Pseudoephedrine vs phenylephrine during 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.

• ACOG does not recommend the use of pseudoephedrine for the first 3 months of pregnancy, and some studies have found a small increased chance of specific birth defects such as gastroschisis. 1
• Studies involving more than 1,500 pregnancies with first-trimester phenylephrine use did not show an increased chance of birth defects, though one study of 1,249 pregnancies reported a slightly higher chance of minor differences of the eyes or ears. 2
• Oxymetazoline nasal spray is absorbed in very small amounts when used as directed in the nose, and studies do not suggest a higher chance of birth defects at recommended doses. 3
• Steroid nasal sprays are absorbed into the body in lower amounts than medication taken by mouth, and fluticasone used as a nasal spray is not expected to increase the chance of birth defects. 4
• For nursing parents the two ingredients also differ: pseudoephedrine might lower milk supply, while phenylephrine has not been studied in breast milk and animal studies suggest it might reduce supply. 1

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 offers a supplement that overlaps with one or more options above. This page describes the pregnancy evidence for each option on its own merits.