Drugs in Pregnancy

Do the Benefits Outweigh the Risks?

Anita T. Mosley, PhD, PharmD; Amy P. Witte, PharmD


US Pharmacist. 2013;38(9):43-46. 

In This Article

Cough, Cold, and Allergy

It is very common for women to experience cough, cold, or allergy symptoms during pregnancy. The use of multiple OTC medications to treat these symptoms increases from the first to the third trimester. According to one study, 92.6% of the obstetric population interviewed self-medicated with OTC medications.[2] The common cold is typically caused by numerous viruses and, therefore, is usually self-limiting. Pregnant women should be advised to first try nonpharmacologic treatments such as a saline nasal spray, the use of a humidifier, and increased hydration.[9,10] The most commonly used cough, cold, and allergy products include antihistamines, decongestants, antitussives, and expectorants (Table 2).[1]

It appears that the older sedating antihistamines, also known as first-generation agents, are safe in pregnancy. The recommended first-line agent is chlorpheniramine (Chlor-Trimeton), which is Category B. According to the Collaborative Perinatal Project, chlorpheniramine use during pregnancy was not associated with an increased risk of malformations.[7] Diphenhydramine (Benadryl) is also an option in patients who need symptomatic relief from allergy or cold symptoms. It is also Category B and was not associated with an increased risk of malformations; however, it can cross the placenta and has been reported to have possible oxytocin-like effects at high doses when used during labor.[9]

The newer nonsedating or second-generation antihistamines, such as loratadine (Claritin), fexofenadine (Allegra), and cetirizine (Zyrtec), have not been extensively studied. Cetirizine may be alternative to chlorpheniramine in the second or third trimester if a first-generation antihistamine is not tolerated.[9,10]

Administration of both inhaled and oral decongestants occurs during pregnancy. Pseudoephedrine (Sudafed) and phenylephrine (Sudafed PE) are the most common oral OTC decongestants used, with 25% of pregnant women using pseudoephedrine as their oral decongestant of choice.[11] However, its use should be avoided during the first trimester due to associated risk of defects from vascular disruption known as gastroschisis. Inhaled decongestants such as oxymetazoline (Afrin) and phenylephrine (Neo-Synephrine) are both Category C and appear to be safe for use.

The primary cough remedy used during pregnancy is dextromethorphan (Delsym). Many studies suggest that there is no association between dextromethorphan use and an increased risk of birth defects.[9,10] However, many of the OTC products containing dextromethorphan also contain alcohol and should be avoided during pregnancy.

Guaifenesin (Mucinex) is the expectorant typically found in most OTC cold medications. Its use appears to be safe during pregnancy, with the exception of the first trimester.[9]