifiers. It is estimated that 8,000 to 10,000 people contract Legionnaire's disease every year. However, it is often difficult to diagnose the disease accurately because symptoms can vary from person to person. Unless a doctor specifically suspects Legionnaire's, the appropriate tests are often not performed. The disease is most dangerous to those who have a weakened immune system due to cancer therapy, smoking, or organ transplants. Pregnancy does not appear to be an increased risk factor for getting this disease. While the U.S. Department of Labor's Occupational Safety and Health Administration has standards in place for work-related systems, it is unclear how many cases of Legionnaire's disease are acquired in private homes and what the optimal methods of prevention are. Proper maintenance of all plumbing systems, air-conditioning systems, and humidifiers should minimize your risk of contracting this disease.

The bottom line: A well-maintained air conditioner is safe in pregnancy.

Air fresheners
Air fresheners and aerosol sprays are used to change the odor of the air.

Concerns: A recent study examining use of air fresheners and aerosols found an association between their use and an increase in ear infections and diarrhea in young exposed children and an increased risk for maternal depression. The researchers concluded that the cause may have been volatile organic compounds (VOCs). VOCs are a large, diverse group of organic chemicals that exist in a gas form at room temperature. VOCs are found in a variety of materials in the home, including aerosol sprays, new building materials (see Building materials), deodorants, and furniture polish (see Household cleaners). The majority of VOCs have not been reported to cause any harmful effects, but a few can cause headaches, dizziness, and worsening of respiratory diseases, such as asthma (see Asthma). Some VOCs have been recognized to be carcinogenic (cancer causing).
The bottom line: Until more is known about the effects of these household air fresheners, it would be wise to avoid heavy use during pregnancy.

Air purifiers
Air purifiers remove allergens from the air using filters.

Concerns: Air purifiers have filters that work to trap particles, such as mold, dust, and pollen, that can cause allergies and asthma (see Asthma). When the filter needs to be changed and is not working optimally, these allergens can be released back into the air, causing an allergy or asthma flare-up. A simple way to avoid this is to keep up with the maintenance of your unit. Follow the manufacturer's suggestions for routine maintenance.

The bottom line: A well-maintained air purifier is safe in pregnancy.

Air travel

Air travel involves travel in airplanes.

Concerns: People have voiced many concerns and theoretical risks relating to flying during pregnancy, including increased risk of miscarriage; effects of pressure changes, dehydration, noise vibration, and radiation; and increased risk of blood clots at high altitudes.

* Risk of miscarriage: One study has shown that flight attendants do have a slightly increased risk of first-trimester miscarriages; however, some researchers now think that the high number of hours a week these women were flying and many other stresses contributed to their increased risk. Similar rates of miscarriage have not been seen in the casual flier.

* Altitude: Most commercial airlines keep the cabin pressurized to 5,000 to 8,000 feet (see High altitudes). Pregnancy at high altitude has been associated with low birth weight, preterm labor, and preeclampsia (hypertension, protein in the urine, and swelling). However, traveling at this altitude for a relatively short period of time does not appear to cause any pregnancy complications.

* Dehydration: Concerns over dehydration are based on an average cabin humidity of less than 25 percent, which is quite dry. However, keeping hydrated is not difficult, and this problem can be overcome.

* Blood clots: The theoretical concern that long periods of immobility may cause blood clots to form in the legs has not been substantiated by any published report to date, although much anecdotal evidence exists. Like dehydration, this concern can be easily addressed by moving about or stretching every couple of hours.

* Noise vibration and radiation: Studies have shown this is of negligible risk to travelers.
Commercial airlines often require documentation of your due date and may restrict your flight in the third trimester due to concerns that you may deliver in the air. Check with the airline before you make travel plans so you won't run into any unexpected problems. Finally, if you are having a high-risk pregnancy, consult with your health care provider before you travel. Consider taking a copy of your prenatal records with you in case you need emergency care while you are away from home.

The bottom line: Air travel is safe in pregnancy. Obviously, if a complication occurs when you are far from home, you may be forced to deal with new doctors. While traveling, make sure to keep well hydrated and stretch your legs every so often. Seat belt use is encouraged and considered to be safe.

Albuterol
Albuterol is a medication used in the treatment of asthma (see Asthma) and preterm labor.

Concerns: One study in laboratory mice reports an association between albuterol and an increased incidence of cleft palate. However, no published studies indicate an association between albuterol use and human birth defects. As a result, this drug has been assigned a pregnancy risk factor category of C (see Appendix 1). Albuterol can also cause hypotension (low blood pressure) and temporary increases in heart rate and so should be taken with care.

Women with well-controlled asthma have fewer pregnancy complications. In light of this, it seems prudent to take all prescribed asthma medications as directed to keep your asthma under good control. Albuterol may be part of this regimen.

The bottom line: Albuterol is safe in pregnancy.

Alcoholic beverages
Alcoholic beverages are made from a fermented mash of various ingredients, including grains or other plants. Popular types of alcohol include whiskey, gin, rum, vodka, wine, and beer.

Concerns:Alcohol is a known teratogen (cause of birth defects). Consumption of alcohol during pregnancy has been associated with intrauterine growth restriction (low birth weight), mental retardation, abnormal facial defects, and other major and minor fetal malformations. Although it appears that fetal alcohol syndrome (FAS) is caused by heavy drinking and/or binge drinking, currently there are no known safe levels of alcohol during pregnancy, and pregnant women are advised not to drink at all.

The bottom line: Although an occasional sip may be okay, there is absolutely no known amount of alcohol that is safe in pregnancy. Most health care providers recommend avoiding all alcohol during pregnancy.

Aleve®
Aleve® is a brand name of naproxen (see Naproxen; Pain relievers).

Allegra®
Allegra® is a brand name of fexofenadine (see Fexofenadine; Allergy medications).

Allerest®
Allerest® is a brand name of naphazoline (see Naphazoline; Allergy medications).

Allergy medications
Allergy medications are used to treat the symptoms caused by allergies, including nasal itching, runny nose, nasal congestion, watery eyes, and sneezing. Common brands include Allegra(r) (see Fexofenadine), Allerest® (see Naphazoline), Claritin® (see Loratadine), Nasacort® (see Triamcinolone acetonide), and Zyrtec® (see Cetrizine). Some are available over the counter while others require a prescription. These medications come in the form of pills, nasal sprays, and eye ointments.

Concerns: Most allergy medications have been assigned a risk factor category of B or C (see Appendix 1).

The bottom line: Most allergy medicines are considered to be safe in pregnancy. Discuss any specific allergy medications with your health care provider.

Alpha-lipoic acid
Alpha-lipoic acid (ALA) is a dietary supplement that has been used to treat many conditions, including diabetes, glaucoma, and alcoholic liver damage.

Concerns: Since ALA is categorized as a food supplement, it is not regulated by the U.S. Food and Drug Administration. Thus, there is no guarantee of the strength, purity, or safety of this product. Several studies have shown that ALA worked better than placebo in lowering blood sugar.

The bottom line: There is not enough known about the effect of ALA to recommend its use during pregnancy. Diabetes during pregnancy is a high-risk condition and should be treated by a physician with medications that are known to work.