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Overview

Being sick is never fun, but especially not when you are pregnant. There are some additional challenges to the common cold during pregnancy. You are more susceptible to getting sick when you are pregnant because your immune system is lower. You may take longer to recover from being ill and to get over a cold. Pregnancy limits what types of medications you can safely take. It is so important to take care of your health when you are expecting. Unfortunately, even when you do take good care of your health, it is possible to catch a cold. Find out what over-the-counter medications you should avoid and how to treat the symptoms of the common cold and flu during pregnancy to get healthier faster.

Article and Resources

How Pregnancy Changes Your Immune System

You are more susceptible to getting sick when you are pregnant because your immune system is lower. A lower immune system sounds like a bad thing, but one big reason for this is so your body doesn’t reject your baby, which is foreign. With a lower immune system, it is harder for your body to fight off a cold or the flu. Also, your symptoms may last longer than they usually would. It is so important to take care of your health when you are expecting. Basic things like eating well, staying hydrated, taking a high-quality prenatal vitamin, getting some exercise, and making sure you are getting plenty of rest are crucial.

The Common Cold & the Flu

Viruses cause both colds and flu. There are more than 200 types of cold viruses, and about one-third of those are rhinoviruses. The influenza virus causes the flu. Any of these viruses become airborne when someone who is infected coughs or sneezes and releases half a million particles into the air. You can also come into contact with the cold or flu viruses by touching a contaminated surface, then touching your mouth, nose, or eyes. These viruses can live 1-2 days on hard nonporous surfaces, like a doorknob, 15 minutes on dry paper tissues, like a dollar bill, and only about 5 minutes on the skin. Please wash your hands often and try to avoid touching your face.

Symptoms of cold and flu are relatively similar. The symptoms include runny or stuffy nose, coughing, sneezing, sore throat, fatigue, and malaise, which is generally feeling unwell. Cold symptoms tend to be milder than flu symptoms, and the flu tends to come on much quicker than a cold. The cold is more common than the flu, and in the U.S., we have an estimated 1 billion colds each year. With viruses that are so common, and a weakened immune system during pregnancy, it can be a challenge to avoid exposure and stay healthy.

Avoiding Cold and Flu Viruses

Cold viruses spread when someone who is infected coughs or sneezes or by coming into contact with a surface that has the virus. The simplest and best things you can do to prevent getting a cold are to wash your hands, don’t touch your face, and to avoid people who have a cold.

Ingredients in Over-the-counter Cold Medicines

Over 80% of expecting mothers take an over-the-counter medication of some kind during their pregnancy. Cold medicines can contain active ingredients like acetaminophen, cough expectorants or suppressants, antihistamines, and decongestants. The FDA classifies all the over-the-counter antihistamines, decongestants, and expectorants as pregnancy category B or C. These classifications are being phased out with more in-depth information. Trying to understand the new rules around these is confusing. You can check out this article for more detailed information on the changes to labeling rules.

To put the B and C classifications into perspective, let’s run through them. Although these classifications are being phased out, you will see them often when looking into medications online. Even if they are limited, they still offer some insight into the safety of a drug.

Category A: Adequate and well-controlled studies have failed to demonstrate a risk to the fetus in the first trimester of pregnancy (and there is no evidence of risk in later trimesters).

Category B: Animal reproduction studies have failed to demonstrate a risk to the fetus, and there are no adequate and well-controlled studies in pregnant women.

Category C: Animal reproduction studies have shown an adverse effect on the fetus, and there are no adequate and well-controlled studies in humans, but potential benefits may warrant the use of the drug in pregnant women despite potential risks.

Category D: There is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience or studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks

Category X: Studies in animals or humans have demonstrated fetal abnormalities and/or there is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience, and the risks involved in the use of the drug in pregnant women clearly outweigh potential benefits.

Safety of Over-the-counter Medications

In the end, the recommendation around any over-the-counter drug is to see your doctor. Let’s dive into the research on these drugs and ingredients to get a better understanding of their safety.

Analgesics

Analgesics are pain relievers and include acetaminophen and NSAIDs (nonsteroidal anti-inflammatory drugs).

Acetaminophen is the active ingredient in Tylenol. When reviewing research, you may see this listed as the brand name Paracetamol. This drug is a painkiller that can also be used as a fever reducer and is in many cold medicines. Acetaminophen has long been thought to be safe for use during pregnancy. A couple of studies released in recent years may be challenging the safety of this drug. One study related an increased risk for asthma in children to maternal use of acetaminophen during pregnancy. In another study in the Journal of American Medicine researchers found an association between acetaminophen use during pregnancy and behavioral problems in children.

The most common NSAID is ibuprofen. There have been some concerns over NSAIDs and miscarriage early in pregnancy, and concern that they can cause a blood vessel in your baby to close prematurely in the third trimester. If you are pregnant and want to take an analgesic, most doctors recommend you should opt for acetaminophen and avoid ibuprofen.

Cough Expectorants or Suppressants

Coughing is your body’s reaction to irritants or secretions in your respiratory system. Medications to help with a cough are either expectorants or suppressants. Expectorants, also called mucolytics, are medications that thin mucus. The goal with this is that it can make it easier to cough up phlegm from your lungs. The most common active ingredient in expectorants is guaifenesin which is in medications like Mucinex.

Cough suppressants, also called antitussives, block the cough reflex. The most common suppressant is dextromethorphan, commonly noted by the letters D.M. after a brand name like Robitussin D.M. Suppressants are usually used when a cough is keeping you awake. Otherwise, doctors recommend an expectorant. Remember, a cough is your body’s natural response to secretions in your respiratory system. Suppressing a cough will not help your body get rid of phlegm and mucus.

Another common type of suppressant in prescription cough syrup is codeine. This is an opioid and this is generally not recommended during pregnancy.

Antihistamines

Allergy medicines commonly contain antihistamines. These may also be in cold medicines because they help with congestion, runny nose, and sneezing. The most common antihistamine is diphenhydramine, which is the active ingredient in Benadryl.

A Cochrane review looked at 18 studies with 4,342 participants and found that antihistamines tended to help in the first day or two of a cold and had no significant effect after that. Unfortunately, this review did not include any studies that included pregnant mothers.

Decongestants

Decongestants narrow your blood vessels, which can help with congestion and stuffy nose. The most common decongestants are pseudoephedrine and phenylephrine, and you commonly see these in medicines like Sudafed. We do not know if these drugs cross the placenta. A study showed a small increased risk of an endocardial cushion defect with the use of phenylephrine. To put “small” into perspective endocardial cushion defects occur in about 0.34 per 1,000 live births. Even if phenylephrine exposure increased the risk 8-fold, the absolute risk of having an affected child would be about 2.7 per 1,000 live births. It can be helpful to put statistics into perspective and there is still a lot we do not know about decongestant use during pregnancy and risks to a baby.

Tips for Taking Over-the-counter Cold Medicine During Pregnancy

It has become so common to reach for an over-the-counter cold medicine when we are sick. When you are pregnant, it brings up a lot of questions about what medications are safe to take for both you and your baby.

The CDC has an initiative called Treating for Two that is trying to tackle the problem of lack of information about taking medications during pregnancy. Overall, their advice is to talk to your doctor.

There is an article on OTC meds in the American Family Physician Journal that sums up the generally accepted guidelines.

  • Avoid medications in the first 12 weeks. This is when miscarriage is the highest, all your baby’s systems are being put into place during this period, and it is considered the most sensitive for development.
  • Avoid aspirin, although I will note that there are exceptions to this if it is prescribed by your doctor, and there is some evidence supporting low dose aspirin for treating preeclampsia.
  • Do not take any over-the-counter medicines for cough, congestion without running it by your care provider.
  • If you do take an over-the-counter medication, avoid the use of extra strength or long-lasting medications, and avoid combination medicines that treat many symptoms at once. You want to minimize your exposure to medications that you do not need. Do not take medications for an extended period of time, or for longer than needed.

Unfortunately, there are not perfect double-blind, placebo-controlled studies we can reference to show these medications are 100% safe during pregnancy. So what can you do? Talk to your doctor or midwife, and you should always run anything, even OTC meds by your doctor or midwife. Ultimately, it is your decision and comes down to what you are comfortable with. You are weighing the potential risk or exposure to the medications with the benefit of the relief the medication gives you. Since there are dozens of cold and flu medicines available over-the-counter, we cannot cover every single one in this article. This is another reason it is always a good idea to run any medications by your doctor or midwife.

Safety of Medications During Breastfeeding

Fortunately, there is a good database with information on taking medication while breastfeeding. LactMed allows you to type in any drug, and it will give you quite a bit of information on the safety of medications and breastfeeding. This includes effects on breastfed infants, effects on lactation and breastmilk, and alternative drugs to consider.

Treating the Cold and Flu Without Medications

Here are some non-medication tips to deal with cold and flu symptoms.

Homeopathy

Homeopathy dates back to the late-eighteenth century. The idea is that disease symptoms are treated by minute doses of substances that produce similar symptoms when provided in larger doses to healthy people. Many homeopathic products are diluted so much that they no longer contain detectable levels of the initial substance. In general, homeopathic product claims are not based on modern scientific methods. Despite the skepticism by the medical community, homeopathy has many adherents. The FTC can’t prevent homeopathic marketers from selling their products; only the FDA could do that. But, the FTC did recently put additional regulations out about labeling homeopathic products.

First, the people producing the remedies need to be able to provide evidence that they work. If they can’t, they need to add a disclaimer to packaging that says, “there is no scientific evidence that the product works” and “the product’s claims are based only on theories of homeopathy from the 1700s that are not accepted by most modern medical experts.” There is an NPR article that does a good job of summing up the recent regulations on labeling from the FTC. Many people swear by homeopathic remedies. Even when evidence may be in short supply, I do want to acknowledge that a lot of people are happy with the efficacy of homeopathy. Please disclose any homeopathic remedies you are using with your doctor or midwife, just like you would any other OTC or prescription medication. If your doctor or midwife approves, and you are comfortable taking a homeopathic remedy, then you can. One popular homeopathic remedy for colds is Umcka, and I previously examined the evidence available on that in this Q&A episode.

Eating and Drinking

Anything you can do to keep your immune system intact and functioning well will help you stay healthy and give your body a better chance at fighting off a virus. Staying healthy includes eating healthy whole foods, and staying hydrated.

Colds and flu can leave you dehydrated, and you will need extra fluids. Water is always the best option, and drinking broths, teas, and juices can also help you stay hydrated.

A high-quality prenatal vitamin contains all of the essential vitamins and nutrients you need during pregnancy. If you are sick extra vitamin C and zinc may be helpful. If you want to take an additional supplement, please run it by your doctor or midwife first. Rather than take a separate supplement, you can focus on foods high in these nutrients. The easiest source of vitamin C is citrus fruits. Foods high in zinc include meats, shellfish, and legumes.

Congestion & Runny Nose

One thing that may help if you are suffering from congestion is a humidifier, especially if you live in a dry climate. Even taking a warm shower or bath can get you some humid air to help. When you are sleeping, you may want to elevate your head on a pillow. You can try using nasal strips to help open your nasal passages or use saline nasal drops or sprays.

One thing that you may experience during your pregnancy that can get confused as a cold symptom is pregnancy rhinitis. The main symptoms are sneezing, nasal congestion, or running nose. If you are experiencing these issues without any other symptoms, you may have pregnancy rhinitis.

If you have a runny nose, you will likely be blowing it a lot. Soft Kleenexes are a must.

Sore Throat

If you have a sore throat, you can try sucking on ice chips if the cold is soothing or, alternatively, drink warm tea. I love the Throat Coat tea from Traditional Medicinals. If you are unsure what teas are safe or what teas you should avoid during pregnancy, check out this episode. Gargling with warm salt water, sucking on throat Lozenges, or drinking hot water with lemon juice and honey added to it may also help.

Fatigue

Fatigue is more intense with the flu than a cold, but both viruses can leave you feeling wiped out. The best thing you can do when you are sick is to rest and get extra sleep. Have your partner help with chores around the house, walking the dog, whatever they can do so that you can get rest. Please, ask for some help so you can get some additional rest and speed up your recovery.

Taking sick days from work may be a challenge when you are trying to save up time off for maternity leave. If you have another child at home, you cannot call in sick from being a mom. If you have the opportunity to take a day off and rest that will help you get healthier sooner.

Fever

A fever is a temperature over 37.5-38.3 Celsius or over 99.5-100.9 Fahrenheit. This is a part of your body’s immune response and is more common with the flu than a cold. Generally, it is recommended you call your doctor if your temperature is 103 F or 39.4 C, or if it is lower but has persisted for more than 24 hours.  Find out from your doctor what they consider a fever to be, and when you should call them.

If you do get a fever, you want to make sure you stay hydrated. Also, take measures to cool off like running a washcloth under cool water and putting that on your forehead, take a tepid bath, or a shower. You don’t wear a lot of layers of clothing, and you should opt for light clothing. Plus, you do not want to bury yourself under a ton of blankets. For more evidence on fever during pregnancy, check out this episode.

When to Contact Your Doctor or Midwife

Call your doctor or midwife if you have any concerns about how you are feeling and your symptoms. If you have a fever that is really high, or not going away for more than 24 hours. Symptoms persisting and not getting better or going away after a week. If you are coughing up yellow or green mucus or are having chest pains, that would also be a sign to contact your care provider. To err on the side of caution, contact your doctor or midwife if you have any questions about how you are feeling or your recovery. Be sure to talk to your doctor or midwife about any meds, including over-the-counter drugs, homeopathic products, and additional supplements.

Lastly, if there is something that is your go-to feel better, whether it is a specific type of soup, binge-watching a show on Netflix, getting some fancy superfood immune-boosting smoothie, do that. Also, lean on your partner if you need to. If you want to be babied when you are sick, let them know. If you prefer to be left alone, speak up so they know to give you some space. Everyone is different in how they want to be treated when they are sick, and what helps them to feel better. Letting your partner know how they can best help may even put you on the road to recovery sooner.

 

Thank you to the amazing companies that have supported this episode.

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