When you find out that you’re expecting a child, one of the first conversations you have with your doctor might be about caffeine. The American College of Obstetricians and Gynecologists (ACOG) recommends drinking no more than 200 milligrams of daily caffeine (about 12 ounces of coffee). A new review of 37 studies previously conducted on the relationship between caffeine and pregnancy suggests that even just two cups of joe could pose risks to a healthy pregnancy.
board-certified OB/GYN and clinical professor at the Yale University School of Medicine
Published in BMJ Evidence-Based Medicine, the study used past research in an attempt to demystify the relationship between maternal caffeine consumption and adverse pregnancy outcomes like miscarriage, low birth weight, stillbirth, pre-term delivery, childhood leukemia, and childhood obesity. “There is substantial cumulative evidence of an association between maternal caffeine consumption and diverse negative pregnancy outcomes,” says author of the study Jack E. James, PhD, a professor at Reykjavik University. “Consequently, current evidence does not support health advice that assumes ‘moderate’ caffeine consumption during pregnancy is safe.”
Not all reproductive health experts and gynecologists agree with this conclusion, however—and that’s because there are a lot of obstacles when it comes to measuring how much a cup of tea or coffee can really affect a pregnancy. “Unfortunately, all of the data on pregnant women and caffeine are from basically observational trials,” says Mary Jane Minkin, MD, a gynecologist and clinical professor of obstetrics, gynecology, and reproductive sciences at Yale University. “These studies are observing real women going through pregnancies and asking about caffeine consumption—they are not prospective, randomized, double-blind trials that we like to do with medications to change one variable and see what happens.” When you’re just observing people, there’s no real way to control the experiment to zero in on the consequence (if any) of consuming caffeine.
Lucky Sekhon, MD, fertility specialist and board-certified OBGYN from NYC, points out that these studies prove even more flawed because of the natural biases that happen in trials that can’t be finely controlled by researchers. “The majority of studies on caffeine use in pregnancy, to date, rely on pregnant women to recall their caffeine consumption before and during their pregnancy, which is often a significant time after they having been pregnant,” she says. “There is often ‘recall’ bias in this case, where women who had an adverse outcome in pregnancy have a greater tendency to recall and possibly exaggerate their exposure to caffeine during pregnancy.”
These studies often also overlook confounding factors that could lead to worse health outcomes. “For instance, women who consume very high levels of caffeine may be from a lower socioeconomic background or have a tendency to also be smokers or take on additional exposures that contribute to adverse pregnancy outcome,” says Dr. Sekhon. For all of these reasons, the ACOG already sent out a note to its members saying that Dr. James’ review didn’t strike them as a reason to alter their current recommendations. And Dr. Sekhon agrees that’s a good call.
“To say that [caffeine] should be avoided at all costs during pregnancy, in my opinion, is an over-extrapolation of the data and not necessary,” says Dr. Sekhon. “I tell women it is okay to consume caffeine in pregnancy, but the daily amount should not exceed 200 milligrams. It is important to be aware of the caffeine contact of not just beverages such as tea or coffee, but also in food.”
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When pregnant, cold and flu season can be particularly challenging because you never quite know which medications are safe to take. While some over-the-counter (OTC) medications get the “green light” to use, others may contain certain ingredients that aren’t necessarily safe in early or late pregnancy (such as ibuprofen or aspirin). But there’s some good news here: Plenty of pregnancy-safe options exist for clearing cold symptoms, including cough medicine.
internal medicine and primary care doctor at Beth Israel Deaconess Medical Center
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Read on to see what healthcare experts have to say about taking cough medicine while pregnant, including safe ingredients to look for, potential side effects, and certain products they recommend.
But there are specific kinds that are best: “Cough medicines that contain guaifenesin and dextromethorphan should be okay for a short time,” says Meleen Chuang, MD, the chief of obstetrics and gynecology at NYU Langone Hospital. Here’s a breakdown of the uses of both:
Dextromethorphan: temporarily relieves coughing and, according to recent studies, is one of the top-recommended cough treatments for people who are pregnant.
Guaifenesin: helps clear lung and chest congestion and is also safe to consume while pregnant, according to Dr. Silver.
Dr. Chuang recommends taking one to two doses for as-needed relief, along with trying home remedies such as warm showers, vapor rub, Vicks shower steamers ($26), or tea with honey and lemon.
Which ingredients are not recommended?
With all the above in mind, Dr. Chuang says there are still some types of cough medicines to stay away from. She recommends steering clear of ones that contain pseudoephedrine—a type of nasal decongestant. Some common OTC meds that contain this ingredient are Sudafed, certain types of Robitussin, and Mucinex D.
Pseudoephedrine can be dangerous in pregnancy because it may increase the risk of things like “uterine contractions, vaginal bleeding, and an increased risk of severe pregnancy complications,” Dr. Chuang adds. So, be sure to check in with your healthcare provider before taking these medicines.
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There are possible side effects and risks
While cough medicines that contain dextromethorphan or guaifenesin are safe to take in moderation, they can have side effects that vary from product to product, says Dr. Chuang. These side effects can also happen when you are not pregnant, so keep that in mind as you are taking any type of cough relief medicine at home. The National Library of Medicine notes common side effects include the following:
Drowsiness
Dizziness or lightheadedness
Restlessness
Nervousness
Nausea or stomach pain
Vomiting
Constipation
Allergic reactions
Be sure to contact your healthcare provider right away if you develop a rash or any other severe and unexpected side effects after taking cough medicine. Also, if you’re pregnant and have high blood pressure, it’s not typically recommended to take cough medicine (especially ones with pseudoephedrine) as they can increase your numbers. So, be sure to check with your provider before trying it, says Dr. Silver.
OK, but what about cough drops?
According to Dr. Chuang, cough drops are a safe alternative remedy to take while pregnant. She recommends looking for drops with simple, soothing ingredients like peppermint, eucalyptus, lemon, or honey—all of which are known to soothe a sore, itchy throat.
Just remember to check cough drop labels to make sure there are no potentially harmful ingredients—like pseudoephedrine—in the product. If you’re ever unsure, ask your healthcare provider for specific recommendations.
5 cough medicines (or alternatives) recommended by OB/GYNs
The next time you’re at the store or the pharmacy looking for something to nip your cold in the bud, Dr. Chuang says the following products are your best bet:
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1.
Robitussin($12): This medicine has both dextromethorphan and guaifenesin to thin mucus and relieve cough. Just make sure you are buying the type that doesn’t have pseudoephedrine.
2.
Mucinex ($15): Plain Mucinex contains guaifenesin to thin mucus for more productive coughing.
3.
Benadryl($14): Even though it’s typically used to relieve allergy symptoms, Benadryl’s main ingredient, diphenhydramine, can help with minor cold symptoms, too.
4.
Tylenol ($7): This medicine, also known as acetaminophen, is a safe choice for pain and fever management.
Dr. Silver also recommends trying a nasal decongestant spray like Vicks Sinex ($15) if you need to relieve coughing in particular. “Post-nasal drip causes coughing,” she says. “Nasal decongestant spray is one of the most effective treatments for a cough because it eases that post-nasal drip.”
Remember
It’s always best to check with your healthcare provider before starting any new medication, even if it’s generally considered safe.
When to see a healthcare provider
During pregnancy, it’s always important to monitor your health carefully. While most cough and cold symptoms are mild and will typically go away on their own, reach out to your healthcare provider if you experience the following symptoms:
Persistent high fever
Shortness of breath
Coughing up thick, yellow-green phlegm
Severe dizziness or fainting
Weight loss
Worsening symptoms despite taking medication
And as mentioned, reach out to your provider right away if you experience a rash or severe, unexpected side effects after taking cough medicine, as this could indicate an allergic reaction.
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The final takeaway
Cough medicine that contains dextromethorphan and guaifenesin is generally safe to take while pregnant, along with other non-cough medicine options like Tylenol and Benadryl for general cold symptom relief. You can also take cough drops, as long as they don’t contain potentially risky ingredients like pseudoephedrine, which can increase your risk for certain pregnancy complications.
It’s best to also incorporate natural cough remedies when you’re feeling under the weather, including drinking tea with lemon and honey, taking a warm shower, or using vapor rub, according to experts.
When in doubt about a medication’s safety during pregnancy, ask your healthcare provider, who can offer personalized treatment recommendations to ensure the safety of you and your pregnancy.
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Iron: It’s a must-have nutrient, especially during pregnancy. Not only does the essential mineral help keep you energized (which, if you’ve ever been pregnant, you know how tiring it can be), but it also helps support a fetus’s growth and development through each trimester. This is why finding the best iron supplement for pregnancy is crucial.
board-certified OB/GYN, reproductive endocrinologist, and medical advisor to Bird&Be
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But how exactly does the mineral work in the body? “Iron helps the body produce hemoglobin, the protein in red blood cells that carry oxygen,” Prati Sharma, MD, board-certified OB/GYN, reproductive endocrinologist, and medical advisor for Bird&Be fertility brand, tells Well+Good. In pregnancy, Dr. Sharma says getting enough iron is non-negotiable since depleted levels may up your risk for issues like preeclampsia1 (high blood pressure), hypothyroidism (underactive thyroid), pre-term birth2, and stunted growth3.
With so many iron supplement options on the market, finding a safe and effective product can feel overwhelming. The good news? Prenatal experts agree that there are a few key features to look for when purchasing an iron supplement.
Below, we’ve compiled everything you need to know, plus eight of our favorite iron supplement picks.
What to look for in an iron supplement for pregnancy
“When choosing an iron supplement for pregnancy, there are several factors to consider to ensure optimal effectiveness and safety,” Lauren Manaker, MS, RDN, registered dietitian nutritionist and author of The First Time Mom’s Pregnancy Cookbook, tells Well+Good. Here’s a breakdown of the key features to look for:
1. Iron dose
Most pregnant people need at least 27 milligrams of iron per day during pregnancy. While your prenatal multivitamin typically covers this, some people with a pre-existing iron deficiency may need additional iron on top of their prenatal. Manaker says that each person’s iron needs may vary, so it’s important to consult a healthcare provider who can assess your iron levels and provide personalized recommendations.
2. Iron form
“Opt for a supplement that contains a highly absorbable form of iron, such as ferrous bisglycinate4 or ferrous fumarate,” says Manaker. She adds that these forms of iron are generally well-tolerated (meaning, they could be easier on your stomach) and have higher absorption rates than other forms of iron, i.e., more of it gets into your bloodstream.
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3. Third-party testing
Most dietary supplements aren’t regulated by the Food and Drug Administration (FDA), so Manaker recommends choosing a supplement that has been third-party tested for quality, purity, and accuracy of the stated ingredients to make sure you’re getting a reliable and trustworthy product. Some third-party certifications that help ensure a product meets rigorous quality standards include the National Sanitation Foundation (NSF) International and the United States Pharmacopeia (USP).
4. Other beneficial ingredients
“Consider supplements that also contain other essential nutrients for pregnancy,” advises Manaker, “such as vitamin C, which may enhance iron absorption.”
Iron supplements can cause constipation
Another important thing to keep in mind when searching for an iron supplement is that some kinds can lead to backed-up bowels. “Higher doses can be hard to tolerate, with constipation being the most common side effect,” says Parti Sharma, MD, a board-certified OB/GYN, reproductive endocrinologist, and medical advisor for Bird&Be fertility brand.
If opting for more gentle forms (like ferrous bisglycinate chelate) doesn’t help, Jillian LoPiano, MD, an OB/GYN and chief health officer at Wisp recommends taking a stool softener (such as docusate or Miralax), which is safe and often prescribed during pregnancy. Just be sure to talk with your healthcare provider before trying it.
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Without further ado, here are our top picks.
The 8 best iron supplements to take during pregnancy
Emily Harland, RDN, LDN, a registered dietitian nutritionist with Worley Nutrition Group recommends these iron capsules from Fullwell Fertility because they’re easily absorbed, gentle on your digestive tract (some iron pills can increase your risk of constipation), and are third-party tested for contaminants, heavy metals, and for quality assurance. “I recommend it to all of my clients needing a high-quality iron supplement,” Harland adds.
Pros:
Contains vitamin C to help absorption
Gentle on the stomach
Third-party tested
Free from most common allergens, including gluten, wheat, dairy, peanuts, tree nuts, and shellfish
Cons:
Contains a proprietary blend of veggie powders and botanical extracts, which some people may not need
Dr. Sharma loves this product because it’s a prenatal vitamin with iron separated into its own capsules. “If the pregnant person is really sick, they can split up the capsules throughout the day and take the iron with whatever food they’re able to keep down,” she says.
She adds that many of her patients are able to tolerate these pills, even when sick, because the type of iron used (ferrous bisglycinate chelate) helps to prevent an upset stomach and constipation.
Pros:
Vegan-friendly
Free from most allergens, including gluten, dairy, yeast, artificial colors and dyes, and preservatives
If iron pills tend to give you constipation even when you’re not pregnant, this product from Nature’s Plus might do the trick. “This high-potency, time-released formula pairs plant-based iron with vitamin C and copper, offering the perfect solution for pregnant people experiencing anemia—sans unwanted side effects [like constipation],” says Brooke Miner, MS, RDN, LDN, a registered dietitian nutritionist at Sunshine State Dietitian in Florida.
Miner adds that all products by this brand are USDA organic and NSF-certified, giving peace of mind to those who consume them.
Registered dietitian nutritionist Megan Scutti, RDN, LDN recommends Needed iron because it’s vegan, non-GMO, free from the top nine food allergens and gluten, and doesn’t contain any unwanted fillers. Not only are the capsules easy to swallow, but their low iron content per serving allows you to personalize your dose depending on your stage of pregnancy, recommended iron levels, and dietary lifestyle. “This makes it the perfect supplement no matter your dietary needs,” Scutti adds.
Manaker recommends this pick from Life Extension because it’s highly absorbable compared to some other types. Why is that? It’s made with a form of iron called iron protein succinylate, which “consists of an iron bound with a protein to help improve its absorption in the digestive system,” Manaker adds. The only downside is that the iron per serving is pretty low, so you might have to take more than one capsule if you are deficient.
Pros:
Affordable
Highly absorbable form of iron
Third-party tested
Non-GMO
Vegetarian friendly
Cons:
The iron dose may be too low for people with severe deficiency
When it comes to the best liquid iron supplement for pregnancy, Manaker turns to NOW Foods Liquid Iron because it provides 18 milligrams of iron per serving. Plus, “this supplement is made with iron in the ferric glycinate form, which is a taste-free, well-absorbed form of iron,” she adds. It’s also dairy-, gluten-, and sugar-free, non-GMO, and Kosher, making it a good choice for a variety of dietary needs.
If swallowing a pill or drinking a (interestingly flavored) liquid is not your jam, a gummy might help you get the daily iron you need. Manaker says this pick from MegaFood has only one gram of added sugar per gummy, and includes key ingredients like iron bisgylcinate, vitamin B12, and vitamin B6. “They’re also free from gelatin, so vegetarians can enjoy them,” she adds. “And like all MegaFood products, these are tested for over 150 pesticides.”
An added bonus? They come in a delicious strawberry flavor and are easy on the stomach.
Editor’s note: Manaker is on MegaFood’s Nutrition Collaborative team.
Type of iron: Ferrochel (ferrous bisglycinate chelate)
Taking iron supplements with a source of vitamin C can help the nutrient better absorb into your stomach and eventually your bloodstream. But instead of having to drink a glass of orange juice or take a separate vitamin C tablet, Thorne Ferrasorb comes with both iron and vitamin C for your convenience.
The specific type of iron in this pill is ferrous bisgylcinate, which may be easier on the stomach, plus “it contains ingredients like folate and B12, to help reduce the risk of deficiencies of other B vitamins,” says Manaker. This makes it a great choice for preventing anemia during pregnancy, as vitamin B deficiency can also lead to anemia.
Just keep in mind: If you’re already taking a prenatal multivitamin with B-complex, talk to your healthcare provider before adding Thorne Ferrasorb, as you could end up over-supplementing.
Pros:
Contains vitamin C to improve iron absorption
Contains other B vitamins
Gluten-, soy-, and dairy-free
Third-party tested by NSF
Cons:
Risk of B vitamin over-supplementation if also taking a prenatal vitamin
Finding the best iron supplement while you’re pregnant can be difficult, but with the help of your healthcare provider—who can test your iron levels and provide recommendations—you can help prevent iron and nutrient deficiencies that may increase your risk of pregnancy complications. If you’re ever unsure of a product or supplement’s safety and efficacy, reach out to your provider for guidance.
Johnson, Alby et al. “The Interplay of Hypertension and Anemia on Pregnancy Outcomes.” Cureus vol. 15,10 e46390. 2 Oct. 2023, doi:10.7759/cureus.46390
Rahmati S, Azami M, Badfar G, Parizad N, Sayehmiri K. The relationship between maternal anemia during pregnancy with preterm birth: a systematic review and meta-analysis. J Matern Fetal Neonatal Med. 2020 Aug;33(15):2679-2689. doi: 10.1080/14767058.2018.1555811. Epub 2019 Apr 9. PMID: 30522368.
Nadhiroh, Siti Rahayu, et al. “Association between maternal anemia and stunting in infants and children aged 0–60 months: A Systematic Literature Review.” Nutrition, vol. 115, Nov. 2023, p. 112094, https://doi.org/10.1016/j.nut.2023.112094.
Fischer, Jordie A J et al. “The effects of oral ferrous bisglycinate supplementation on hemoglobin and ferritin concentrations in adults and children: a systematic review and meta-analysis of randomized controlled trials.” Nutrition reviews vol. 81,8 (2023): 904-920. doi:10.1093/nutrit/nuac106
