In every pregnancy, a woman starts out with a 3-5% chance of having a baby with a birth defect. This is called her background risk. This sheet talks about whether exposure to pseudoephedrine may increase the risk for birth defects over that background risk. This information should not take the place of medical care and advice from your healthcare provider.

What is pseudoephedrine?

Pseudoephedrine is a decongestant that is used to treat nasal congestion (“stuffy nose”) caused by colds or allergies. Pseudoephedrine is sold under many different brand names. Pseudoephedrine can be combined with other ingredients to help treat other symptoms that may come with having a cold or allergies. In many places, products containing pseudoephedrine are only available upon request behind the pharmacy counter.

Can using pseudoephedrine make it more difficult for me to become pregnant?

There are no studies looking at whether pseudoephedrine could make it harder to get pregnant.

Can using pseudoephedrine increase the chance of miscarriage?

There are no studies looking at whether pseudoephedrine would increase the risk of miscarriage.

I am in my first trimester of pregnancy and have a very stuffy nose. Will taking pseudoephedrine cause birth defects?

However, until more information is available it is better not to take pseudoephedrine in the first trimester.*

Most studies have not found an increased chance for birth defects when pseudoephedrine is used during the first trimester. However, some studies have found a small increased chance for specific birth defects. These birth defects are: gastroschisis (an opening in the baby’s abdominal wall), small intestinal atresia (part of the small intestine is not fully developed) and hemifacial microsomia (part of the face is smaller than it should be). If you have already taken pseudoephedrine in the first trimester, remember that the risk for these birth defects, if any at all, is very small.

Is it true that smoking can increase the chance of birth defects related to the use of pseudoephedrine?

One study showed that when a mother who smokes cigarettes also takes pseudoephedrine, the risk of having a child with gastroschisis may be greater than if she was exposed to either one alone. However, the risk is considered very low.*

I am 8 months pregnant and for the past few days I have been suffering from a cold. Can I use pseudoephedrine to relieve my nasal congestion?

Talk with your healthcare provider before making any changes to this medication.*

If you use a decongestant after the first trimester, it is best to choose one that contains only one active ingredient (not one with many active ingredients). This avoids exposing the baby to other medications that may not be needed. Never take more than the recommended dose. Talk to your healthcare provider if you have questions about how much to take.

Pseudoephedrine can constrict blood vessels, which might raise blood pressure. If you have high blood pressure, talk to your healthcare provider about medications that would be best for you.

Will taking pseudoephedrine during pregnancy affect my baby’s behavior or cause learning problems?

There are no studies looking at whether pseudoephedrine use in pregnancy would be associated with long term health concerns.

Can I use pseudoephedrine if I am breastfeeding?

At recommended doses, only a small amount of pseudoephedrine gets into breast milk. In most cases, pseudoephedrine is not likely to cause side effects in the breastfed baby. However, a few cases of irritability have been reported. If you are worried about any symptoms that the baby has, contact the child’s healthcare provider.

Pseudoephedrine may reduce the amount of milk that you produce. Given this concern, it may be best to wait to use pseudoephedrine until your milk supply is well established. If you notice a decrease in your milk supply, pseudoephedrine use can be stopped.

Be sure to talk to your health care provider about all your breastfeeding questions.

What if the father of the baby takes pseudoephedrine or phenylephrine?

There are no studies looking at possible risks to a pregnancy when a father takes pseudoephedrine, but a father’s use of common decongestants is not expected to cause birth defects. In general, exposures that fathers have are unlikely to increase risks to a pregnancy. For more information, please see the MotherToBaby fact sheet on Paternal Exposures at:

* Section Updated May 2020

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