What should I avoid during pregnancy?

What to Avoid During Pregnancy

Pregnant women must avoid alcohol, illicit drugs, smoking, certain medications (especially NSAIDs after 20 weeks and ACE inhibitors), specific high-mercury fish, bed-sharing preparations that increase SIDS risk, excessive heat exposure, and soft/undercooked foods that pose infection risks.

Substances That Must Be Avoided

Alcohol and Illicit Drugs

• Avoid all alcohol periconceptionally and throughout pregnancy as it increases the risk of SIDS and causes fetal harm 1
• Alcohol use combined with bed-sharing places infants at particularly high risk of SIDS 1
• Avoid all illicit drugs during pregnancy and after birth due to increased SIDS risk and developmental harm 1
• Prenatal and postnatal exposure to alcohol or illicit drugs significantly increases SIDS risk 1

Tobacco

• Stop smoking immediately - use behavioral programs or formal smoking cessation programs 1
• Maternal smoking during pregnancy increases SIDS risk, even if parents don't smoke in bed 1
• Moderate to heavy smoking (>20 cigarettes per day) with comorbidities is a relative contraindication to exercise 1

Medications to Avoid or Use With Extreme Caution

NSAIDs (like Ibuprofen):

• Avoid NSAIDs at approximately 30 weeks gestation and later due to risk of premature closure of fetal ductus arteriosus 2
• Limit use between 20-30 weeks to lowest effective dose and shortest duration (maximum 48 hours if possible) due to risk of oligohydramnios and fetal renal dysfunction 2
• If NSAID use extends beyond 48 hours after 20 weeks, ultrasound monitoring for oligohydramnios is necessary 2
• Discontinue immediately if oligohydramnios occurs 2

ACE Inhibitors:

• ACE inhibitors are contraindicated in pregnancy and should be avoided in women who may become pregnant 1

Other Medications:

• Avoid FDA pregnancy category X medications 1
• Avoid most category D medications unless maternal benefits clearly outweigh fetal risks 1
• Review all over-the-counter medications, herbs, and supplements with your healthcare provider 1
• Avoid isotretinoin (Accutane), warfarin (Coumadin), and certain antiseizure medications 1

Foods and Beverages to Avoid

High-Mercury Fish

• Avoid fish with highest mercury contamination potential: shark, swordfish, king mackerel, and tilefish 1
• Limit other fish consumption while still aiming for at least two servings of fish weekly, preferably oily fish 1

Dietary Restrictions

• Limit saturated fat, cholesterol, sodium, and sugar intake 1
• Completely avoid trans-fatty acids 1
• Avoid alcohol in any amount 1

Environmental and Activity Hazards

Heat Exposure

• Avoid saunas, hot tubs, and jacuzzis, especially in early pregnancy 3
• If using a hot tub, limit exposure to less than 10 minutes, ensure water temperature is below 39.0°C (102.2°F), and exit immediately if feeling unwell 3
• Avoid hot yoga due to dehydration risk 3
• Avoid physical activity in excessive heat, especially with high humidity, to prevent maternal hyperthermia 3
• Do not overbundle or cover the infant's face and head after birth 1

Workplace and Home Toxins

• Avoid exposure to heavy metals, solvents, pesticides, endocrine disruptors, and allergens at home, in the neighborhood, and workplace 1
• Review Material Safety Data Sheets for workplace exposures 1

Infant Sleep Safety Preparations (Postpartum Planning)

Bed-Sharing Situations to Avoid

While pregnant, understand these bed-sharing situations must be avoided after birth:

• Never bed-share when infant is younger than 3 months, regardless of smoking status 1
• Never bed-share if you or partner are current smokers or if you smoked during pregnancy 1
• Never bed-share when excessively tired 1
• Never bed-share after using medications (certain antidepressants, pain medications) or substances that impair alertness 1
• Never bed-share on soft surfaces (waterbed, old mattress, sofa, couch, armchair) 1
• Never bed-share with soft bedding including pillows, heavy blankets, quilts, and comforters 1
• Devices promoted to make bed-sharing "safe" (in-bed co-sleepers) are not recommended 1

Infant Sleep Environment

• Keep soft objects (pillows, quilts, comforters, sheepskins) out of infant's sleeping environment 1
• Bumper pads are not recommended due to suffocation, entrapment, and strangulation risk 1

Important Screening and Monitoring

Infections

• Screen for periodontal, urogenital, and sexually transmitted infections as indicated 1
• Update immunizations: hepatitis B, rubella, varicella, Tdap, HPV, and influenza as needed 1

Medical Conditions

• Screen for and manage hypertension and diabetes 1
• Screen for depression, anxiety, and domestic violence 1
• Ensure tight control of pregestational diabetes 1

Nutritional Deficiencies

• Avoid multiple nutrient deficiencies and chronic undernutrition 1
• Take daily multivitamin containing folic acid 1

Common Pitfalls to Avoid

The "just a little won't hurt" fallacy: No amount of alcohol is proven safe in pregnancy 1. Even occasional use increases SIDS risk.

Over-the-counter medication assumption: Many women assume OTC medications are safe - they require the same scrutiny as prescription drugs 1.

Late NSAID use: Many women don't realize common pain relievers like ibuprofen become dangerous after 20 weeks gestation 2.

Heat exposure in first trimester: The critical period for neural tube development makes heat exposure particularly dangerous early in pregnancy, yet many women are unaware 3.

Untreated chronic conditions: Delaying management of hypertension, diabetes, or thyroid disease poses greater risk than appropriately selected medications 1.