Hidden risks of over-the-counter drugs in early pregnancy

Caroline Wanjiku, a mother of three, has always believed she knew her body well, and health concerns were rarely cause for alarm.

Wanjiku had weathered her share of colds, infections, and minor discomforts without much fuss.

So, when she began to feel nauseated and tired, she dismissed it as hormonal changes - just another part of being a woman. When the symptoms worsened, she suspected malaria, a frequent and familiar visitor in her region.

Pregnancy? That never even crossed her mind. She was on family planning, after all.

So, like many women in her village, she walked to the nearest pharmacy, bought some painkillers and malaria medication, and moved on with life, unaware that her body was carrying a life and that her choices in those early weeks could have lasting consequences.

Weeks turned into months. Her period was late, but she'd missed it before. Still unconvinced, she brushed it off as stress or hormonal changes. But when three months passed without menstruation, a flicker of doubt grew stronger. Reluctantly, she visited the nearby dispensary for a pregnancy test, just to rule it out.

The result was positive.

“I was disappointed,” she admitted. “I hadn’t planned for another child, and I wasn’t ready. But I accepted it. What else could I do? Life goes on.”

She quietly moved on, adjusting her expectations and telling no one outside her closest circle. With no obvious health issues and her baby moving normally, she felt there was no need for extra medical visits. Scans, in her eyes, were an unnecessary expense.

“I had done this three times before,” she said. “So I thought I knew what to expect. Besides, scans and tests cost money I simply didn’t have.”

Living in a remote village with limited access to healthcare, Wanjiku, like many women in similar situations, was forced to make difficult choices throughout her pregnancy.

With limited finances and long distances to the nearest clinic, every medical decision came down to urgency and affordability. In her community, prenatal scans were viewed as a luxury, only sought when there were clear signs of complications.

During her final hospital visit before delivery, Wanjiku saw no cause for concern. The baby was active, she had experienced no pain or bleeding, and everything seemed normal. Trusting her body and her experience, she skipped the recommended scan.

“I didn’t think it was necessary,” she said. “The baby was kicking. I felt fine. There were no signs that anything was wrong.”

But nothing could have prepared Wanjiku for what came next.

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In the delivery room, she was met with a life-changing reality. Her baby was born with a cleft lip - something she had never seen before. What should have been a joyful moment turned into one filled with shock, fear, and uncertainty.

“I had never seen anything like it,” she said softly. “I didn’t know what to think. I blamed myself. Maybe it was the family planning. Maybe it was the medicine I took for a urinary tract infection before I knew I was pregnant. I had no answers - only fear.”

Wanjiku’s story is not unique. Many women, especially those on contraceptives or with irregular cycles, may not recognise early signs of pregnancy. Symptoms like fatigue, nausea, or body aches can mimic more common illnesses like malaria or urinary tract infections. As a result, many resort to over-the-counter treatments before confirming whether they’re pregnant.

By the time the pregnancy is discovered, the crucial early weeks - when the baby’s brain, heart, and facial features are forming - have already passed. Unfortunately, some medications taken during this period may interfere with development, increasing the risk of complications like miscarriage or birth defects, which may include cleft lip and cleft palate.

Dr Esther Mukuhe, a medical practitioner in Nairobi, observes the consequences of these decisions every day. She reports treating up to five cases a month involving miscarriages, near-miscarriages, or other complications, many of them affecting first-time mothers who were unaware they were pregnant.

“Many women assume they’re suffering from everything except pregnancy,” she explains. “They self-diagnose and self-medicate without running a single test.”

Common medications used to treat pain, infections, or colds can be risky when taken during early pregnancy. Even seemingly harmless drugs can affect how a baby’s tissues grow and fuse. Some alter vitamin levels in the body, while others may disrupt the formation of facial structures, leading to conditions like cleft lip or palate.

And yet, the problem isn’t just the medicine - it’s the assumption that pregnancy can’t be the cause.

Dr Mukuhe urges all sexually active women - even those on birth control - to consider pregnancy a possibility when symptoms arise. A simple, inexpensive pregnancy test can help prevent a chain of complications.

“Before taking medication for a UTI, fungal infection, or even a headache, take the test,” she says. “It’s a small step that can protect both mother and child.”

She also emphasises the importance of proper medical evaluation after a miscarriage. Relying on herbal remedies or skipping post-miscarriage care can jeopardise future pregnancies or lead to infections and fertility issues.

She notes that during the first trimester - especially between weeks five and nine - the embryo undergoes critical development. This includes the formation of the brain, heart, and face. If harmful substances are introduced during this stage, they can interfere with tissue fusion or organ growth, leading to lifelong health problems.

Some over-the-counter drugs - particularly those used to reduce pain, inflammation, or congestion - have been linked in studies to an increased risk of miscarriage or birth defects. Even short-term or mild exposure can be harmful if it occurs during this sensitive time.

The challenge is that many women don’t realise they’re pregnant until after this period has passed.

She advises women to take a pregnancy test before using medication for symptoms like nausea, fatigue, or fever. Always seek medical advice - don’t rely on pharmacies or online searches. Some drugs are safe later in pregnancy but risky early on. Prioritise antenatal care; early scans and tests are vital investments in your baby’s health.

A 2025 systematic review and meta-analysis published in Discover Public Health examined over-the-counter (OTC) medication use during pregnancy and found that approximately 36 per cent of pregnant women globally reported using at least one OTC drug during pregnancy.

Among these, paracetamol (acetaminophen) was the most commonly used, particularly in the second trimester when symptoms like headaches and body aches tend to increase. While paracetamol has traditionally been considered safe for use in pregnancy, growing evidence has raised concerns about potential risks, including neurodevelopmental disorders such as ADHD and asthma in children.

Supporting this, a comprehensive systematic review and meta-analysis published in Allergologia et Immunopathologia in 2021 analysed data from approximately 330,550 pregnancies, including 44,502 cases where paracetamol use was recorded.

The analysis revealed that children born to mothers who used paracetamol during pregnancy faced a 30–35 per cent higher risk of developing asthma or persistent wheezing compared to those unexposed in utero.

The Discover Public Health review also noted that nearly 10 per cent of birth defects worldwide may be attributed to maternal medication use, emphasising the importance of cautious drug use during pregnancy, even for medications that are available without a prescription.

Non-steroidal anti-inflammatory drugs (NSAIDs), though used less frequently (by about 8 per cent of pregnant women), were also identified in the study as potentially harmful. These drugs have been linked to serious complications, including an increased risk of miscarriage, especially when taken during the early stages of pregnancy.

The study further highlighted a common and dangerous misconception: that OTC medications are inherently safe because they do not require a prescription. In reality, their safety can vary greatly depending on the timing, dosage, and frequency of use, as well as the individual health profile of the pregnant woman.

In Kenya, although comprehensive national data is limited, available research and regional trends suggest that OTC medication use during pregnancy is widespread. Analgesics like paracetamol are easily accessible in pharmacies and are frequently used to manage pregnancy-related symptoms.

Many women, however, self-medicate without consulting healthcare professionals, often relying on experience, peer advice, or recommendations from pharmacists. This highlights the urgent need for greater public health education and guidance on the safe use of medications during pregnancy.