General Obstetrics and Gynecology: ObstetricsUse of oral decongestants during pregnancy and delivery outcome
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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Cited by (32)
Management of the Upper Airway Distress During Pregnancy
2023, Immunology and Allergy Clinics of North AmericaCitation Excerpt :Use of oral decongestants is not known to cause rhinitis medicamentosa, but there is mixed data surrounding their safety in pregnancy. A retrospective analysis of more than 4000 women who used oral decongestants both early and later in pregnancy found no increase in the risk of congenital malformations, lower rate of preterm births, and/or low birth weight compared with the general population.54 In contrast, a retrospective case-control study of gastroschisis found the use of pseudoephedrine during pregnancy to be a significant risk factor.55
Medical management of rhinitis in pregnancy
2022, Auris Nasus LarynxCitation Excerpt :A recent more comprehensive study retrospectively evaluated oral and topical decongestants on congenital malformations. Following first trimester exposure of phenylephrine and phenylpropanolamine, they reported an increased risk of endocardial cushion defects, and pyloric stenosis and ear defects respectively [50]; the same risks were reported in previous studies [51,52]. There was also a reported increased risk in limb defects with first trimester use of pseudoephedrine as well as first trimester use of intranasal decongestants and imidazoline derivatives (e.g. xylometazoline) with pyloric stenosis and tracheo-oesophageal fistulae respectively [50].
Rhinitis 2020: A practice parameter update
2020, Journal of Allergy and Clinical ImmunologyCitation Excerpt :Phenylephrine has also been associated with endocardial cushion defects (odds ratio, 8.0), ear defects (odds ratio, 7.8), and pyloric stenosis (odds ratio, 3.2).590 However, a Swedish prospective study looked at the use of these 2 decongestants during early and late pregnancy in 2474 and 1771 women, respectively, and no teratogenic effects were reported.593 The adverse effects of oral decongestants taken during the second and third trimesters appear to be much less compared with the effects during early pregnancy, but caution should be used throughout pregnancy and prolonged use should be avoided.
Drugs that affect autonomic functions or the extrapyramidal system
2009, Side Effects of Drugs AnnualCitation Excerpt :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.
Over-the-counter medications in pregnancy
2014, American Family PhysicianCitation Excerpt :Risk of ventricular septal defects or limb malformations has been observed with decongestants but have not been substantiated.17,21,22 Two studies (n = 5,400) show a decreased risk of preterm birth, low birth weight, and preterm labor among women using a variety of oral decongestants in pregnancy.23,24 There are only a few studies on the safety of topical (nasal and ophthalmic) decongestants, none of which demonstrate increased fetal risk.6,19,20
Oculo-auriculo-vertebral spectrum and maternal drug ingestion: cause or coincidence?
2023, Hearing, Balance and Communication
Supported by a grant from K. and A. Wallenberg Foundation, Stockholm, Sweden (B.K.).