Condition or symptom	Incidence among pregnant patients	Nonpharmacologic treatments and lifestyle modifications	Over-the-counter treatments available and their use in pregnancy
Acne^21–23	Up to 43% Typically worsens in late pregnancy	Avoid oily cosmetics Cleanse face twice daily Reduce dairy and high glycemic index food intake	Azelaic acid: acceptable to use Adapalene (Differin): avoid use because of possible teratogenicity Benzoyl peroxide: acceptable to use
Constipation¹⁴	25% to 40%	Increase water intake (> 64 oz per day) Increase dietary fiber intake (> 20 to 35 g daily) Engage in light physical activity Reduce iron dosing to every other day when appropriate in those patients requiring iron therapy	Bulk-forming agents (e.g., psyllium husk): acceptable to use Multispecies probiotics: acceptable to use; may be effective^15,16 Osmotic laxative (e.g., polyethylene glycol 3350, magnesium hydroxide): acceptable to use, but prolonged use can cause electrolyte imbalance
Gastroesophageal reflux disease¹⁰	Approximately 30% to 50%, reaching 80% in some populations	Elevate head of bed or lie on left side Reduce or avoid trigger foods (e.g., fatty, spicy, citrus) Avoid lying down within three hours after eating	Aluminum or magnesium antacids: acceptable to use; avoid magnesium trisilicate Bismuth subsalicylate: avoid use; similar risk as NSAIDs Calcium carbonate: preferred antacid H² antihistamines (e.g., cimetidine, famotidine, nizatidine [Axid]): acceptable to use^5,11,12,14 Proton pump inhibitors (e.g., esomeprazole, lansoprazole, omeprazole): acceptable to use in the second and third trimesters; possible increased risk of minor malformations^12,14 Sodium bicarbonate: avoid use; can cause maternal or fetal fluid overload and metabolic alkalosis
Headache³²	Estimate 40%	—	Acetaminophen: acceptable to use; may increase risk of neurodevelopmental disorders and asthma^33–39 Caffeine: acceptable for migraine treatment; less than 200 mg per day^32,40 Magnesium oxide: acceptable for migraine prophylaxis; 400 to 800 mg per day⁴¹ NSAIDs: avoid use in the first trimester and after 20 weeks’ gestation^42–44
Hemorrhoids¹⁸	15% to 41%, reaching up to 85% in some populations	Take a sitz bath Increase water intake Increase fiber-rich foods Exercise or walk for 30 to 60 minutes three to five times per week Do not ignore the urge to defecate, spend less than three minutes on the commode, and attempt to defecate 30 to 40 minutes after each meal	Low-potency topical corticosteroids (e.g., hydrocortisone 1%): acceptable to use^18,26 Topical lidocaine: acceptable to use after the first trimester¹⁹ Topical pramoxine: acceptable to use in the third trimester ²⁰
Insomnia	Sleep disturbance: 66% to 97%^45,46	Improve sleep hygiene Exercise Limit caffeine intake Restrict fluid intake in the hours before sleep	H₁ antihistamines (e.g., diphenhydramine, doxylamine, hydroxyzine): acceptable to use⁴ Melatonin: probably safe but lacks adequate human data to recommend its use over antihistamines⁴⁷
Low back pain	Up to 68%⁴⁸	Stretch Participate in physical therapy or osteopathic manipulation therapy Use a heating pad (not applied to abdomen or pelvis)	Acetaminophen: acceptable to use; may increase risk of neurodevelopmental disorders and asthma^33–39 NSAIDs: avoid use in the first trimester and after 20 weeks’ gestation^{28,29,42–44} Topical lidocaine: acceptable to use after the first trimester¹⁹
Nausea and vomiting³	Nausea: 50% to 80% Vomiting: 50%	Take prenatal vitamins one month before conception Dietary modifications: eat small, frequent meals and dry, bland foods Change prenatal vitamin to folic acid supplement	Ginger: acceptable to use in the first trimester; increased risk of vaginal bleeding with use after 17 weeks’ gestation; 1,000 to 1,500 mg per day for four consecutive days^6–9H₁ antihistamines: acceptable to use^11,12; diphenhydramine, 25 to 50 mg every four to six hours, or doxylamine, 12.5 mg three to four times per day³ [corrected] Vitamin B₆ (pyridoxine): safe to use; 10 to 25 mg three to four times per day⁹ [corrected]
Rhinitis^{5,30,31,49,50}	18% to 30%³⁰ Among patients with chronic allergic rhinitis, 30% experience worsening symptoms in pregnancy³¹	Elevate head of bed Reduce allergen exposure Nasal strips	Hypertonic saline nasal rinse: safe to use³¹ Intranasal antihistamines (e.g., azelastine): acceptable to use Intranasal corticosteroids (e.g., budesonide, fluticasone [Flonase], mometasone): acceptable to use; helpful in chronic or allergic rhinitis; no proven efficacy for pregnancy-induced or nonallergic rhinitis^49,50; budesonide, 50 mcg in each nostril once or twice per day, is the preferred agent and most widely studied in pregnancy Second-generation H₁ antihistamines (e.g., cetirizine [Zyrtec], loratadine, fexofenadine): acceptable to use; cetirizine and loratadine are preferred Stimulant decongestants: avoid use; possible risk of congenital malformations^51,52