Is it a cold? The flu? It’s just miserable.
It’s Friday afternoon and you have had a tickle in your throat since you woke up this morning, along with pressure behind your nose and in your forehead, and a drippy nose. You are sure that you have a cold and not the flu or COVID-19. You have been trying to contact your doctor about what you can take because you are pregnant and worried about taking the wrong medication. With each hour that passes, you know it is unlikely that you will get in touch with them. Now you are worried about going into the weekend without medication.
What to do? Ideally, your doctor’s office would have given you a list of medications that they approve for pregnant patients to take for common medical issues like colds, diarrhea, constipation, and others. However, pregnant women are reaching out to MotherToBaby specialists because this does not always happen. You call MotherToBaby and talk to a specialist about your concerns. Although we do not make recommendations about what to take, we can give you information about the use of any medications you ask us about in pregnancy.
What is a cold? A cold is caused by one of more than 200 viruses that result in inflammation of the membranes in your throat and nose. The symptoms can range in severity. You may know people who only experience one day of the most bothersome symptoms, such as congestion, and others who suffer for several days and have a lingering cough for weeks.
Fever
In adults, a fever is a temperature of 100.4°F (38°C) or higher. Having a cold doesn’t usually cause a fever, but even if your temperature is only a little bit higher than usual, you may not feel well and want to take something. Most healthcare providers recommend acetaminophen to treat fever, headache, and body pain in pregnancy. Studies on acetaminophen use during pregnancy have not shown a higher risk to the developing baby when it is used as directed for a short time to treat these symptoms.
A high fever that is untreated in pregnancy increases the chance of birth defects. A temperature of 101°F that lasts for over 24 hours has been associated with risks for neural tube closure defects and others. You can read more about fever at https://mothertobaby.org/fact-sheets/hyperthermia-pregnancy/.
Is it the flu or a cold?
If you are unsure if you have the flu or a cold, check out this helpful CDC guide: https://www.cdc.gov/flu/about/coldflu.html. If you think you might have the flu, it is important to get into your healthcare provider’s office for a flu test. If you have the flu, your healthcare provider can write you a prescription for antivirals. Antivirals are recommended for the treatment of flu for the general public, including pregnant women. Data shows that early treatment of pregnant women with antivirals lessens the severity of the disease and reduces hospitalization and death from severe symptoms. According to CDC, antivirals should be started within 48 hours of when symptoms start. However, even if started after 48 hours, they show a benefit. Oral oseltamivir (Tamiflu) and zanamivir (Relenza) are FDA approved antiviral medications for the treatment of influenza (flu). We have a fact sheet on antivirals at https://mothertobaby.org/fact-sheets/antiviral-medications-treatprevent-influenza-the-flu-pregnancy/.
Cough: medication options
When a pregnant woman takes a medication that enters her bloodstream, the developing baby is likely be exposed to the medication. It is a good idea to learn about the medication choices that are less likely to be a concern for the developing baby.
When you walk down the pharmacy aisle, there are rows of cough and cold products, some with many ingredients. In pregnancy, it is preferable to take a medication that contains only those ingredients that address the specific symptoms you have. In addition, because many cough syrups can contain up to 10% alcohol, it is important to select an alcohol-free syrup.
Cough drops and throat lozenges can contain flavorings such as honey, medications to numb the throat (anesthetics), vitamins, and other ingredients. It is important to read the ingredients on the label. When used as directed, menthol, honey, and other flavorings are not a known concern for pregnant women, as they are consumed in candy and food outside of cold remedies. However, consuming high amounts of vitamins in cough lozenges might put you over the recommended amounts in pregnancy, especially if you are already taking a prenatal vitamin. It is also a good idea to avoid cough drops that contain herbal ingredients, as many of them haven’t been studied for use in pregnancy.
Cough: non-medication options
Honey and warm tea/water may be helpful in relieving a sore throat caused by coughing and may thin secretions so that the cough is more productive. Concerns about infant botulism from giving honey (and honey-containing products) to children under one year of age are sometimes misunderstood, and many pregnant women think these concerns apply to them as well. The warning against the use of honey only applies to infants less than 1 year of age, not to pregnant women.
Nasal Congestion: medication options
A stuffy nose can cause painful sinuses and make it less enjoyable to eat and impossible to sleep. Over-the-counter nasal decongestant choices fall into two categories: oral (pills by mouth) or nasal spray. Oral decongestants include pseudoephedrine and phenylephrine. Nasal sprays may contain phenylephrine, oxymetazoline, or steroid medications. Taking an oral decongestant means that your developing baby will be exposed to the medication. Nasal sprays reduce the chance of exposure to your baby, depending on the frequency of use and dose. Always read the labels and take as directed.
Nasal congestion: non-medication options
Nasal irrigation (bulb syringe, squeeze bottle, or neti pot): Studies of nasal irrigation have not shown a proven benefit on the duration or severity of colds. However, individual users that are committed to this treatment for colds swear by its benefits. For pregnant women, the most reassuring part is that it uses only water (use only previously boiled, distilled or sterile water to irrigate) and saline, so there is no medication involved and no exposure to the pregnancy. It is important to keep nasal irrigation equipment clean and sterilized to avoid the risk of infection.
Shower tablets/vaporizers: Effervescent shower vapor tablets have become quite popular as they often provide temporary congestion relief. These tablets are placed on the shower floor and as the warm water reaches the tablet, it dissolves, emitting a vaporizer-like effect. Typically, these shower tablets contain sodium carbonate, sodium bicarbonate (baking soda), and essential oils (such as peppermint, rosemary, eucalyptus, and lavender). While there are no studies on the use of shower tablets during pregnancy, essential oils are used in many candles, lotions, and other home products, so exposure to these oils is likely already quite extensive. To date, information has not suggested a concern with the use of shower tablets during pregnancy.
Humidifiers: Humidifiers are used to add moisture to the air and provide relief from sinus pressure, dry skin and throat. They use only water so there is no medication exposure. It is important to keep humidifiers clean to avoid the risk of putting mold and bacteria into the air which could then cause or irritate allergies.
Nasal strips: Nasal strips, also called nasal dilator strips, are marketed to individuals who have difficulty sleeping due to snoring, and claim to help with congestion from colds. Although there are no studies that demonstrate that these products help with colds, there is some evidence that they may help with snoring by spreading the nose and widening the air passage. Nasal strips do not contain medication, so there is no concern about their use during pregnancy.
Electric blankets and heating pads: Electric blankets are sometimes used by people experiencing body chills from having the flu or a cold. Electric blankets produce heat that varies from 86°F (30°C) to 122°F (50°C) which can be comforting. However, there is some concern about the use of electric blankets during pregnancy, as some studies have suggested a possible risk from the heat. There is a theoretical concern that electric blanket use in early pregnancy might raise body temperature and increase the risk of birth defects. However, the studies on electric blanket use during pregnancy have many limitations and have not consistently shown an adverse effect on pregnancy. As the studies are unclear, pregnant women may want to avoid the higher heat to avoid concerns and anxiety.
Remedies to Avoid
Vitamin C and zinc: When you feel a cold coming on, you could be tempted to reach for vitamin C and zinc. This is not recommended during pregnancy. First, there is insufficient evidence that vitamin C or zinc are effective in preventing or treating colds. Second, the doses of vitamin C and zinc in supplements for colds are higher than recommended doses for pregnant women. The recommended vitamin C dose is 80 mg for pregnant teens and 85 mg per day for pregnant adults. The recommended dose for zinc is 12 mg for pregnant teens and 11 mg per day for pregnant adults. If you are taking prenatal vitamins, it is likely that they contain the vitamin C and zinc that you need for the day.
Non-steroidal anti-inflammatory drugs (NSAIDs): For most healthy pregnant women, over-the-counter pain relievers such as ibuprofen, naproxen, and aspirin are generally not recommended during pregnancy. NSAIDs are associated with a risk for premature closure of the ductus arteriosus (a heart and lung condition) in the baby if the medication is used at higher doses in the second half of pregnancy. Although low dose aspirin is sometimes recommended in pregnancy under a doctor’s supervision to treat or prevent specific medical conditions, regular strength aspirin and other NSAIDs are not typically recommended for treating pain or fever in pregnancy.
Herbal products: Many herbal supplements marketed for treating for cold and flu have not been studied in pregnancy, so the possible risks are not known. In addition, the benefits of using herbal supplements are not always proven. For example, echinacea has been promoted as a cold remedy, but a review of over twenty-four double-blind trials with over 4,000 participants did not find that it shortened the duration of colds compared to a placebo.
Prevention
Masks: Although adults can spread flu at least one day prior to having symptoms and can spread a cold up to a few days before symptoms appear, wearing a facial mask once symptoms start may help reduce the spread of infection to others if the mask is worn correctly.
Hand washing and hand sanitizer: Studies conducted in workplaces, colleges, and other locations have shown that frequent hand washing and regular use of alcohol-containing hand sanitizer reduces the spread of the viruses that cause upper respiratory tract infections. The key is to wash your hands regularly throughout the day and avoid touching your nose, mouth, and eyes. Studies show that with common colds, the hands are the most common vehicle for infection, whereas the flu is more likely to spread from droplets in the air.
Antiviral-Kleenex tissues: Antiviral tissues contain layers of antivirals. However, they have not been studied well enough to suggest that they prevent colds. Until more information is available, it is important to wash your hands after blowing your nose to prevent spreading the infection to others, regardless of the tissue type used.
References:
Botto LD, Lynberg MC, Erickson JD. (2001). Congenital heart defects, maternal febrile illness, and multivitamin use: A population-based study. Epidemiology. 12:485-90.
Centers for Disease Control and Prevention. (2025). Treating Flu with Antiviral Drugs. Retrieved from https://www.cdc.gov/flu/treatment/antiviral-drugs.html
Centers for Disease Control and Prevention, NIOSH Science Blog, April 9, 2020. Respiratory Protection During Outbreaks. Retrieved from https://blogs.cdc.gov/niosh-science-blog/2020/04/09/masks-v-respirators/
Chambers CD, Johnson KA, Felix RJ, Dick LM, Jones KL. (1997). Hyperthermia in pregnancy: a prospective cohort study. Teratology. 55:45.
Hubner, N-O., Hubner C., Wodny M., Kampf G., Kramer A. (2010). Effectiveness of alcohol-based hand disinfectants in a public administration: Impact on health and work performance related to acute respiratory symptoms and diarrhea. BMC Infectious Diseases. Retrieved from http://www.biomedcentral.com/1471-2334/10/250
Karsch-Völk, M., Barrett B., Kiefer D., et al. (2014). Echinacea for preventing and treating the common cold. The Cochrane Database of Systematic Reviews. 2014(2):CD000530.
