General Obstetrics and Gynecology: Obstetrics
Use of oral decongestants during pregnancy and delivery outcome

https://doi.org/10.1016/j.ajog.2005.06.087Get rights and content

Objective

The purpose of this study was to evaluate delivery outcome after maternal use of oral decongestants.

Study design

We identified 2474 women who had reported the use of oral decongestants (mainly phenylpropanolamine) during early pregnancy and 1771 women who used prescription oral decongestants later in pregnancy. With Mantel-Haenszel analysis, comparisons were made with all women who gave birth in Sweden.

Results

The risk ratio for any congenital malformation after the use of oral decongestants was 0.96 (95% CI, 0.80-1.16). Women who were prescribed decongestants after the first antenatal visit less often than expected had infants who were born preterm (odds ratio, 0.68; 95% CI, 0.52-0.88), of low birth weight (odds ratio, 0.53; 95% CI, 0.37-0.77), small-for-date (odds ratio, 0.71; 95% CI, 0.47-1.08), or perinatally dead (odds ratio, 0.53; 95% CI, 0.22-12.5).

Conclusion

No teratogenic effect of oral decongestants was found. An association found between the late pregnancy use of such drugs and a favorable neonatal outcome can be explained hypothetically by the postulated association between pregnancy rhinitis and placental hormones.

Section snippets

Material and methods

The study is based on Swedish population-based health registers. The Medical Birth Register contains medical information on almost all births in Sweden since 1973.7, 8 Since 1983, the register is based on copies of the original medical documents that were completed at antenatal care centers (practically all women attend the free antenatal care service), at delivery units, and at the pediatric examination of the newborn infants. From this register, information was obtained on the year of

Results

During the study period, 2442 women reported the use of oral decongestants before the first antenatal visit (that is, mainly in the first trimester). There were 32 twin deliveries and 2 triplet deliveries, with a total of 2474 infants (records for 2 infants who were born in multiple births were missing). Prescriptions for such drugs were also given at the antenatal care visit to 1771 women. Among these women, there were 40 twin births and a total of 1810 infants (record of one infant who was

Comment

We found no statistically significant effect of the use of decongestants on total malformation rate or on the rate of any specific malformation. We used prospectively collected information on drug use, which was obtained either from interviews in early pregnancy or from the medical documentation of drug prescriptions during pregnancy. In this way, recall bias could be avoided. Phenylephrine was not used in Sweden during the study period, so our data refer to pseudoephedrine and (mainly)

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    It is currently wise to avoid phenylpropanolamine. There was no evidence of teratogenic effects of oral decongestants (mostly that contained phenylpropanolamine) in 2474 Swedish women who had reported the use of oral decongestants during early pregnancy and 1771 women who used oral prescription decongestants later in pregnancy (52C). Paradoxically, use of decongestants showed favorable neonatal outcomes such as a reduced risk of preterm birth, low birth weight, small-for-date infants, and perinatal deaths.

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Supported by a grant from K. and A. Wallenberg Foundation, Stockholm, Sweden (B.K.).

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