Getting sick can feel especially tough when you’re pregnant. Unfortunately, during pregnancy, you’re more vulnerable to illnesses like colds, the flu, and COVID-19. This episode helps you understand what kind of illness you might have, how to treat your symptoms safely, and when to reach out to your doctor or midwife. Learn how these viruses spread, what symptoms to watch for, and how to distinguish between common cold, pregnancy rhinitis, or strep throat. Find out about evidence-based, non-medical strategies to ease symptoms. Hear about research on homeopathic remedies like Umcka and herbal teas for cold relief. Plus, a review of what we know about the safety of over-the-counter medicines and ingredients like acetaminophen, antihistamines, decongestants, and cough suppressants.

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How Your Immune System Changes During Pregnancy
Your immune system protects you from viruses, bacteria, and other pathogens. While the traditional view was that your immune system is suppressed during pregnancy, newer research shows there is more complexity. Instead of being suppressed, it shifts. Some parts are dialed down, and others are dialed up to safeguard both you and your baby. The placenta plays a vital role in this process. It helps regulate immune responses, sends antibodies to your baby, and can recognize pathogens and signal your immune system. Hormones like estrogen, progesterone, and hCG also influence how your immune system functions throughout pregnancy.

These changes are necessary, but they can leave you more vulnerable to illness or make you feel sicker than usual. Your body is working hard; your resources are focused on growing your baby, and your immune system is balancing the need to protect you while also tolerating your baby. For a detailed look at how to support and boost your immune system during pregnancy, you can check out the separate episode on that topic. In this episode, we will focus on what happens when you do get sick, how to manage symptoms safely, which treatments to consider or avoid, and when to call your doctor or midwife.

The Common Cold, the Flu, and COVID-19  

The common cold, the flu, and COVID-19 are all caused by viruses. More than 200 types of viruses can lead to a cold, with about one-third being rhinoviruses. Influenza viruses cause the flu. Coronaviruses can cause respiratory infections, including the common cold and COVID-19.

Symptoms of these illnesses often overlap and can include a runny or stuffy nose, coughing, sneezing, sore throat, fatigue, fever, and feeling generally unwell. Cold symptoms tend to be mild. The flu and COVID-19 usually come on more quickly than a cold and are more likely to cause a fever. COVID-19 can be more severe than the flu, and any of these infections can lead to complications.

You can sometimes tell the difference between a cold and the flu by how quickly symptoms start. The flu tends to hit hard and fast, while a cold generally develops more gradually. Distinguishing these from COVID-19 is much more difficult based solely on symptoms. The only sure way to know is to get diagnostic testing for influenza and SARS-CoV-2. If those tests are negative, your symptoms are more likely due to a common cold virus.

How Viruses Spread  

These viruses spread when you breathe in particles in the air or touch a contaminated surface and then touch your face. When someone who is infected coughs or sneezes, they can release hundreds of thousands of tiny droplets into the air. A person can carry and spread a virus without showing any symptoms. Factors such as temperature, humidity, and airflow influence how long viruses remain in an environment.

You can lower your risk of illness by avoiding contact with anyone who shows symptoms. The same goes if you are the one who is sick. Isolating yourself and avoiding contact with others helps stop the spread of illness. Enclosed rooms with poor airflow increase the risk of exposure to airborne particles. Outdoor areas or well-ventilated spaces with air filtration or open windows are safer.

If you touch surfaces, especially in public or crowded areas, you might pick up viruses on your hands. One of the easiest and most effective ways to prevent illness is to wash your hands often and avoid touching your face. After touching a contaminated surface, a virus must still enter your body through your nose, mouth, or eyes to cause infection. Aim to wash your hands with soap and water for at least 20 seconds. If you can’t access a sink, use an alcohol-based hand sanitizer.

Immunity and Vaccines  

When you are exposed to a virus, your immune system can develop antibodies and memory cells that help protect you the next time you encounter that virus. With colds and the flu, this is complicated because many different viruses can cause similar symptoms, and they continue to evolve. There is no vaccine for the common cold. There is a seasonal flu vaccine that is updated each year to target the strains expected to circulate. Professional organizations such as the American College of Obstetricians and Gynecologists recommend that pregnant individuals receive an inactivated or recombinant influenza vaccine during flu season because influenza infection can be more severe during pregnancy and can affect both you and your baby. For an in-depth examination of the risks and benefits of the flu vaccine during pregnancy, see this episode.

There are also vaccines for COVID-19. In May 2025, federal health authorities updated their guidance, no longer routinely recommending COVID-19 vaccination for healthy children and pregnant individuals, instead emphasizing an individual-based or shared decision-making approach. Professional medical organizations, including ACOG, still recommend COVID-19 vaccination during pregnancy. You can learn more about the research on the risks and benefits of the COVID-19 vaccine during pregnancy here.

Treating Cold and Flu Symptoms 

Doctors typically do not prescribe medications to patients with a cold without complications. There are some prescription antiviral drugs to treat the flu. There are also prescription treatments for COVID-19. Please contact your doctor or midwife if you have any symptoms. This will allow them to monitor how you feel and give you the most up-to-date instructions and recommendations. Plus, they should know your pregnancy’s particulars and any conditions that could put you at a higher risk. Contacting your care provider will also help you decide whether to have a test, receive treatment, or continue monitoring. 

Talk to your doctor or midwife about your symptoms as they happen and discuss any treatments or over-the-counter medications you plan to take. Avoid self-diagnosing and treating symptoms if you might need medical care; instead, see your healthcare provider. If you and your provider are comfortable managing your symptoms at home, there is plenty of information available on what is safe and effective during pregnancy. Let’s review the non-pharmacological options first, then consider medications. 

Non-Medication Treatments for Cold and Flu

Many non-pharmacological remedies may help you find some relief from cold and flu symptoms. Many expecting parents start with these methods before resorting to medications.

Eating and Drinking  

Anything you do to keep your immune system functioning well will help you stay healthy and give your body a better chance to fight off a virus. That starts with eating healthy, whole foods, and staying well hydrated. You should get most of your nutrients directly from your diet, not from supplements. A high-quality prenatal vitamin can help fill in gaps and ensure you and your baby get critical nutrients.

If you are sick, taking extra vitamin C and zinc may help. A review found that zinc, when taken within 24 hours of symptom onset in syrup or lozenge form, can reduce the duration and severity of colds. There is evidence that vitamin C supplementation may lower the risk of catching a cold for specific groups. Other studies show that vitamin C may shorten the length or decrease the severity of colds. Citrus fruits are an easy source of vitamin C, and foods high in zinc include meats, shellfish, and legumes.

Viruses can cause dehydration, especially if you have a fever, so you’ll need extra fluids. Water is always the best choice, but broths, teas, and juices can also help keep you hydrated. You might also want to add electrolytes if you’re losing a lot of fluid or having trouble staying hydrated.

Congestion and Runny Nose   

One symptom you can easily confuse with a cold is pregnancy rhinitis. The main symptoms are sneezing, nasal congestion, and a runny nose. If you are dealing with these issues without a fever, cough, or other signs of illness, it may be pregnancy rhinitis. Symptoms tend to increase as pregnancy progresses and are most common in the third trimester. The good news is that pregnancy rhinitis resolves after your baby is born.

If your congestion is due to a cold, a humidifier may help, especially in a dry climate. A warm shower or bath can also provide relief by adding moisture to the air. When you sleep, try elevating your head on extra pillows. You can use nasal strips to help open your nasal passages and saline nasal drops or sprays to keep them moist.

Sore Throat

If you have a sore throat, you can try sucking on ice chips if the cold feels soothing or drinking warm tea. Other remedies include gargling with warm salt water, sucking on throat lozenges, or drinking hot water with lemon juice and honey.

I love Throat Coat tea from Traditional Medicinals when I get a sore throat. Although there may be some risks of drinking this during pregnancy. That is because it contains licorice root, about 820 mg per serving. Real licorice has a compound called glycyrrhizin, which can influence how the body regulates cortisol.

One study showed that children of mothers who ate large amounts of licorice during pregnancy, around 250 grams per week, scored lower on cognitive and memory tests, showed more signs of ADHD, and girls experienced earlier puberty. Other research links more than 500 mg of glycyrrhizin per week with shorter pregnancies. Black licorice usually has more glycyrrhizin than red licorice, and not all products labeled as licorice contain real licorice root. For example, many red licorice candies, like Twizzlers, do not contain licorice root at all. If you’re unsure which teas are safe or which you should avoid during pregnancy, check out this episode. 

If you have a severe sore throat without other cold symptoms, you might have strep throat. Strep differs from a cold or the flu because bacteria, not a virus, cause it. Your doctor or midwife can test for strep and prescribe antibiotics if you test positive. Viral illnesses won’t get better with antibiotics, but antibiotics will work for strep since it is a bacterial infection.

Fatigue  

Fatigue is more severe with COVID-19 or the flu than with a cold, but all viruses can leave you feeling exhausted. The best thing you can do when you’re sick is to rest and get extra sleep. Your sleep and immune function are closely connected. When your immune system activates, it can alter your sleep needs. Your body works extra hard to fight off infection, and rest is one of the best ways to recover quickly.

Taking sick days from work can be difficult when you’re saving time off for maternity leave. If you have another child at home, you can’t simply call in sick because you’re a mom. If you can take a day off to rest, it will help you recover faster. Sometimes, spending a little more time up front can save you days of dealing with being sick later. 

Fever

A fever is part of your body’s immune response as a natural defense against infection. This symptom is more common with the flu and COVID-19 than with a cold. The Centers for Disease Control and Prevention and the American College of Obstetricians and Gynecologists define a fever as a body temperature of 100.4°F or 38.0 °C. 

There are concerns about fevers during pregnancy. A review and meta-analysis that included 46 studies found maternal fever was associated with neural tube defects, oral clefts, and congenital heart defects. There were some conflicting results among the studies on whether you should use medication to reduce fever. Ultimately, there is still so much we do not know about how fevers can affect a baby in utero. There are no universal guidelines on what temperature or the length of a fever is harmful, or exactly what impact a fever could have. Kee in mind, that there is a significant difference between running a fever of 100.4°F (38°C) for an hour and 103°F (39.4°C) for a day or longer. There are many questions that scientists are still working to answer. We will discuss antipyretics (medications to reduce fevers) later in this article.

If you get a fever, focus on staying well hydrated and keeping your body from overheating. Drink plenty of fluids. Also, use simple cooling measures, such as placing a cool, damp washcloth on your forehead, taking a tepid bath or shower, and wearing light clothing instead of bundling up under heavy blankets. For more evidence on fever during pregnancy, check out this episode. 

Homeopathy and Other Remedies

After basic comfort measures, some people turn to homeopathy and herbal remedies for additional relief. Homeopathy dates back to the late eighteenth century. It is based on the idea that disease symptoms can be treated with very small doses of substances that, when given in larger amounts, would cause similar symptoms in healthy people. Many homeopathic products are diluted to such an extent that they no longer contain detectable levels of the original substance.

The Federal Trade Commission cannot stop homeopathic companies from selling their products, but it can regulate how they market their products. According to the FTC, claims about homeopathic products are not based on modern scientific methods and are not supported by current medical experts, but homeopathy still has many supporters. Manufacturers are required to have evidence that their products are effective. If they lack such evidence, the label must include a disclaimer stating: “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.” 

Many people feel that homeopathic remedies help them, even though there is not strong scientific. If you choose to use homeopathy, please disclose any remedies to your doctor or midwife, just as you would with any other over-the-counter or prescription medication.

Umcka

One popular homeopathic remedy to treat cough, sore throat, congestion, and other respiratory ailments is Pelargonium sidoides, a medicinal plant native to South Africa. Umcka is a brand name of the herb; a couple of others you could see are Zucol and Kaloba.  You can get it in tablet or liquid form. 

Several studies have examined Umcka, including a meta-analysis of ten clinical trials that generally showed positive results. Most research focused on acute bronchitis or respiratory infections. Based on limited evidence from a small number of trials with acceptable methodology, the conclusion was that Pelargonium sidoides may help relieve symptoms in acute bronchitis, rhinosinusitis, and the common cold. However, the clinical significance of these effects remains unclear.

All studies in the meta-analysis were sponsored by a manufacturer of Umcka and conducted within the same region. Overall, the quality of these studies was considered low. Side effects included gastrointestinal issues such as nausea, vomiting, diarrhea, or heartburn, as well as allergic skin reactions like itching and hives. Unfortunately, pregnancy was a criterion for excluding participants in all the reviewed Umcka studies.

Safety of Over-the-Counter Medications

Cold medicines contain active ingredients like acetaminophen, cough expectorants or suppressants, antihistamines, and decongestants. The recommendation for any over-the-counter drug is to see your doctor. Nearly any label will state something to the effect of, “If pregnant or breastfeeding, ask a health professional before use.” Let’s walk through each major category of cold medicine ingredients and examine the research on these drugs to understand their safety better.

Analgesics for Pain Relief and Fever

Analgesics are pain relievers and include NSAIDs (nonsteroidal anti-inflammatory drugs) and acetaminophen. These are also antipyretics, which are medicines that reduce fever. Analgesics treat minor aches and pains, reduce a fever, or may be present in combination medicines to treat colds or other symptoms. Let’s examine the main types of pain relievers available over the counter.

NSAIDs (nonsteroidal anti-inflammatory drugs)

NSAIDs include aspirin and ibuprofen. Both are pain relievers, anti-inflammatory agents (reducing swelling and inflammation), and antipyretics (reducing fever).

Aspirin

Doctors generally advise against aspirin during pregnancy as a pain reliever and fever reducer. The risks of taking aspirin during pregnancy vary depending on the stage of pregnancy. During the first trimester, aspirin poses a concern for pregnancy loss and congenital disabilities. During the third trimester, the risk of the premature closure of a vessel in the fetus’s heart increases. Use of high-dose aspirin for long periods in pregnancy also increases the risk of bleeding in the brain of premature infants.

One thing that sets aspirin apart from other NSAIDs is its antiplatelet effect, which reduces blood clotting. There is evidence that low-dose aspirin may reduce the risk of preeclampsia. A meta-analysis found that low-dose aspirin in high-risk pregnancies is associated with a decrease in the rate of preeclampsia by approximately 10%. Low-dose aspirin comes in 81 mg tablets, compared to a standard tablet containing 325mg. The American College of Obstetricians and Gynecologists supports the use of low-dose aspirin for the purpose of preventing preclampsia in those with risk factors.

Ibuprofen  

Ibuprofen is also usually not recommended during pregnancy. There is evidence that ibuprofen can increase your risk for miscarriage early in your pregnancy. The FDA recommends pregnant mothers avoid ibuprofen after 20 weeks because it can result in low amniotic fluid.

Acetaminophen

Due to the risks associated with aspirin and ibuprofen, acetaminophen has been the primary recommendation for a pain reliever or fever reducer during pregnancy. As a result, up to 65% of pregnant mothers reported using acetaminophen at least once during their pregnancy. You may know acetaminophen by the brand names Paracetamol or Tylenol. More than 600 over-the-counter medications include this drug as an active ingredient, including many cold medicines.

There has been growing attention on possible links between acetaminophen use in pregnancy and neurodevelopmental outcomes such as autism spectrum disorder. This was covered in-depth in a separate episode. To bring you up to speed, here is what you need to know.

A review of nine separate studies found that acetaminophen use during pregnancy is associated with adverse neurodevelopment, including ADHD, autism spectrum disorder, and lower IQ. In one study, researchers related an increased risk for asthma in children to maternal use of acetaminophen during pregnancy. Another study found an association between acetaminophen use during pregnancy and behavioral problems in children.

The FDA states, “Clinicians should consider minimizing the use of acetaminophen during pregnancy for routine low-grade fevers. This consideration should also be balanced with the fact that acetaminophen is the safest over-the-counter alternative in pregnancy among all analgesics and antipyretics; aspirin and ibuprofen have well-documented adverse impacts on the fetus.”

AGOG’s position is that, “Acetaminophen is one of the few options available to pregnant patients to treat pain and fever, which can be harmful to pregnant people when left untreated. Maternal fever, headaches as an early sign of preeclampsia, and pain are all managed with the therapeutic use of acetaminophen, making acetaminophen essential to the people who need it. The conditions people use acetaminophen to treat during pregnancy are far more dangerous than any theoretical risks and can create severe morbidity and mortality for the pregnant person and the fetus.”

Based on the research we have, there are valid concerns about acetaminophen use and autism. Remember that autism is a spectrum disorder and is not caused by a single factor, but rather likely results from many environmental and genetic influences. The research available on acetaminophen use during pregnancy does not demonstrate a direct causal relationship. Hopefully, we will see more research in the future.

In the meantime, there is some disagreement between government health organizations and physician groups. Due to mixed messaging, care providers might have different opinions on the safety of acetaminophen during pregnancy. Some doctors may be more cautious about their pregnant patients taking acetaminophen. Some may restrict use to longer-lasting or higher fevers, rather than short-term low-grade fevers or minor aches and pains. If you are sick but not experiencing a fever or severe pain, and want to take cold medicine, consider one that does not contain acetaminophen. If you have questions, please discuss them with your doctor or midwife to get their recommendation.

Cough Expectorants and Suppressants

Coughing is your body’s way of removing irritants and secretions from your respiratory system. Cough remedies usually fall into two groups: expectorants and suppressants. Expectorants, also known as mucolytics, thin mucus so it’s easier to cough up phlegm from your lungs. The most common active ingredient is guaifenesin, which is in medications like Mucinex.

Cough suppressants, or antitussives, work by blocking the cough reflex. The most common over-the-counter suppressant is dextromethorphan, often listed as “DM” after a brand name like Robitussin DM. Suppressants can be helpful if a persistent cough keeps you from sleeping, but remember that coughing is a natural way for your body to clear mucus. If you are bringing up a lot of phlegm, an expectorant might be more suitable than a suppressant.

Some prescription cough syrups contain codeine, which is an opioid, and generally not recommended during pregnancy.

Unfortunately, ACOG does not have specific guidelines for cough medicines. Many sources cite both dextromethorphan and guaifenesin as generally safe during pregnancy. There is a study that found possible associations between using these in the first trimester and increased risks of some birth defects, but we really need more research. Recommendations may vary by provider, with some suggesting avoiding these in the first trimester.

Antihistamines  

Antihistamines are commonly found in allergy medications and may also be included in cold remedies because they help alleviate congestion, a runny nose, and sneezing. ACOG has specific guidelines for using antihistamines to treat allergies, but not specifically for cold medicines.

While drug manufacturers frequently include antihistamines in combination cold medicines, they are not miracle drugs for colds. A Cochrane review looked at 18 studies with 4,342 participants and found that antihistamines tended to help during the first day or two of a cold and had no significant effect afterward. Unfortunately, this review did not include any studies on pregnant mothers. There are many different types of antihistamines, and trying to understand each one included in various medications can be very confusing. If you are considering a cold medicine that contains an antihistamine, please consult your doctor or midwife first.

Decongestants

Decongestants constrict your blood vessels, which can relieve congestion and a stuffy nose. The most common decongestants are pseudoephedrine and phenylephrine, often found in medicines like Sudafed.

According to ACOG, pseudoephedrine has been linked to a small risk of abdominal wall birth defects and is not recommended during the first three months of pregnancy. A study showed a slight increase in the risk of an endocardial cushion defect (a type of heart 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 eightfold, the absolute risk of having a child with this defect would be roughly 2.7 per 1,000 live births. While this helps put the statistics in perspective, there is still much we do not know about decongestant use during pregnancy and the potential risks to a baby.

Summarizing Cold Medicines

The safest option is to skip cold medicine altogether, which removes any potential risk to your baby. Some expecting parents prefer this approach, especially during the first trimester when development is most sensitive.

Of course, the trade-off is that cold medicine can help you feel better while your body fights off an illness. If you decide to take one, aim for the lowest effective dose for the shortest possible time. Choose medicines that target only the specific symptoms you have, and avoid extra-strength or combination products that include ingredients you may not need. Depending on your symptoms, you may decide that rest, fluids, and comfort measures are enough. But if your symptoms are significant and you feel like you need medication, check with your doctor or midwife so they can help you choose the safest option.

Brand Name vs. Generic Medications

When you look at over-the-counter medications, you will often see a brand name, like DayQuil, Theraflu, or Mucinex, and lower-cost generic versions. In theory, if the active ingredient and dose are the same, the medications should work the same way. In practice, there have been concerns about quality control and even fraud in some areas of generic drug manufacturing. An in-depth investigation on The Drive Podcast with Peter Attia, M.D., and journalist Katherine Eban highlights issues with how some generic drugs are produced and tested. This podcast episode compelled me to spend a little bit more to purchase only brand-name medications.

Medications During Breastfeeding

Once your baby is born, you still need to be careful about medication use because many drugs can pass into breast milk. Fortunately, there is an excellent resource with information on the safety of medications during breastfeeding. LactMed is a comprehensive database where you can look up a drug by its generic or brand name to find out how much of the medication enters breast milk, possible effects on a nursing baby, and any known effects on milk supply. It also lists alternative medications that might be safer while breastfeeding. LactMed is a valuable resource, and you should continue to consult your doctor, midwife, or pediatrician before taking any medications while breastfeeding.

Weighing the Risks and Benefits of Over-the-Counter Cold Medications 

When it comes to over-the-counter cold medicines in pregnancy, there are rarely perfect answers. We do not have large, long-term, double blind, placebo-controlled trials proving that these medications are 100% safe for pregnant mothers and babies. Most of the time, we work with limited data, older studies, or information on individual ingredients rather than on every possible combination product.

You should talk with your care provider before you take any medication, even if it is available over the counter. Your doctor or midwife can look at your specific situation, including your medical history, other medications, allergies, and how far along you are in your pregnancy. Then, together, you can decide when it makes sense to use medication and which options are likely to be safest.

In the end, this is a risk-benefit decision. On one side is the potential risk of exposing your baby to a medication. On the other hand, there is the benefit of relieving symptoms such as fever, severe congestion, or lack of sleep, which can also affect your health. A practical approach is to start with non-medication strategies first. If you opt to take medicine, choose single-ingredient products rather than multi-symptom formulas when possible. You should use the lowest effective dose, and limit how long you take it. There is no one right answer for every pregnant mother. After reading this article, you have a lot more information to have a conversation with your care provider and make an informed choice you can feel confident about.

Prioritize Rest

When you are sick, the most important thing you can do is rest. Your body is already working hard to grow a baby, and it needs extra energy to fight off an illness. If possible, ask friends or family to help so you can slow down. That might mean having someone drop off a meal, pick up groceries, or walk your dog.

If you have a partner, lean on them. Let them know what feels most supportive when you are sick. Some people want extra attention and comfort, and others feel better with quiet and space. Share what you need so your partner can help you protect your rest. The more you can step back from daily tasks and truly rest, the sooner your body can recover.

When to Contact Your Doctor or Midwife

This podcast is not medical advice. My goal is to provide you with information and tools to help you have better conversations with your care team and make informed decisions. Call your doctor or midwife whenever you are concerned about your symptoms or how you are feeling. Specific reasons to call include a high fever that doesn’t improve after 24 hours, symptoms that persist or worsen, coughing up yellow or green mucus, or any chest pain or trouble breathing. When in doubt, it’s always best to check in. Talk with your doctor or midwife about any medications you’re considering, including over-the-counter drugs, homeopathic products, and supplements, so you can be confident your plan is safe for you and your baby.

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