Pseudoephedrine in Pregnancy and Breastfeeding
      
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Pseudoephedrine (Sudafed )

The American College of Obstetricians and Gynecologists (ACOG) and The American College of Allergy, Asthma and Immunology (ACAAI) recommend oral decongestants be avoided during the first trimester "...unless the expected benefit is large and unique"[9]

Sympathomimetic agent used as a decongestant (vasoconstrictor). Molecular weight:201.70
CATEGORY: C

A retrospective study by Werler MM,  et al. , found that among mothers of 206 infants with gastroschisis and 126 mothers of infants with small intestinal atresia infants with gastroschisis had an increased risk (odds ratio = 1.8) of having been exposed to pseudoephedrine during gestation. The risk for gastroschisis was increased further (odds ratio = 4.2) among infants who had been exposed to pseudoephedrine combined with acetaminophen. The risk of small intestinal atresia was also increased for any use of pseudoephedrine (odds ratio = 2.0) and for use of pseudoephedrine in combination with acetaminophen (odds ratio = 3.0). The authors of the study cautioned that underlying maternal illness may have confounded the results of this study [1].

Gastroschisis is a congenital defect of the anterior abdominal wall characterized by an opening beside the umbilical cord that allows bowel to protrude. Gastroschisis is thought to arise from disruption of blood flow  to the affected abdominal wall [2]. The defect is uncommon and occurs in the general population with an incidence of  2.4 to 3.2 per 10,000 births in the general population with the highest incidence in women 15-19 years of age ( 26.5 per 10,000 births) [3,4]. The uncommon occurrence of gastroschisis should  be considered when counseling patients or interpreting the literature as to the increased risk for gastroschisis after any particular drug ingestion.

In contrast to the above epidemiological study by Werler MM, et al. three retrospective studies of 1,842 newborns exposed to pseudoephedrine during the first trimester found no increased risk for malformations [5-7]. In addition a prospective study by Schatz et al. also found no increased risk for malformations in 714 infants after exposure to pseudoephedrine at any time during pregnancy[8].

BREAST FEEDING: Pseudoephedrine is excreted into breast milk and may suppress lactation [10, 11]. The reported milk:plasma ratio (at 3 hours) is 3.9 [10]. At the maximum recommended pseudoephedrine doses, the calculated infant dose delivered via milk is less than 10% of the maternal dose [11]. The American Academy of Pediatrics and the WHO Working Group on Human Lactation consider the occasional use of pseudoephedrine to be compatible with breast feeding [12, 13].

NEONATAL SIDE EFFECTS: Agitation

SEARCH LITERATURE

ADDITIONAL READING:

  • Over the Counter Cold Medications in Pregnancy
    1998 Illinois Teratogen Information Service

    1.Werler MM, et al Maternal medication use and risks of gastroschisis and small intestinal atresia. Am J Epidemiol. 2002;155:26-31 MEDLINE
    2. Hoyme HE, et al. ;The vascular pathogenesis of gastroschisis: intrauterine interruption of the omphalomesenteric artery.J Pediatr. 1981;98:228-31.MEDLINE
    3. Reid KP, et al., The epidemiologic incidence of congenital gastroschisis in Western Australia. Am J Obstet Gynecol. 2003;189:764-8. MEDLINE
    4. Nichols CR, et al., Rising incidence of gastroschisis in teenage pregnancies. J Matern Fetal Med. 1997;6:225-9.MEDLINE
    5. Briggs GG,Freeman RK, Yaffe SJ, Drugs in Pregnancy and Lactation 6th edition, Baltimore, MD: Williams & Wilkins,2002 p 1187.
    6. Aselton P et al. First-trimester drug use and congenital disorders. Obstet Gynecol. 1985;65:451-5.  MEDLINE
    7. Jick H et al. First-trimester drug use and congenital disorders.JAMA. 1981;246:343-6.  MEDLINE
    8. Schatz M et al. The safety of asthma and allergy medications during pregnancy. J Allergy Clin Immunol. 1997;100:301-6.MEDLINE
    9. The use of newer asthma and allergy medications during pregnancy. Position Statement. The American College of Obstetricians and Gynecologists (ACOG) and The American College of Allergy, Asthma and Immunology (ACAAI). Ann Allergy Asthma Immunol. 2000;84:475-480. MEDLINE
    10. Findlay JW et al: Pseudoephedrine and triprolidine in plasma and breast milk of nursing mothers. Br J Clin Pharmacol 18:901-6, 1984.  MEDLINE
    11. Aljazaf K, Pseudoephedrine: effects on milk production in women and estimation of infant exposure via breastmilk.Br J Clin Pharmacol. 2003;56:18-24. PMID:  MEDLINE
    12. The WvHO Working Group, Bennet PN (ed).: Drugs and Human Lactation. Elsevier, Amsterdam, New York, Oxford, 1988.
    13.Transfer of drugs and other chemicals into human milk. Pediatrics. 2001 Sep;108(3):776-89. Review.

    Created: 11/27/2002
    Updated: 10/6/09

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