Most guidance says it's better to avoid Pepto-Bismol during pregnancy. The active ingredient, bismuth subsalicylate, is a salicylate (in the same family as aspirin), and health authorities advise against salicylates in pregnancy — particularly later on. This reflects what bodies like the NHS, FDA, and ACOG say about salicylates; your provider can suggest a safer option for your symptoms.
Pepto-Bismol is an over-the-counter medicine for upset stomach, heartburn, nausea, indigestion, and diarrhea. Its active ingredient is bismuth subsalicylate. The "salicylate" part matters: it is chemically related to aspirin, which is why the pregnancy advice is more cautious than for many other stomach remedies.
The FDA warns against using salicylate-containing products, including aspirin, in the third trimester, because they can affect the baby's circulation — specifically premature closure of a fetal blood vessel called the ductus arteriosus — and increase bleeding risk around delivery. The NHS advises avoiding aspirin-type medicines in pregnancy unless a doctor recommends them. Because bismuth subsalicylate is a salicylate, most clinicians extend the same caution to Pepto-Bismol. Evidence on occasional early-pregnancy use is limited, which is another reason authorities lean careful rather than reassuring.
For heartburn or indigestion, ACOG and the NHS note that antacids (such as calcium carbonate) and, when needed, medicines like famotidine are generally used in pregnancy. Bismuth-free options are usually preferred over Pepto-Bismol. For nausea or diarrhea, hydration and diet often come first, and your provider or pharmacist can point you to a pregnancy-appropriate product. Always check the label, since some combination stomach products also contain salicylates.