Cetirizine in Pregnancy: Is It Safe? What You Need to Know

When you're pregnant and fighting sneezes, itchy eyes, or a runny nose, the last thing you want is to choose between feeling awful and taking something that might hurt your baby. cetirizine, a second-generation antihistamine used to treat allergies like hay fever and hives. Also known as Zyrtec, it's one of the most commonly used allergy meds during pregnancy because it doesn't make most people sleepy like older options such as diphenhydramine. But is it truly safe? That’s the question so many expectant parents are asking—and it’s not as simple as yes or no.

Studies tracking thousands of pregnant women who took cetirizine show no clear link to birth defects or complications. A large 2019 review of data from over 10,000 pregnancies found no increased risk of major malformations when cetirizine was used in the first trimester. That’s reassuring, but it doesn’t mean it’s risk-free for everyone. Your body changes during pregnancy, and so does how your system handles drugs. Cetirizine crosses the placenta, but at very low levels, and it’s not stored in fetal tissue. That’s why doctors often recommend it over first-gen antihistamines, which can cause drowsiness in both mom and baby, or even affect uterine contractions.

Still, not all allergy meds are created equal. loratadine, another second-generation antihistamine. Also known as Claritin, it’s often preferred as a first choice because even more data supports its safety in early pregnancy. fexofenadine, the active ingredient in Allegra. Also known as Telfast, it’s another low-risk option with minimal absorption into the bloodstream. If your symptoms are mild, sometimes simple fixes like saline nasal rinses, avoiding triggers, or using a humidifier can cut down—or even eliminate—the need for pills. But if you’re struggling to sleep, breathe, or function because of allergies, the stress of uncontrolled symptoms can be worse than the medication.

What you shouldn’t do is self-prescribe or assume all antihistamines are the same. First-gen ones like diphenhydramine (Benadryl) are okay occasionally, but not for daily use—especially late in pregnancy, because they can cause jitteriness or breathing issues in newborns. And never mix cetirizine with other cold or allergy meds without checking the label. Many contain multiple ingredients, including decongestants like pseudoephedrine, which are not recommended in pregnancy.

If you’re thinking about starting, stopping, or switching your allergy med while pregnant, talk to your doctor or pharmacist. They’ll look at your history, your symptoms, your trimester, and your overall health to help you pick the safest, most effective option. There’s no one-size-fits-all answer, but you’re not alone in this. Thousands of women have used cetirizine safely during pregnancy—and with the right guidance, you can too.

Below, you’ll find real-world insights from patients and providers on managing allergies during pregnancy, including what works, what doesn’t, and which meds come with the most reliable safety data.