Is Benadryl (diphenhydramine) safe to use at 28 weeks of gestation?

From the Guidelines

Benadryl (diphenhydramine) is generally considered safe to use at 28 weeks of gestation, but its use should be approached with caution due to limited data on its safety during pregnancy, particularly concerning potential associations with cleft palate 1. When considering the use of Benadryl during pregnancy, it's crucial to weigh the potential benefits against the risks. The most critical period for concern about congenital malformations due to medication use is the first trimester, when organogenesis occurs 1. However, since the question pertains to use at 28 weeks, which is in the second trimester, the primary concern shifts towards the safety profile of the medication during this period.

Key points to consider:

• Benadryl is a first-generation antihistamine, and while first-generation antihistamines have been observed to be safe, they may have undesirable sedative qualities and effects on performance 1.
• There is a mention of a case-control study suggesting an association between diphenhydramine and cleft palate, which has not been sufficiently refuted 1, indicating a need for caution.
• The recommended approach for managing allergies or other conditions during pregnancy should prioritize non-medication methods when possible, such as avoiding triggers and using saline nasal sprays.

Given the information and prioritizing morbidity, mortality, and quality of life, the use of Benadryl at 28 weeks of gestation should be judicious and ideally under the guidance of a healthcare provider. It's essential to follow the recommended dosage and to be aware of potential side effects such as drowsiness, dry mouth, and constipation. Additionally, considering the potential for high doses or prolonged use to affect the newborn temporarily, especially in the third trimester, careful monitoring and consultation with healthcare providers are advised 1.

From the FDA Drug Label

If pregnant or breast-feeding, ask a healthcare professional before use The FDA drug label does not answer the question.

From the Research

Safety of Benadryl at 28 Weeks of Gestation

• The safety of Benadryl (diphenhydramine) at 28 weeks of gestation is a concern due to its potential effects on the fetus and the pregnancy.
• A study published in 2022 2 found that the use of antihistamines, including diphenhydramine, before or during early pregnancy was associated with a reduced risk of developing early-onset pre-eclampsia in allergic women.
• However, another study published in 2013 3 found no significant association between the use of diphenhydramine in early pregnancy and specific birth defects.
• It is essential to note that diphenhydramine is a first-generation antihistamine, which has been overshadowed by second-generation antihistamines with similar efficacy and fewer adverse effects 4.
• The use of diphenhydramine during pregnancy should be approached with caution, and alternative treatments should be considered whenever possible.

Potential Risks and Considerations

• The use of diphenhydramine during pregnancy has been associated with potential risks, including birth defects and pre-eclampsia.
• However, the evidence is not conclusive, and more research is needed to fully understand the effects of diphenhydramine on the fetus and the pregnancy.
• It is crucial to weigh the potential benefits of using diphenhydramine against the potential risks and to consider alternative treatments that may be safer and more effective.

Recommendations

• Pregnant women should consult their healthcare provider before taking any medication, including diphenhydramine.
• Alternative treatments, such as second-generation antihistamines, may be considered for pregnant women who require antihistamine therapy.
• Healthcare providers should carefully evaluate the potential risks and benefits of using diphenhydramine during pregnancy and consider alternative treatments whenever possible 2, 3, 4.