Nasal Sprays use for hayfever and colds with pregnant women means risking rare birth defects

Pregnant women who use nasal sprays for colds and hayfever increase the risk of rare birth defects

Using decongestants in first trimester of pregnancy linked to birth defects
Some over-the-counter medicines raise risk of heart and stomach problems
Phenylephrine and phenylpropanolamine – commonly used by hayfever sufferers – should be avoided by pregnant women, say experts

PUBLISHED: 14:50, 23 July 2013 | UPDATED: 14:52, 23 July 2013

Women who use decongestants such as nasal sprays in the first three months of pregnancy may raise their child’s risk of certain rare birth defects.

Some types of over-the-counter decongestants, such as those commonly used by hayfever sufferers, were linked to rare birth defects of the digestive tract, ear, and heart, new research found.

‘Major birth defects of any kind affect about two to three per cent of live born infants, so they are rare,’ study author Dr Allen Mitchell said.

‘The associations we identified involved defects that generally affect less than 1 per 1,000 infants. Some of them may require surgery, but not all are life-threatening.’

Decongestants are some of the most commonly used drugs, however, so fully understanding the consequences of taking them during pregnancy is important, he added.

A team at Boston University worked with a large collection of data on babies born with birth defects between 1993 and 2010.

Nurses interviewed the mothers of babies with birth defects not caused by chromosome problems, and Dr Mitchell’s group analysed the results.

Mothers were asked about medications they took while pregnant and in the two months before becoming pregnant.

First-trimester use of phenylephrine was tied to an eight-fold higher risk of a heart defect called endocardial cushion defect – a condition in which the walls between the heart chambers are poorly formed.

Phenylpropanolamine, which is also found in some decongestants, was linked to an eight-fold risk of defects of the ear and stomach.

For the first time, the authors also found links between first-trimester use of pseudoephedrine and limb defects.

Use of imidazolines – found in nasal decongestant sprays and eye drops – was tied to a doubling of the risk of having a baby with an abnormal connection between the trachea and oesophagus.

‘The risks we identified should be kept in perspective,’ Dr Mitchell cautioned. ‘The risk of an endocardial cushion defect among babies whose mothers did not take decongestants is about three per 10,000 live births.’

Even the eight-fold increase in risk indicated by the study results, while it sounds large, would translate to a 2.7 in 1,000 chance the baby would have the defect, he said.

Assuming the findings are correct, he added, the researchers could not speculate about why these drugs might be linked to this handful of defects.

They found no link between the medications and several other deformities that had been suggested by previous studies, such as clubfoot or defects of the eye or face, according to the report published in the American Journal of Epidemiology.

‘This should offer some reassurance to women who have taken these medications in pregnancy,’ Dr Mitchell told Reuters Health.

‘Since the absolute risks for these rare birth defects are still very small, pregnant women should not be very worried after having used these drugs,’ said Marleen van Gelder, an epidemiologist at Radboud University Nijmegen Medical Centre in the Netherlands who was not involved in the study but has researched birth defects and decongestants.

‘However, it should always be determined whether the beneficial effects of treatment outweigh the possible risks for the developing foetus.

Dr Mitchell believes there’s enough evidence indicating a possible connection to birth defects that doctors should not be recommending that pregnant women take decongestants, but should evaluate each woman’s need for the drugs on a case-by-case basis.

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