Is It Safe to Take Decongestants During Pregnancy?

A question about Claritin-D: I went to see a fertility specialist, and she told me that it was not safe to take decongestants while pregnant or even during that ambiguous two-week wait period. (She did say it was okay to drink lightly during the two-week wait, so I know she isn’t totally strict on every aspect.) But my allergies are really bad! I asked her if the risk was just because it hadn’t been tested, and she said no, that this one is well documented. Is that true?
—Allergy Sufferer

As a fellow allergy sufferer (and mom to allergy sufferers), I feel you. Your specialist is right, though. The decongestant part of Claritin-D is not recommended due to birth defect risk.

Stepping back: One important component of allergy treatment is antihistamine. In Claritin, this is delivered by the active ingredient of loratadine; in Zyrtec it is cetirizine. These are both category B drugs, meaning we have compelling evidence of safety for them during pregnancy. If they work for you, you should feel comfortable taking them.

However, many people find that their allergies respond better if they combine the antihistamine with a decongestant. In Claritin-D, the loratadine is combined with pseudoephedrine. Although concerns have been raised about links between pseudoephedrine (and related compounds) and birth defects, recent data do not support such a link. In particular, a large study published in 2025 analyzed data from more than 250,000 pregnancies, of which over 300 had exposure to high doses of pseudoephedrine early in pregnancy. The researchers did not see an elevated risk of birth defects overall, or in any particular organ system.

This data is very reassuring, but given older evidence of a slight increase in the risk of birth defects with related compounds, many doctors will still recommend caution. The reassuring evidence is new, and may take time to show up in medical recommendations.

If you do want to avoid decongestants, what can you do? First, regular Claritin is okay, so maybe that will give you some relief. Second, steroid-based nasal sprays (e.g. Flonase) are considered safe. Finally, in the second and third trimester, Claritin-D is more accepted, unless you’ve got hypertension. Talk to your doctor if you have any questions on the right regimen and timing.

Hang in there!