Pregnancy affects every system in your body, including your immune system. It is so important to take care of your health when you are expecting. Even when you take precautions to avoid getting sick, you can get a cold, flu, or COVID-19 at some point over the nine months of your pregnancy. Being sick is never fun and can be especially challenging when pregnant. Learn how to treat symptoms safely to return to feeling healthy faster. This article examines the evidence of non-pharmacological treatments for cold or flu symptoms and the safety of over-the-counter medications during pregnancy.
This podcast is not intended as medical advice. You should discuss any symptoms with your doctor or midwife and talk to them about taking any medications, including over-the-counter medicines.
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How Pregnancy Changes Your Immune System
The classic perspective is that pregnancy suppresses your immune system. This suppression is designed to keep your body from rejecting your baby during pregnancy since your baby is foreign. This is a very simplified and basic explanation. Advancements in our understanding of the immune system during pregnancy paint a more colorful picture. In current understandings, we see the placenta as an immune regulatory organ. The placenta secretes antiviral molecules, transports antibodies from you to your baby, and can recognize pathogens and alert your immune system. For more in-depth information, see this article.
An intricate symphony is going on in your immune system to protect you and your baby during pregnancy. Perhaps a more accurate way to describe it would be that pregnancy suppresses some aspects of your immune system and enhances others. Scientists are working to understand better how your immune system changes during pregnancy. Some recent research shows a precise timing of immunological events occurring during term pregnancy. There is also research showing that hormones like estrogen, progesterone, and hCG help to regulate your immune system during pregnancy.
Keep in mind that your body is working incredibly hard right now. Pregnancy affects every system in your body. Your caloric intake and energy requirements are higher; you carry more weight, produce, and circulate more blood. Plus, making room for your baby puts extra pressure on other organs, impacting digestion and even your lung volume. Basic things like eating well, staying hydrated, taking a high-quality prenatal vitamin, getting exercise, and ensuring adequate sleep are crucial.
The Common Cold, the Flu, and COVID-19
The common cold, flu, and COVID-19 are all caused by viruses. There are more than 200 types of cold viruses, and about one-third are rhinoviruses. Influenza viruses cause the flu. Coronaviruses can cause respiratory infections like the common cold and COVID-19.
Symptoms of cold, flu, and COVID-19 are relatively similar. The symptoms include runny or stuffy nose, coughing, sneezing, sore throat, fatigue, fever, and malaise, generally feeling unwell. Cold symptoms tend to be mild. The flu and COVID-19 tend to come on much quicker than a cold and often include a fever. COVID-19 can be more severe than the flu. With any of these viruses, there is the possibility of having a severe infection and developing complications.
You can usually tell the difference between a cold and the flu by the rapid onset of symptoms with the flu. Telling the difference between these and COVID-19 may be more of a challenge. The only accurate way to tell the difference would be to get a diagnostic test for influenza and SARS-CoV-2 to see if you are positive for either. The presence of symptoms with negative results for influenza and SARS-CoV-2 would indicate a cold.
How Viruses Spread
These viruses spread by touching a contaminated surface or inhaling particles in the air. These viruses become airborne when someone who is infected coughs or sneezes and releases half a million particles into the air. Someone can carry and spread one of these viruses and be asymptomatic. This means that you are showing no signs of illness. Variables like temperature, humidity, and airflow can affect how long these viruses remain in an environment.
There are many things you can do to try and avoid contracting a virus. If you know someone who has any symptoms of being sick, you want to avoid contact with them. This isn’t just a physical touch, but being in the same room with them as well. The same goes for you if you have any symptoms. By isolating yourself and avoiding others, you can prevent others from catching what you have. Enclosed rooms with little or no airflow put you at a higher risk of airborne particles. Being outside or in well-ventilated places with air filtration systems or open windows is ideal.
If you touch surfaces, especially in public places or high-traffic areas, you may get a virus on your hands. One of the simplest and best things you can do to prevent getting sick is to wash your hands often and don’t touch your face. If you touch a contaminated surface, you still need to introduce the virus into your body through your nose, mouth, or eyes to potentially make you sick. The general guideline is to wash your hands for a minimum of 20 seconds. If you don’t have immediate access to a sink and soap, you can also use an alcohol-based hand sanitizer.
Immunity and Vaccines
If you had previous exposure to a specific virus, you might develop immunity. One of the issues with cold and flu cases is that many different viruses cause them, and they are continually evolving. No vaccines are available for the common cold, but you can get a flu vaccine. The World Health Organization’s Global Influenza Surveillance and Response System predicts which flu strains will be the most common the following year, and they select 3 or 4 to create the vaccine. The American College of Obstetricians and Gynecologists recommends that all pregnant women get a flu vaccine.
ACOG also recommends that all eligible persons aged six months and older, including pregnant and lactating individuals, receive a COVID-19 vaccine or vaccine series. In the practice advisory updated as of 9/20/2022, ACOG states, “Despite ACOG’s persistent advocacy for the inclusion of pregnant individuals in COVID-19 vaccine trials, none of the COVID-19 vaccines approved under EUA have been tested in pregnant individuals. However, studies in pregnant women have begun, and post-market surveillance is underway.”
Treating Cold and Flu Symptoms
Patients who have a cold without complications are typically not prescribed medications. There are some prescription antiviral drugs used 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 you should go in for a test, treatment, or monitoring.
Please talk to your doctor or midwife about your symptoms when they arise and discuss any treatments or over-the-counter medications you plan to take. You do not want to self-diagnose and treat symptoms if you need medical care and should be seeing your care provider. If you and your care provider are comfortable treating your symptoms at home, there is a lot of information available on what works and is safe during pregnancy. Let’s examine the non-pharmacological options and then dive into medications.
Treatments for the Cold and Flu
Many non-pharmacological remedies may help you find some relief from cold and flu symptoms.
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 a virus. Staying healthy includes eating healthy whole foods and staying hydrated.
You should get the bulk of your nutrients directly from your diet, not a supplement. You should also take a high-quality prenatal vitamin to ensure you get all the critical nutrients you and your baby need. 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. One of the easiest sources of vitamin C is citrus fruits. Foods high in zinc include meats, shellfish, and legumes.
Viruses can leave you dehydrated, and you will need extra fluids. This is especially true if you are running a fever. Water is always the best option, and drinking broths, teas, and juices can also help you stay hydrated. You may also consider adding electrolytes.
Congestion & Runny Nose
A humidifier may help if you are suffering from congestion, especially if you live in a dry climate. Even a warm shower or bath can get you some humid air to help. When 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 symptom you may experience during pregnancy that can get confused with a cold is pregnancy rhinitis. The main symptoms are sneezing nasal congestion, or runny nose. If you are experiencing these issues without any other symptoms, you may have pregnancy rhinitis. There is a strong correlation between symptoms and gestational week – the further you are, the more common it is. Pregnancy rhinitis is most common in the third trimester and will disappear after you have your baby.
If you have a sore throat, try sucking on ice chips if the cold is soothing, or 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. Other remedies are gargling with warm salt water, sucking on throat lozenges, or drinking hot water with lemon juice and honey.
Fatigue is more intense with COVID-19 or the flu than a cold, but all viruses can leave you feeling wiped out. The best thing you can do when you are sick is to rest and get extra sleep. Your sleep and immune function are closely linked. When your immune system is activated, it can alter your need for sleep. In turn, your sleep affects both your innate and adaptive immune systems. Your body is working extra hard to fight off infection, and rest is one of the best things you can do to get better as quickly as possible.
Taking sick days from work may be challenging when trying to save time off for maternity leave. If you have another child at home, you cannot call in sick from being a mom. If you can take a day off and rest, that will help you get healthier sooner. Sometimes investing a little more time upfront can save you days of struggling with being sick later.
The Centers for Disease Control and Prevention and the American College of Obstetricians and Gynecologists define a fever as 38 °C 100.4 °F. A fever is a part of your body’s immune response and is more common with the flu and COVID-19 than a cold. Generally, you should 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. Ask your doctor or midwife what they consider a fever to be and when you should call them.
If you get a fever, you want to ensure you stay hydrated. Also, take measures to cool off, like running a washcloth under cool water and putting that on your forehead, taking a tepid bath, or a shower. Opt for light clothing and avoid burying yourself under blankets. Please ask your care provider about using a medication to reduce your fever. For more evidence on fever during pregnancy, check out this episode.
Homeopathy dates back to the late-eighteenth century and is based on the view that disease symptoms can be treated by minute doses of substances that produce similar symptoms when provided in larger quantities to healthy people. Many homeopathic products are diluted to such an extent that they no longer contain detectable initial substance levels.
The Federal Trade Commission can’t prevent homeopathic marketers from selling their products; only the FDA can do that. But, the FTC did put additional regulations out about labeling homeopathic products. According to the FTC, homeopathic product claims are not based on modern scientific methods and are not accepted by modern medical experts, but homeopathy has many adherents. The FTC requires 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 the 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.”
Many people swear by homeopathic remedies. Even when evidence may be in short supply, I want to acknowledge that many people are happy with the efficacy of homeopathy. Please disclose any homeopathic remedies you use with your doctor or midwife, just like any other OTC or prescription medication.
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 tablets or as a liquid.
There have been some studies on Umcka and a meta-analysis of ten clinical studies that overall found positive results. Most studies focused on acute bronchitis or respiratory infections. The conclusion was that based on the limited evidence from very few clinical trials with acceptable methodology, Pelargonium sidoides might offer symptom relief in acute bronchitis, rhinosinusitis, and the common cold. The clinical relevance of these effects remains uncertain. All of the studies in this meta-analysis were sponsored by a manufacturer of Umcka, and all were in the same region. Overall the quality of the studies was low. Side effects found were gastrointestinal complaints such as nausea, vomiting, diarrhea, or heartburn, and allergic skin reactions with itching and hives were reported in the included trials.
Unfortunately, pregnancy was one of the criteria for excluding participants in all of the studies reviewed on Umcka.
Safety of Over-the-counter Medications
Over 80% of expecting mothers take an over-the-counter medication of some kind during their pregnancy. Cold medicines contain active ingredients like acetaminophen, cough expectorants or suppressants, antihistamines, and decongestants. The recommendation around any over-the-counter drug is to see your doctor. Any label will state something to the effect of, “If pregnant or breastfeeding, ask a health professional before use.” Let’s examine the research on these drugs and ingredients to understand their safety better.
Analgesics are pain relievers and include acetaminophen and NSAIDs (nonsteroidal anti-inflammatory drugs).
Acetaminophen may also be referred to by the brand names Paracetamol or Tylenol. More than 600 over-the-counter medications include this drug as an active ingredient. Typically, medical professionals prefer acetaminophen over ibuprofen during pregnancy. Acetaminophen has long been thought to be safe during pregnancy. As a result, up to 65% of pregnant mothers reported using acetaminophen at least once during their pregnancy. Unfortunately, there is some recent research that may be challenging the safety of this drug in pregnancy.
In one study, researchers related an increased risk for asthma in children to maternal use of acetaminophen during pregnancy. Another study in the Journal of American Medicine found an association between acetaminophen use during pregnancy and behavioral problems in children. More recently, 91 scientists, clinicians, and public health officials released a consensus statement cautioning against using acetaminophen during pregnancy. They examined many studies on both humans and animals. They found the use of acetaminophen might alter fetal development, which could, in turn, increase the risks of certain neurodevelopmental, reproductive, and urogenital disorders. The professionals behind this statement called for agencies like the FDA and obstetric and gynecological societies (like ACOG) to review the evidence and reevaluate the risks of this drug. This statement has an in-depth analysis of available research.
Days after this statement cautioning against the use of acetaminophen was released on 9/23/2021, ACOG released its statement that “This consensus statement, and studies that have been conducted in the past, show no clear evidence that proves a direct relationship between the prudent use of acetaminophen during any trimester and fetal developmental issues.” ACOG goes on to say, “ACOG’s clinical guidance remains the same, and physicians should not change clinical practice until definitive prospective research is done. Most importantly, patients should not be frightened away from the many benefits of acetaminophen. However, as always, any medication taken during pregnancy should be used only as needed, in moderation, and after the pregnant patient has consulted with their doctor.”
Ibuprofen is an NSAID (nonsteroidal anti-inflammatory drug). NSAIDs also include aspirin and some other pain relievers. Ibuprofen is usually not recommended during pregnancy. The FDA recommends pregnant mothers avoid ibuprofen after 20 weeks because it can result in low amniotic fluid. There is also evidence that ibuprofen and NSAIDs can increase your risk for miscarriage early in your pregnancy.
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 useful when coughing keeps you awake. Otherwise, you may want to use 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 are common in allergy medicines. These may also be in cold medicines because they can help with congestion, runny nose, and sneezing. The most common antihistamine is diphenhydramine, 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 narrow your blood vessels, which can help with congestion and a stuffy nose. The most common decongestants are pseudoephedrine and phenylephrine, which are commonly seen in medicines like Sudafed. We do not know if these 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 help put statistics into perspective, and there is still a lot we do not know about decongestant use during pregnancy and the risks to a baby.
Tips for Taking Over-the-counter Cold Medicine During Pregnancy
It has become common to reach for an over-the-counter cold medicine when sick. When you are pregnant, it brings up many questions about what medications are safe to take for both you and your baby.
The CDC has an initiative called Treating for Two to tackle the lack of information about taking medications during pregnancy. Overall, their advice is to talk to your doctor. An article on OTC meds in the American Family Physician Journal summarizes the generally accepted guidelines.
- Avoid medications in the first 12 weeks. The first trimester is when miscarriage is the highest, all your baby’s systems are being put into place during that period, and it is considered the most sensitive for development.
- Avoid aspirin. There are exceptions if your doctor prescribes low-dose aspirin to treat preeclampsia.
- Do not take any over-the-counter medicines for cough or congestion without running them by your care provider.
- If you take an over-the-counter medication, avoid using extra strength or long-lasting drugs, and avoid combination medicines that treat many symptoms at once. You want to minimize your exposure to medications that you do not need. You also do not want to take medicines for an extended period or longer than required.
Brand Name vs. Generic Medications
You have many options for medications from brands like Tylenol or Motrin, or there are less expensive options that are generic. There is an argument that if the active ingredients are identical, there is no difference in taking a generic over a brand-name medication. If the active ingredients are identical, then that would be true. Unfortunately, there is a lot of fraud in generic drug manufacturing. There is an excellent episode of the Drive Podcast with Peter Attia, M.D., and Katherine Eban, an investigative journalist, about widespread fraud in the generic drug industry. This podcast episode compelled me to spend a little bit more to only purchase brand-name medications.
Weighing the Risks and Benefits of Over-the-Counter Cold Medications
You often hear on this podcast that there are no perfect double-blind, placebo-controlled studies we can reference to show that these medications are 100% safe during pregnancy. So what can you do? Talk to your care provider, and you should always run anything, even over-the-counter medications, by your doctor or midwife. Ultimately, it is your decision and depends on what you are comfortable with. You weigh the potential risk or exposure to the medications with the benefit of the relief the medication gives you.
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, giving you quite a bit of data on the safety of medicines and breastfeeding. This includes effects on breastfed infants, effects on lactation and breastmilk, and alternative drugs to consider.
Asking for Help
If you are not feeling well, please ask friends or family to help you rest and recover. If you can have someone drop off a meal for you, run to the store, or come by and walk your dog, please do it. Your focus should be on getting better. If you have a partner, lean on them for help. Let them know if you want your partner to baby you when you are sick. If you prefer they leave you alone, speak up, so they know to give you some space. We are all different in what we want when we are sick and what helps us to feel better. Letting your partner know how they can best help may put you on the road to recovery sooner.
Lastly, if something is your go-to to feel better, whether it is a specific type of soup, binge-watching a show on Netflix, or getting some fancy superfood immune-boosting smoothie, do that. When I was pregnant with my daughter, one of the items my midwife asked me to purchase before my birth was immune support from Zand. This has become my go-to remedy anytime I feel like I have a cold or flu coming on. This is an herbal blend that includes ingredients like echinacea and elderberry. It tastes kind of like Jägermeister. Since my last pregnancy, I have always kept this on hand and take it when I feel like I am coming down with something. It could be the placebo effect, but it is my go-to, and I swear by it.
When to Contact Your Doctor or Midwife
This podcast is not intended to be medical advice. I intend to help get you more information and tools to add to your toolbox and help you make informed decisions. Call your doctor or midwife if you have any concerns about how you are feeling and your symptoms. Some specific signs that you should call are if you have a fever that is high or not going away for more than 24 hours. Call if your symptoms persist and not getting better. If you cough up yellow or green mucus or have 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 your symptoms or recovery. Be sure to talk to your doctor or midwife about any medications, including over-the-counter drugs, homeopathic products, and additional supplements.
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