Cold Medicine Options in the Second Trimester of Pregnancy

How do the options compare?

Each option is graded against five practical criteria: obstetric guideline support, pregnancy evidence depth, dose transparency, expected onset, and interactions that require provider coordination.

• MotherToBaby reports that most studies do not suggest pseudoephedrine increases birth defects, but some studies reported small associations with specific defects; it also says ACOG does not recommend pseudoephedrine during the first three months. 1
• MotherToBaby says available studies do not suggest guaifenesin greatly increases the chance of birth defects, although the evidence is limited and products may contain additional ingredients. 2
• MotherToBaby reports that several studies did not find an increased chance of birth defects with diphenhydramine, while other reports have been inconsistent; it also describes sleepiness and reports involving high or prolonged use late in pregnancy. 3
• A review of common-cold care in pregnancy emphasizes checking labels because many over-the-counter products contain multiple ingredients, and it discusses using single-ingredient products when medication is needed. 4
• A case-control study compared 12,734 infants with birth differences and 7,606 infants without them. It found associations between first-trimester exposure to some specific decongestants and rare birth differences, but did not reproduce every earlier finding. Small exposed groups and multiple comparisons limit interpretation; these results do not establish a second-trimester risk estimate. 5

Which option makes sense?

The findings above apply to the populations and circumstances studied. They do not establish that every compared option is appropriate for you. Please consult your healthcare provider before acting on this summary.

Disclosure: Pregnancy Smart makes supplements that overlap with some options above. This comparison describes the evidence, not our own product; where our formulation is relevant it is named.