It’s Friday afternoon and you have had a tickle in your throat since you woke up this morning, pressure behind your nose and in your forehead, and, a drippy nose. You are sure that you have a cold and it is not a flu or COVID-19. You have been trying to get a hold of your doctor because you want them to tell you what you can take because you are pregnant and worried about taking the wrong medication. With each hour that passes you know that it is unlikely that you will get a hold of them. Now you are worried about going into the weekend without medication.

What to do? You call MotherToBaby and you talk to a specialist about your concerns. We specialists hear the worry in your voice when you call us and it comes through in the chats and texts that you send us. Ideally, your doctor’s office would have given you a list of medications, ahead of time, that they approve for pregnant patients to take for common medical issues like colds, diarrhea, constipation, and others. However, pregnant people are reaching out to MotherToBaby specialists because this is not happening often enough.

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 and you may know people who only experience one day of the most bothersome symptoms, such as congestion, and others that suffer from a cold for several days and have a lingering cough for weeks.

Fever

In most people, colds do not produce a fever. In adults, a fever is a temperature of 100.4°F (38°C) or higher. Even if your temperature is 99°F however, you may not feel well and want to take something. The most recommended medication for the treatment of fever, headache, and body pain in pregnancy is . Studies on acetaminophen use during pregnancy have not shown a higher risk to the developing baby.

Fever that is untreated and high in pregnancy is a risk for birth defects. A temperature of 101°F, over 24 hours, has been associated with risks for neural tube closure defects and others. You can read more about it here.

Is it a flu or a cold?

If you are unsure if you have the flu or a cold, check out this helpful CDC guide. If you think that you might have the flu, it is important to get into your doctor’s office because they can usually do a flu test in the office. If you have flu, the doctor can write you a prescription for antivirals. Antivirals are recommended for the treatment of flu in the general public including pregnant people. Data shows that early treatment of pregnant people with antivirals lessens the severity of the disease, and reduces hospitalization and mortality. According to CDC, antivirals should be started within 48 hours of the symptoms starting however, even if given after 48 hours, they show a benefit. Oral oseltamivir (Tamiflu) and zanamivir (Relenza) are antiviral medications that are FDA approved for the treatment of influenza (flu). We have a fact sheet on antivirals that goes over the studies and specific recommendations

Cough: medication options

Whenever a pregnant person takes a medication by mouth, the developing baby will almost certainly be exposed when that medication enters the mom’s bloodstream. It is a good idea to learn about the 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 has the least number of ingredients, taking only those ingredients that address the specific symptoms. In addition, because most cough syrups can contain up to 10% alcohol, it is important to select an alcohol-free syrup.

Cough lozenges and throat lozenges can have ingredients that add a sweet flavor such as honey, medications to numb (anesthetics), vitamins, and others. It is important to read the ingredient label. Menthol, honey, and other flavorings are not a known concern for pregnant people and are consumed in candy and food outside of cold remedies. However, consuming vitamins in cough lozenges may cause you to take too many vitamins, especially if you are already taking a prenatal.

Cold/Flu: non-medication options

Honey and warm tea/water may be helpful in relieving a sore throat from coughing and may thin secretions so that the cough is more productive. Concerns about infant botulism and warnings that children under one year of age avoid honey (and honey-containing products) have been misunderstood and many pregnant women think it applies to them as well. The warning against the use of honey only applies to infants less than 1 year of age.

Nasal Congestion: medication options

A stuffy nose makes it less enjoyable to eat, impossible to sleep, and causes painful sinuses. The over-the-counter nasal decongestant choices fall into two categories, oral and topical/spray. Oral (pill) decongestants include pseudoephedrine and phenylephrine. Nasal sprays may contain phenylephrine or oxymetazoline. Taking an oral decongestant means that your developing baby will be exposed to the medication. The nasal sprays reduce the chance of exposure to your baby, depending on the frequency of use and amount. 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, there are individual users that are committed to this treatment for colds and 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) so there is no medication involved and no exposure to the pregnancy.

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 and sodium bicarbonate (baking soda), and essential oils (peppermint, rosemary, eucalyptus, and lavender). While there are no studies on the use of shower tablets during pregnancy, the ingredients are used in many candles, lotions, and many other home products so exposure is likely already quite extensive. To date, information has not suggested that there would be a concern with the use of shower tablets during pregnancy.

Humidifier: The humidifier is used to add moisture to the air and provide relief from sinus pressure, dry skin and throat. It uses only water so there is no medication exposure.

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 the websites do not include studies that demonstrate that these products help with colds, there is some evidence that they may help with snoring. Nasal strips do not contain medication and work by spreading the nose and widening the air passage, therefore a concern does not exist for use in pregnancy.

Electric blankets and heating pads: Electric blankets are sometimes used by people experiencing body chills from flu and cold. Electric blanket use in pregnancy is seen as controversial by some as some studies have suggested that there could be a risk from the heat or from the electricity. There is a theoretical concern that as with fever, electric blanket use might raise body temperature. A fever of 101°F or higher for an extended period of time during early pregnancy increases the risk for birth defects. The studies on electric blanket use during pregnancy have many limitations and have not consistently shown an adverse effect to pregnancy.

Remedies to Avoid

Vitamin C and zinc: When you have a cold, or believe that it is 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 much higher than recommended dose for pregnant people. The vitamin C dose recommended for pregnant people is 80 mg for teens and 85 mg per day for adults. The recommended dose for zinc is 12 mg for pregnant teens and 11 mg per day for pregnant adults. If you are taking a prenatal, it is very likely that it contains the vitamin C and zinc that you need for the day.

Non-steroidal anti-inflammatory drugs (NSAID): For most healthy pregnant women, over-the-counter pain relievers such as ibuprofen, naproxen, and aspirin are generally not recommended during pregnancy. However, some pregnant women continue to take these medications at specific doses under a doctor’s supervision, due to an underlying medical condition, and they benefit by taking them.

NSAID’s 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 in late pregnancy, at higher doses

Herbal combinations: Herbal medications for colds and flu have not been studied in pregnancy, therefore, possible benefits or risks are not known.  Echinacea has been promoted as a cold remedy, however; a Cochrane 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 a day prior to symptoms starting and can spread a cold up to a few days before symptoms appear, wearing a surgical mask once symptoms start may help reduce the spread of infection from coughing, assuming that the mask is worn correctly and it is the right type of mask.

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 (colds). 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 self-infecting and that flu is more likely to spread from droplets in the air.

Antiviral-Kleenex tissues: Antiviral tissues have not been studied well enough to suggest that they prevent colds; however, they do contain layers of antivirals. Until more information is available, it is important to wash your hands after blowing your nose regardless of the tissue type used to prevent spreading the infection to others.

References:

Botto LD, Lynberg MC, Erickson JD. Congenital heart defects, maternal febrile illness, and multivitamin use: A population-based study. Epidemiology 2001;12:485-90.

Centers for Disease Control and Prevention. (2014). Seasonal Flu. Retrieved from http://www.cdc.gov/flu/professionals/antivirals/avrec_ob.htm

Centers for Disease Control, NIOSH Blog, April 9, 2020

https://blogs.cdc.gov/niosh-science-blog/2020/04/09/masks-v-respirators/

Chambers CD, Johnson KA, Felix RJ, Dick LM, Jones KL. Hyperthermia in pregnancy: a prospective cohort study. Teratology 1997;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. DOI: 10.1002/14651858.CD000530.pub3

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