What is the treatment for urticaria (hives) in pregnancy?

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Last updated: February 23, 2025 • View editorial policy

From the Guidelines

For hives during pregnancy, the recommended first-line treatment is oral antihistamines, which are considered safe for use during pregnancy, as they are the mainstay of therapy and over 40% of hospitalized patients with urticaria show a good response to them 1. When managing urticaria in pregnant women, it's essential to prioritize treatments that minimize risks to both the mother and the fetus.

  • The preferred antihistamines for use in pregnancy are second-generation options like cetirizine (Zyrtec) or loratadine (Claritin) at standard doses, due to their safety profile and effectiveness in reducing symptoms.
  • Start with a 10 mg dose of cetirizine or loratadine once daily, and if symptoms persist, the dose can be increased to twice daily under medical supervision.
  • In addition to medication, general measures such as applying cool compresses to affected areas, wearing loose, breathable clothing, avoiding known triggers, and using fragrance-free, gentle soaps and moisturizers can help alleviate symptoms.
  • For severe cases, a short course of oral corticosteroids, such as prednisone, may be prescribed by a doctor, typically starting at 20-40 mg daily for 3-5 days, then tapering off. It's crucial to consult an obstetrician promptly if hives persist or worsen, as severe cases may rarely indicate an underlying condition requiring further evaluation 1.

From the Research

Treatment Options for Urticaria in Pregnancy

  • The treatment for urticaria in pregnancy often involves the use of antihistamines, with second-generation antihistamines being preferred due to their safety profile 2, 3, 4.
  • A study found that most patients (60%) with chronic urticaria used urticaria medication during pregnancy, including standard-dose second-generation H1-antihistamines (35.1%), first-generation H1-antihistamines (7.6%), high-dose second-generation H1-antihistamines (5.6%), and omalizumab (5.6%) 2.
  • The use of desloratadine, a second-generation antihistamine, during pregnancy was not associated with a significant increased risk of major birth defects, spontaneous abortion, preterm birth, small size for gestational age, or stillbirth compared to loratadine use in pregnancy 4.
  • For patients with chronic spontaneous urticaria who do not respond to H1-antihistamines, options such as omalizumab, ciclosporin A, or montelukast may be considered as third-line treatments 5.

Safety of Antihistamines in Pregnancy

  • Antihistamines are generally considered safe during pregnancy, although results from published studies are inconsistent 6.
  • A study found that the rates of preterm births and medical problems of newborns in patients with chronic urticaria were similar to population norms and not linked to treatment used during pregnancy 2.
  • Another study found that the use of antihistamines during early pregnancy was not associated with a significant increased risk of birth defects 6.

Management of Urticaria in Pregnancy

  • It is essential to keep urticaria under control during pregnancy to minimize the risk of preterm birth and other complications 2.
  • Emergency referrals for urticaria increased the risk of preterm birth, emphasizing the importance of sufficient treatment to manage urticaria during pregnancy 2.
  • The choice of treatment for urticaria in pregnancy should be based on the severity of symptoms and the safety profile of the medication, with second-generation antihistamines being a preferred option due to their safety and efficacy 2, 3, 4.

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.