Is Pepto-Bismol safe during pregnancy?

What does the evidence say about Pepto-Bismol during pregnancy?

1. Once bismuth subsalicylate reaches your stomach and intestines, it splits into salicylic acid and bismuth, which puts it in the same salicylate family as aspirin. 1
2. Products containing bismuth subsalicylate aren't recommended during pregnancy, especially in the second and third trimesters, due to possible effects on fetal kidney function, amniotic fluid, and the fetal heart and blood vessels. 1
3. For travelers' diarrhea during pregnancy, clinicians are told to skip bismuth subsalicylate because of how salicylates could affect the fetus, and to use oral hydration with azithromycin or a cephalosporin instead when medication is truly needed. 2
4. The product's own FDA-required Drug Facts label carries a salicylate allergy alert and tells anyone who is pregnant or breastfeeding to ask a health professional before use. 3
5. Aspirin itself is best avoided late in pregnancy because of bleeding risk and the chance of early closure of the fetal ductus arteriosus, and that same concern extends to related NSAID and salicylate compounds. 4

Is Pepto-Bismol safe in each trimester?

• First trimester. In the first trimester, most clinicians steer patients toward non-salicylate options for occasional stomach upset, since bismuth subsalicylate shares its chemistry with aspirin and there isn't much first-trimester safety data. If nausea or diarrhea is bad enough that you're considering medication, that's a good moment to consult your healthcare provider rather than pick an over-the-counter salicylate product on your own.
• Second trimester. MotherToBaby flags the second trimester, along with the third, as a time when bismuth subsalicylate use is discouraged. Short-term digestive symptoms at this stage are usually managed with hydration, diet adjustments, or a provider-approved alternative instead.
• Third trimester. Caution is strongest in the third trimester. The same salicylate chemistry that makes low-dose aspirin a bleeding and ductus-arteriosus concern late in pregnancy applies here too, and it may also affect fetal kidney function and amniotic fluid at this stage. Most providers ask patients to set it aside as delivery approaches.