Data on Tums during pregnancy?
January 28, 2006 3:41 PM   Subscribe

Calcium carbonate (Tums) during pregnancy:

Doctors tell you it's safe to take Tums during pregnancy; in fact, some encourage you to take it regularly for the calcium. However, I've discovered that it is considered a pregnancy category C drug, meaning that it is 'probably safe,' but that animal studies may show detrimental effects. (Human studies are generally not done on pregnant women.)

So, out of pure curiosity, and because my search skills are failing me today, can anybody find anything more specific on calcium carbonate? Any increased incidence of, well, anything? Any correlations? I realize it won't be hard data, but I am interested. I've found like information on things like Tylenol, but I'm having no luck here.

To avoid any possible debate coming up: I understand that categories A-C are generally considered okay, but my personal choice is to remain on the safe side and avoid anything questionable. Convention may differ, but what can I say; I'm a conservative (read: paranoid) gal where my fetus is concerned, and I'm okay with that. I'm just looking for information here.
posted by moira to Health & Fitness (17 answers total)
Category C just means that there haven't been formal tests demonstrating Tums' safety during pregnancy. It doesn't mean anyone has any expectation that detrimental effects will show up--just that they can't completely rule them out.

FWIW, my wife took Tums like they were candy during her two pregnancies, and both she and our children suffered no ill effects whatsoever.
posted by cerebus19 at 3:55 PM on January 28, 2006

Best answer: This link might be useful.
posted by makonan at 3:59 PM on January 28, 2006

That being said, you shouldn't go overboard on calcium carbonate, either. But of course any medicine you take during pregnancy should generally be taken in moderation.

If you have heartburn anything like my wife's during her pregnancies, however, you may find yourself wanting a lot of Tums.
posted by cerebus19 at 3:59 PM on January 28, 2006

My wife's doctor told her to take Mylanta, and not to take Tums. I have no idea why the distinction was made. Anyway, everything turned out fine, AFAIK.
posted by JekPorkins at 4:10 PM on January 28, 2006

SafeFetus.Com is a great website for this kind of information. According to their data sheet on Tums, there isn't a specific risk classification. In terms of fetal risk, they say:

- The dose of calcium is within the recommended dietary allowance (RDA) in pregnancy but should be avoided in the first trimester because of potential teratogenicity.
- Safe in the last two trimesters if chronic high doses are avoided.
- The use of calcium in pregnancy may cause fetal hypomagnesemia, increased deep tendon reflexes and increased muscle tone.

Whether or not fetal hypomagnesemia's effects are of concern I cannot tell you.

I think that may be a good question for our new ob/gyn member and self-proclaimed expert on all things pregnancy, Dr. Amy.

(On a personal note, I stayed away from Tums throughout all of my pregnancies, because they just seemed too inncocuous and overlooked to be really safe. For stomach problems I went to ginger, for calcium, cheese, spinach and broccoli. It worked all six times.)
posted by Dreama at 4:12 PM on January 28, 2006

cerebrus19 is spot-on. cat C drugs really just mean there's no data available. you can read this as either a) good (we've used it before, seems to be ok, it's not cat D or X), or b) bad (we have noooo idea whut this does).

for TUMS, it's the former. it's actually recommended that women take calcium during their pregnancy. just don't take more than 2 grams/day. i think TUMS usually comes in 400 or 600mg tablets.

if you take an excess of calcium, you may predispose yrself to gettin all funky, with systemic GI or neurological effects. if, for some reason, you start to feel funky (nausea, vomiting, diarrhea, constipation, confusion, fatigue, heart palpitations), stop takin them and see yr physician. these could be signs of milk-alkali syndrome.

if you've got a family history of thyroid problems, let yr physician know, too.

most people are fine taking <2 g/day calcium. keep in mind that calcium carbonate is present in things other than tums! the amount of calcium found in milk ain't bad, and won't throw you over the>
finally, if you have persistent heartburn that isn't relieved by TUMS or the amount of TUMS you need to take, go back to yr doc. he'll suggest summin else, such as pepcid.

whatever you do, don't take this as official advice. for all you know, i may be a crackpot psychopath holding 5 million shares in the makers of TUMS. consult yr physician before taking ANYTHING new or changing up yr dose.
posted by herrdoktor at 4:14 PM on January 28, 2006

- The dose of calcium is within the recommended dietary allowance (RDA) in pregnancy but should be avoided in the first trimester because of potential teratogenicity.

well, according to the gubbmint:
- Pregnant women need 1,000 milligrams (mg) of calcium each day. If you are 18 or younger, you need 1,300 mg of calcium each day.

and according one of THE bumpinest OB/GYN textbooks (Danforth's OB/GYN):
- Calcium supplementation is not necessary in women with a diet that includes adequate dairy foods. Absent this, calcium supplementation may be used on an as-needed basis to meet the recommended dietary allowance (RDA) of 1200 to 1500 mg per day during pregnancy and 2000 mg per day with lactation.

can't link straight to the Danforth page-- i'm gettin it through a log-in medical-type site. so yeah, if yr havin heartburn, go ahead and take some TUMS. just don't take more than 2g/d.

posted by herrdoktor at 4:25 PM on January 28, 2006

Sorry I'm not really answering your question, but I just had my baby recently and I ate the maximum recommended dose of Tums on a daily basis, starting at week 18. My baby is perfectly healthy. Um, so far. Seriously though, the use of Tums during pregnancy is SO common that any problems would have been discovered by now. And I personally recommend the new smooth dissolve Tums. They taste like Smarties.
posted by peep at 4:26 PM on January 28, 2006

argh, sorry for the 3rd post. the first sentence in the above post should've been small. it's a quote from Dreama's comment.
posted by herrdoktor at 4:27 PM on January 28, 2006

Response by poster: Hmmm; I think I wasn't very clear. I'm aware of the verbatim definition of cat. C, and I'm considering it off limits, period. Was just curious what info was out there. I like specifics.

I know Tums is, by all accounts, probably okay, so yeah, call me crazy for preferring other options where I can. There are plenty of ways for me to supplement my diet with other sources and to avoid or address heartburn.

Herrdoktor, I'll address the thyroid thing with my doc again. (Had mentioned a family history, but nothing was said to me about how that might affect anything or about any additional tests.) In the meantime, if you're still around, what is the relationship with calcium?
posted by moira at 4:53 PM on January 28, 2006

i don't want you to think i think yr crazy for pursuing options other than TUMS. i don't want you to think yr crazy for doing so, either. dreama hit on some good stuff, and there are lot of other options for heartburn, such as various teas and extracts. i can't vouch for them myself, nor can i provide you with any studies, but some patients have said that peppermint helps them (the only thing i've come across in the past about this suggested that peppermint actually can make heartburn WORSE by relaxing the esophageal sphincter).

honestly, i don't think TUMS is bad during pregnancy: i'd even go so far as to say there's _nothing_ wrong with taking it during yr pregnancy, as long as it's around 1-1.5 gms/d. the calcium carbonate gets busted down to elemental calcium anyway, and it's the same thing you'll find in various foodstuffs.

all that said, yeah, eat well. get yr calcium that way if you can. i'm not gonna tout "natural is best," because i really dunno. all i can say is that a) the governmental guidelines say it's ok, b) ACOG (American College of OB/GYN-- the medical board that "board certified" OB/GYNs are members of) suggests it, c) the OB/GYN textbook says it's ok. all of this with the caveat that you should take supplements if yr not gettin enough from food.

bottom line: eat well. you can be fine without the calcium from TUMS. heartburn? can be excruciating, and there are plenny of options other than TUMS and pepcid. go crazy, but be informed: lots of herbal/alternative/natural remedies can be potentially harmful (eg: garlic and bleeding).

re: thyroid and calcium. hyperthyroidism is associated with hypercalcemia because thyroid hormone increases the rate of bone turnover. basically, it keeps remodeling itself, releasing calcium. i kinda simplified things, but parathyroid problems cause hypercalcemia as well: parathyroid hormone (parathormone) increases calcium absorption from the gut, and also the breakdown of bone for its calcium.

congrats, and best of luck!
posted by herrdoktor at 7:41 PM on January 28, 2006

Your question raises a number of issues:

1. What does "category C" really mean?

It is important to realize that category C is a governmental declaration not a medical declaration. The FDA categories were promulgated to transmit information to physicians and other providers, but also for legal purposes. Therefore, they are written in "legalese" to reduce the legal liabilities of drug companies.

2. Everything in medicine is a matter of balancing risk vs benefit, and people often have a very poor understanding of risk.

For example, I bet that you do something every day that has a documented risk to your baby that is many orders of magnitude greater than any theoretical risk posed by Tums: you ride in motor vehicles (car, bus, subway, etc.). Many unborn babies have been killed or permanently damanged because their mothers were riding in vehicles. It happens all the time. Nonetheless, you willing undertake this risk. Why? It's because you have calculated that the benefit of riding in a motor vehicle outweighs the risk to your baby.

The same reason should apply in evaluating the use of Tums. Remember, there is a tiny theoretical risk of using Tums, but there are also risks from not using Tums. If you have serious heartburn, you may develop esophageal damage. An ulcer cannot be good for you or for your baby. Surgery for a gastointestinal bleed is certainly not good for you or your baby. In addition, there are also theoretical risks of having a calcium deficiency. When obstetricians weight these risks, most think that treating heartburn offers more benefits than risks, so they recommend Tums (or other antacids that often work more effectively). You need to make that risk benefit analysis for yourself.

3. While it is undoubtedly true that some medications should be avoided during pregnancy, that is a far cry from concluding that all substances pose some sort of danger.

Speaking personally now, as both an obstetrician and a mother of four, I think the "culture" of pregnancy as it exists in the US today is obsessed with nutrition and personal habits (having a glass of wine, etc.) which in the scheme of overall child health are relatively trivial, and ignore other issues that are far more likely to impact child health like how to actually care for and raise the child that you have. To me it seems equivalent to being obsessed with the details of the wedding and paying no mind to the marriage itself.

So, in summary, if you don't want to take Tums (and especially if you don't need to take Tums), don't take Tums. Just keep in mind that you willing assume risks to your baby that are far more substantial than any theoretical risk of Tums. That doesn't mean that you are a bad mother, far from it. It just means that you do what needs to be done: you balance risks and benefits.
posted by DrAmy at 6:41 AM on January 29, 2006 [1 favorite]

I ♥ DrAmy.
posted by padraigin at 11:17 AM on January 29, 2006

Response by poster: There is a lot of presumption going on here in response to a very simple question, which was: Cat. C is unclear; what do we know about Tums? I don't know; I've never used it or read up on it. That's why I asked. Medical opinions and personal anecdotes are something I've taken into account. I want data. I want the same kind of data that says for Tylenol (Cat. B), yes, it is okay to take occasionally if necessary, but it may be associated with an elevated risk of gastroschisis.

My philosophy is simple and practical: I prefer to avoid unknowns where reasonable during my pregnancy. If there was a magic snake oil potion that claimed to do the same thing, I'd want solid information and Cat. A or maybe B slapped on before using it with wild moderation. What I had in mind, however, was more along the lines of avoiding large meals, certain foods and postures, and late-night liquids. If the reflux were to continue or worsen, I would certainly look into the best and safest treatment available. I'm not under the impression that calcium carbonate is a vicious poison to my fetus, and if my condition worsens significantly, I am reasonable enough to reevaluate my stance. Right now, that isn't necessary for me.

This is a personal culture of having the healthiest lifestyle possible and avoiding drugs where I can. I take the mental and emotional well-being of my child just as seriously, and back that up with several child development classes, experience, and scheduled parenting classes, among others. I prefer to go into this as well-equipped as possible on all fronts.

I didn't come right out and state/justify this stance in detail because I didn't see it as necessary for answering the question. In fact, I asked that the big debate be avoided. Your concern is laudable, but misplaced and based on a lot of assumption.

I've worked too intimately with and too long in health care to think that physicians are omniscient. It is my habit, born out of some unfortunate experience, to be an informed patient, and to have the means to judge risk-benefit for myself.

As an aside, Tums as a calcium supplement is a non-issue. There are a gazillion other more readily absorbed sources out there.

Makonan, thanks for the link. It had a little bit of what I was looking for, and may be as much as we know. Dreama, thank you as well for an interesting site. Unfortunately, it doesn't list its sources.

Peep, I'll be sure to look for the smooth dissolve if I end up going that direction later on in my pregnancy. Mmmm, smarties.

Herrdoktor, thank you for the info regarding calcium intake and thyroid conditions. My first blood test probably measured my levels, but I'll be sure to check on that.
posted by moira at 12:26 PM on January 29, 2006

Are you taking Tums due to an acidic stomach? This might sound weird, but due to my ulcer, I found a much better way to calm my stomach is gelatin. As in, chewy gummi-bears, or similar. The Haribo ones are perfect, and you only need a couple.

No chalky side effects, and it works instantly, where as I found Tums and similar antiacids took 10 mins or so for getting relief.
posted by lundman at 5:55 PM on January 29, 2006

Response by poster: Gelatin, really? Huh.
posted by moira at 1:42 PM on January 30, 2006

Well, I'm coming to this discussion very late but I think the reason everyone keeps bringing up the definition of Pregnacy class C is that it means there IS no data. So making a request for data is futile. If it existed Tums would be a class B or Class D drug.

That said, I don't take class C drugs for exactly the same reason as you, at least not without there being a very strong benefit from it. Not proven harmful is not the same thing as proven safe. It could go either way, B or D and I'd never take a class D drug so I don't see how C is much better.

The real question is, WHY isn't there any data? Millions of pregnant women are downing Tums everyday on the reccommendations of their dr's. Whay hasn't someone tracked the outcome?
posted by singetex at 8:15 PM on June 9, 2006

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