How to Prepare for and Ask the Right Questions About Medications with Your OB/GYN

When you’re planning a pregnancy or already pregnant, your body changes in ways no other time in your life will. That includes how your body reacts to every pill, drop, or supplement you take. What was safe last year might not be safe now. And what you think is harmless-like a herbal tea or a fish oil capsule-could be doing more harm than good. The good news? Your OB/GYN is trained to help you sort this out. But only if you show up prepared.

Why Medication Talks with Your OB/GYN Are Different

Most doctors review your meds once a year. Your OB/GYN needs to do it every visit-especially if you’re pregnant or trying to conceive. Why? Because some medications can interfere with ovulation, increase miscarriage risk, or affect fetal development. Even common painkillers like ibuprofen can be risky after 20 weeks of pregnancy. And while your primary care doctor might not think twice about your St. John’s Wort or melatonin, your OB/GYN knows these can mess with hormones or reduce birth control effectiveness by up to 50%.

ACOG (the American College of Obstetricians and Gynecologists) says every woman planning pregnancy should have a full medication review. That includes everything: prescriptions, over-the-counter drugs, vitamins, herbal teas, CBD gummies, and even topical creams. If you’re breastfeeding, the stakes are even higher-meds can pass into breast milk and affect your baby’s sleep, digestion, or brain development.

What to Bring to Your Appointment

Don’t rely on memory. Write it down. Here’s exactly what to include:

• Prescription meds: Name, dose, how often you take it, and why. Example: Levothyroxine 75 mcg, one pill daily, for hypothyroidism.
• Over-the-counter drugs: Ibuprofen, acetaminophen, cold pills, antacids-even if you only take them once a month.
• Supplements: Prenatal vitamins, iron, omega-3s, magnesium, zinc. Don’t forget brands. Some prenatal vitamins have too much vitamin A, which can be toxic.
• Herbs and teas: Red raspberry leaf, ginger tea, chamomile, evening primrose oil. Yes, even “natural” stuff. Evening primrose oil, for example, can trigger contractions.
• Recreational substances: Alcohol, nicotine, cannabis. Be honest. Your OB/GYN isn’t here to judge-they’re here to help you stay safe.

Pro tip: Take photos of each bottle with your phone. If you can’t remember the exact dose, a picture of the label is better than guessing. One patient in Denver brought a spreadsheet with 17 items-including a brand of turmeric supplement she didn’t think counted. Her OB printed it and kept it in her chart. That’s the kind of prep that makes a difference.

Questions to Ask Your OB/GYN

Don’t wait for your doctor to ask. Come ready with these questions:

• Is this medication safe during pregnancy or breastfeeding? Don’t settle for “probably.” Ask if it’s classified as Category A, B, C, D, or X (A is safest, X is dangerous).
• Is there a safer alternative? For example, if you’re on a blood pressure med like lisinopril (Category D), ask about labetalol or methyldopa (both Category C, but safer in pregnancy).
• Do I need to stop this before trying to conceive? Some meds, like acne treatments (isotretinoin) or certain antidepressants, need to be cleared from your system months before pregnancy.
• What happens if I can’t stop this med? If you have epilepsy, depression, or high blood pressure, you might need to stay on your med. Your OB/GYN should explain the risks vs. benefits clearly.
• Will this affect my fertility? Some antidepressants, thyroid meds, and even high-dose zinc can impact ovulation.
• How will you monitor me if I keep taking this? For example, if you’re on thyroid medication, you’ll need TSH tests every 4-6 weeks during pregnancy.

Common Mistakes People Make

You’re not alone if you’ve made one of these:

• Thinking “natural” means safe. St. John’s Wort, black cohosh, and dong quai can interfere with hormones or cause uterine contractions.
• Forgetting supplements. A 2022 survey found 41% of patients didn’t mention supplements because they didn’t think they counted as “medication.”
• Waiting until you’re pregnant to ask. If you’re trying to conceive, start this conversation at least 3 months before stopping birth control. Folic acid, for example, needs to be in your system for at least a month before conception to prevent neural tube defects.
• Assuming your OB/GYN knows your full history. They might not have access to your other doctors’ records. You’re the only one who knows everything you’re taking.

What Your OB/GYN Won’t Tell You (But Should)

Many OB/GYNs focus on pregnancy-safe meds but don’t talk about what happens after birth. If you’re breastfeeding, ask:

• Which meds are safe while nursing? SSRIs like sertraline are usually fine. Benzodiazepines? Not so much.
• How long after taking a dose should I wait to breastfeed? For some pain meds, waiting 2-4 hours reduces baby exposure.
• Will this affect my milk supply? Antihistamines, decongestants, and some birth control pills can reduce milk production.

Also, don’t assume your OB/GYN knows about your cannabis use. Only 38% of providers routinely screen for medical marijuana-even though 18% of reproductive-aged women use it. If you use it for pain, anxiety, or nausea, tell them. There are safer ways to manage symptoms during pregnancy.

What to Expect After the Discussion

If you’re on a risky med, your OB/GYN might:

• Switch you to a safer option
• Refer you to a maternal-fetal medicine specialist
• Order blood tests to check levels (like thyroid or lithium)
• Recommend a pharmacist who specializes in pregnancy meds

Some practices now use apps like Babyscripts to track blood pressure or medication adherence during pregnancy. If yours does, sign up. It reduces errors and gives you real-time feedback.

Why This Matters More Than Ever

More women are entering pregnancy with chronic conditions-diabetes, asthma, depression, autoimmune diseases. In 2010, 44% of pregnant women had at least one chronic condition. By 2025, that number is expected to hit 58%. That means more meds, more interactions, more risks.

The FDA’s Pregnancy and Lactation Labeling Rule from 2015 tried to fix this-but 42% of commonly prescribed drugs still lack clear safety data. That’s why your role as an informed patient matters more than ever. You’re not just a passive recipient of care. You’re the most important part of the team.

Final Tip: Practice Before You Go

Write down your list. Say it out loud. Ask a partner or friend to quiz you: “What’s your dose of Synthroid?” “Do you still take that fish oil?” “Did you mention the CBD oil?”

Patients who prepare their lists 72 hours before their appointment spend 15-20 fewer minutes in the exam room and report 40% higher satisfaction. Why? Because the conversation shifts from “What are you taking?” to “Let’s make sure this is safe for you and your baby.”

You deserve to feel confident about every pill you swallow during this time. And with the right prep, you can.