From the Guidelines
Loratadine and cetirizine are the preferred antihistamines to use during pregnancy due to their excellent safety records and minimal risk of congenital malformations, as supported by recent studies 1. When considering antihistamine use during pregnancy, it's essential to weigh the benefits and risks.
- First-generation antihistamines like chlorpheniramine and diphenhydramine have long safety records, but they may cause drowsiness.
- Second-generation antihistamines such as loratadine and cetirizine are generally preferred options as they cause less sedation while effectively treating allergy symptoms. The recommended dosages for these medications remain standard: loratadine 10mg once daily, cetirizine 10mg once daily. These medications should be used at the lowest effective dose for the shortest duration necessary to control symptoms. While no medication can be guaranteed absolutely safe during pregnancy, loratadine and cetirizine have not been associated with birth defects or adverse pregnancy outcomes in observational studies 1. It's always advisable to discuss medication use with your healthcare provider before starting any treatment during pregnancy, as individual circumstances may affect recommendations. Non-medication approaches like avoiding allergen triggers, using saline nasal sprays, and keeping indoor air clean can also help manage allergy symptoms during pregnancy. In general, antihistamines have not been linked to increased risk of congenital anomalies, and loratadine or cetirizine should be preferred as they have been most used 1.
From the FDA Drug Label
If pregnant or breast-feeding: if breast-feeding: not recommended if pregnant: ask a health professional before use. If pregnant or breast-feeding, ask a health professional before use.
The safe antihistamines to use during pregnancy are not explicitly stated in the provided drug labels.
- Cetirizine and loratadine require consultation with a health professional before use during pregnancy 2 3. It is recommended to consult a health professional before using any antihistamine medication during pregnancy.
From the Research
Safe Antihistamines During Pregnancy
The following antihistamines are considered relatively safe to use during pregnancy:
- Second-generation antihistamines such as cetirizine and loratadine 4
- First-generation antihistamines, although they have been less studied than second-generation antihistamines, have not shown increased teratogenic risk in meta-analyses 5
Antihistamines to Avoid During Pregnancy
The following antihistamines should be avoided during pregnancy:
- Intranasal antihistamines 4
- First-generation antihistamines, due to their potential to cross the placenta and affect the fetus, although the risk is not well established 6
General Considerations
When using antihistamines during pregnancy, it is essential to:
- Evaluate each medication for potential fetal injury or congenital malformations 4
- Consider the risk-benefit assessment before prescribing any medication 6
- Choose medications with a well-established safety profile, such as cetirizine and loratadine 4, 5
- Be aware that approximately 10-15% of pregnant women report antihistamine use during pregnancy, and results from published studies are inconsistent 7