From the Research
The recommended treatment for hives (urticaria) during pregnancy begins with non-medication approaches such as avoiding triggers, wearing loose clothing, and using cool compresses, with first-line medication treatment being oral antihistamines, specifically second-generation options like cetirizine (10mg daily) or loratadine (10mg daily) due to their established safety profiles in pregnancy, as supported by studies such as 1 and 2.
Treatment Approach
When considering the treatment of hives in pregnancy, it's crucial to prioritize both the safety of the fetus and the relief of symptoms for the mother. The approach should be multi-faceted:
- Non-medication approaches are the first line of treatment, including avoiding known triggers, wearing loose, comfortable clothing, and applying cool compresses to affected areas.
- Medication treatment, when necessary, should start with oral antihistamines.
Medication Options
Given the safety profiles and efficacy:
- Second-generation antihistamines such as cetirizine (10mg daily) or loratadine (10mg daily) are preferred for their effectiveness and safety in pregnancy, as indicated by 1.
- First-generation antihistamines like diphenhydramine (25-50mg every 4-6 hours, not exceeding 300mg daily) or chlorpheniramine (4mg every 4-6 hours, maximum 24mg daily) can be used for severe or persistent symptoms, though they may cause drowsiness.
Severe Cases
For cases unresponsive to antihistamines:
- Short courses of oral corticosteroids like prednisone (10-40mg daily for 3-7 days) may be considered in the second or third trimester under close medical supervision.
- Topical corticosteroids can provide relief for localized areas.
Safety Considerations
All medications should be used at the lowest effective dose for the shortest duration necessary, with treatment supervised by healthcare providers experienced in managing pregnancy conditions, as emphasized by studies such as 3 and the general principle of minimizing risk while treating the condition effectively.