Can something as simple as over the counter medication affect your unborn child? Pseudoephedrine (brand name Sudafed) can have adverse effects on your fetus. It’s hard to think that something as simple as cold medications taken for a runny nose could cause rare birth defects.
Hi, I’m Hilary — The Pregnancy Nurse 👩⚕️. I have been a nurse since 1997 and I have 20 years of OB nursing experience, I am also the curly head behind Pulling Curls and The Online Prenatal Class for Couples. 🩺 I have helped thousands of moms have their baby and seen tens of thousands of moms with stuffy noses that were driving them crazy. They were desperate for something to help. So, let’s talk about Sudafed, and some possible other remedies for your stuffy nose.
Please note, at no point during this article will I tell you TO take Sudafed or NOT to take Sudafed. Please talk with your provider before taking any medication or if you think you are sick/ill. By continuing to read this article you agree to my terms.
Stuffy nose in pregnancy
First, let’s talk about your nose in general during pregnancy. You may be itching to take an oral decongestant because your nose just seems blocked up with nasal congestion. Sadly, that’s pretty normal in pregnancy. You have to remember that you have a LOT more blood in your body to feed not only your own body, but also to create another human.
Areas that have a lot of blood flow, like your nose (think about how much blood comes out of your nose during a nosebleed — btw those are common in early pregnancy) tend to expand with all that extra blood, making you FEEL like you have stuffy nasal passages, or are congested, when in reality it’s just all that extra blood.
Sinus congestion is just a symptom of pregnancy (and not a fun one).
If you’re a first time mom, this may be really annoying (and some moms only experience this during certain seasons, so you might not have seen it in your previous pregnancies).
But, it is true that common decongestants can cause your baby not to form right.
This is where I give my strongest warning.
BEFORE TAKING THE ADVICE on this blog or any place on the internet, you need to speak with your healthcare provider. It is important that they know what medications you ARE taking and your health care provider can give you recommendations based on specifics about YOU.
I am really writing this article to help you understand WHY your nose feels stuffy, and why your doctor might say not to talk anything for it.
While pregnant patients are at an increased risk from Sudafed, there are also other reasons not to take this medication (like high blood pressure, or diabetes). I think a lot of us think that if a medication is sold over the counter, it is safe — but many of them can have side effects due to your unique circumstances in your body. So, talk with your provider or pharmacist before starting anything new, pregnant or not.
Please note that this is a risk with ANY of the oral decongestants, so even if it is another brand name, you MUST talk with your provider before using it.
THIS WEBSITE IS MEANT FOR ENTERTAINMENT PURPOSES ONLY AND IS NOT MEDICAL ADVICE. PLEASE SPEAK WITH YOUR HEALTHCARE PROVIDER ABOUT YOUR HEALTH CONCERNS.
even if it’s just over the counter medications
BTW, feeling like there’s too much to keep track of? I have a good option for you!!!!
What does Sudafed normally do?
Ok, now that I have you scared of sudafed, let’s talk a little bit about what it does normally in your body?
It’s main job is to reduce the “swelling” of blood vessels in your nasal passages. But, as it does this — it does it in your all your vessels (which is why it is a problem for people with blood pressure concerns). It doesn’t know you’re taking it as cold medicine and to only do it in your nose.
AS you can imagine these types of active ingredients could hurt the blood flow to your placenta — which is likely where we start to see issues.
BTW, these types of issues happen at even just the recommended dose, so even that can be problematic.
BTW if you love having information given to you in easy and simple ways you should check out this course. It really helps simplify pregnancy & birth!
What’s wrong with sudafed?
Your placenta is made of TONS of blood vessels. As you can imagine constricting those blood vessels (like you want it to do in your nose) that brings a lot of possible risks to your developing fetus.
This study by Werler and Mitchell outlines a lot of those risks including small intestinal atresia (that study also includes aspirin and Tylenol). This study (also by Werler and Mitchell) dives deeper into what types of malformations they see with sudafed use.
That 2nd study shows that the vascular disruptions can cause pregnancy complications with the heart, ears and intestines.
Please note that this study included anyone who just took one dose of the medication. So, just a single dose, or short term use of decongestants has shown that it can be problematic.
Looking for this same kind of info on cough medicine in pregnancy? << that article has all the good info!
What’s the American College of Obstetricians Say?
Sudafed is a category C in pregnancy. They also recommend against taking it in your first trimester, but it can be recommended (UNDER THE ADVICE OF YOUR HEALTHCARE PROVIDER) in the 2nd and third trimesters if there are no underlying medical conditions that would say otherwise. There is some good info on this site.
Those studies also looked at combination products, like those combined with aspirin or tylenol and found them to be problematic as well. As a note, I much prefer to just take one medication at a time so I am sure what I am taking.
Sudafed PE vs Sudafed
While these do very similar things they actually have different active ingredients (although both have similar pregnancy effects). You can learn more about them here.
Sudafed by Trimester
Obviously, your trimester exposure to sudafed is really what matters.
First Trimester of pregnancy
First trimester use of phenylephrine has shown some risk of birth defects (although there are also studies that show no increased risk).
It is recommended pregnant moms do NOT take Sudafed in the first trimester especially.
Second trimester is when things start to get a bit fuzzier, so definitely talk with your provider if you are miserable.
Again, ALWAYS talk with your provider about the risks vs the benefits for you in this phase of your pregnancy. However, as baby has all of their “parts” at this point it’s not quite as scary. As always, make sure you’re following their recommended dose. And make sure what medicine exactly they recommend (a lot of these sound very similar).
Also, in the third trimester, many pregnant people have increased blood pressure. That can certainly add to the issues involved in sudafed.
Alternatives to Sudafed
If you have a lot of sinus congestion, there are still other options. Some things help your immune system adjust to all this new blood flow.
Frankly, the more I learn about Sudafed, the less I try to take it. I much prefer some of these other options, and hopefully you will too!
There are a couple of different types of saline sprays. Saline (salt water) and also medicated sparays)
Medicated Nasal Decongestant Sprays
These are in the same category as sudafed. Make sure to talk to your provider before using these.
Saline Nasal Spray
As these mostly are just rinsing out your nasal passages with water, they are normally considered safe. However, talk with your doctor before using these.
I know that things like the Netti pot (I use a nasal rinse bottle) can scare some people, but I absolutely LOVE them when I’m congested. I actually think they’re better than Sudafed.
Of course, keep in mind that these are NOT going to stop the swelling in your nasal passages due to the increased blood supply. They would be more to wash out that gunk that’s all through your sinuses.
Allergy medication is very different. If you’re suffering from hay fever or other upper respiratory allergies talk with your provider. Often things like Benadryl or other over the counter allergy medications are considered safe.
If your eyes are itching talk with your provider (often you can do this type of thing with a phone call rather than a full visit). To see which ones are safe for you. Some do have active ingredients that can become systemic. Many are just saline though — which would be pretty safe.
If you find it hard to breathe at night, these might help. They just help open-up your nose-holes to help you breathe better. Often they’re used for snoring, but they might help with your swollen nasal cavities.
There are prescription decongestants available. Talk with your provider and if they are not your OB make sure you tell them you are pregnant when they prescribe you anything.
There are a lot of things you can try including hot showers or a steam treatment. However, as I’ve said before — if the main issue is swollen membranes in your nose (due to the increased blood supply) — this won’t help that (and could momentarily make it worse). I actually have a whole post on home remedies for a cold during pregnancy.
What to do if you have a sinus infection?
If you’re experiencing symptoms of a sinus infection, call your provider. They may want to see you, or they may want you to go to you regular doctor for treatment.
My sister site also has a post on what to do if you have a cold or the flu and are pregnant.
What to do if you have a sore throat?
Sore throats can come for a variety of reasons. If it is strep throat you definitely need to see a provider. However, I find that a salt water gargle often helps quite a bit. Talk with your provider if you have a sore throat to see what they recommend.
Sudafed and Breastfeeding
Of course, medication considerations can still be big even when baby is out if you are breastfeeding.
While sudafed is normally considered safe during breastfeeding, the problem isn’t really the medicine in your breastmilk. The problem would again root with the decreased blood flow might hurt your milk production.
I can’t tell you how many moms have a HUGE drop in supply after Sudafed and have a REALLY hard time getting it back up. Just something to think about. My friend Katie has a great article on Sudafed & breastfeeding.
What to do if you took sudafed in early pregnancy?
Many moms take medication or drugs before they know they are pregnant. The most important thing you can do is tell your provider and be as honest as you can so they can tell you the risks you might have.
The REALLY good news is that in those studies I cited earlier the VAST majority of babies did not have any consequences even when mom took sudafed early on — so that should help you sleep better.
I personally believe that we give our babies a huge gift when we give them the most benign environment to grow in. It really is a time to let mother nature take over. Of course, we also recommend taking prenatal vitamins, since folic acid has been shown to help prevent neural tube defects. So, the studies are always evolving — so be SURE to talk with your provider. 🙂 Have I said that enough yet?
Have you taken a prenatal class yet? Most people picture hours and hours spent taking them in a stuffy hospital room, but The Online Prenatal Class for Couples can be done in just a few hours and is taken entirely on-demand — whenever you’re ready. Good news, it starts at just $35.
And, if you’re not quite sure you’re ready for that whole thing, check out my free prenatal class. It’s your first step toward getting in the driver’s seat of your birth.
- About the Author
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Hilary Erickson, BSN RN
A nurse since 1997, she has worked in various fields including pediatrics, geriatrics & hospice.
She has 20 years of labor and delivery experience in the San Jose, CA and Phoenix, AZ areas.
She is also the curly head behind the website Pulling Curls and is the creator of The Online Prenatal Class for Couples — the #1 hospital-based prenatal class on the internet.