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Overview

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 get sick. You will likely be coping with some kind of illness during your pregnancy. There are some additional challenges to colds and flu when you are pregnant. Plus, we also have COVID-19 going around right now. Pregnancy limits what types of medications you can safely take. 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.

This podcast is not intended as medical advice. You should be running any symptoms you experience or any medications you are taking by your doctor or midwife; this also goes for over-the-counter medicines.

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. It is harder for your body to fight off a cold or the flu with a lower immune system. 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, 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 of those are rhinoviruses. Influenza viruses cause the flu. Coronaviruses can cause respiratory infections like the common cold. A coronavirus was also responsible for past outbreaks like the SARS virus in 2003 and MERS in 2012. SARS-COV-2 is the coronavirus causing the disease COVID-19.

Symptoms

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, which is 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. Some additional symptoms you could experience with COVID-19 are difficulty breathing or loss of taste or smell. 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. To make things even more complicated, someone can carry and spread one of these viruses and be asymptomatic. This means that you are showing no signs of illness.

How Viruses Spread

These viruses spread either through touching a contaminated surface or by 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.

This study compares SARS-CoV-2 with SARS-CoV-1, which is closely related. While there have been questions about how long SARS-CoV-2  lives outside of the body, this study gives us some general guidelines. Aerosols can stay in the air for up to 3 hours. On copper, the virus can survive up to 4 hours, up to 24 hours on cardboard, and up to 2-3 days on plastic and stainless steel. These timeframes are similar to other viruses. Plus, variables like temperature, humidity, and airflow can affect how long these viruses remain in an environment. If you touch a contaminated surface, you can introduce a virus into your body by touching your mouth, nose, or eyes.

Avoiding Viruses

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 other people from catching what you have. Being in enclosed rooms with little or no airflow puts you at a higher risk from airborne particles. Being outside, or being in well-ventilated places with air filtration systems or open windows is ideal.

Another way to limit your risk from the airborne transmission is to wear a face mask. This has become a politically charged debate, especially in the United States. Some areas or business will require face masks. The science is still out on how much masks limit your risk and how effective different types are. There have also been questions raised about whether there are additional risks from long term use of masks. Hopefully, we will have more evidence on this topic in the future.

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 colds and flu cases is that many different viruses cause them, and they are continually evolving. There are no vaccines available for the common cold, but you can get a flu vaccine. Every year the World Health Organization’s Global Influenza Surveillance and Response System predict which strains of the flu 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 all pregnant women get a flu vaccine. For more evidence on the flu vaccine and information on safety, see this article.

At the time of this episode, we still do not know if COVID-19 confers immunity for some time after infection, and no vaccines are currently available for SARS-CoV-2.

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. The medical community is still working on finding the most effective remedies to treat 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 with treating your symptoms at home, there is a lot of information available on what works and what is safe during pregnancy.

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 of these ingredients as pregnancy category B or C. The FDA is phasing out these classifications in favor of 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 the 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. Any label will state something to the effect of, “If pregnant or breastfeeding, ask a health professional before use”. Let’s dive into the research on these drugs and ingredients to understand their safety better.

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 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. In one study, researchers 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 that you 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 useful when a cough is keeping 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

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, 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 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 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 many questions about what medications are safe to take for both you and your baby.

The CDC has an initiative called Treating for Two trying to tackle the problem of 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 that sums up 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.
  • Avoid aspirin, although I will note that there are exceptions to this if your doctor prescribes it. 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 drugs, and avoid combination medicines that treat many symptoms at once. You want to minimize your exposure to medications that you do not need. Also, do not take medicines for an extended period or longer than required.

You often hear on this podcast that there are not perfect double-blind, placebo-controlled studies we can reference to show that these medications are 100% safe during pregnancy. There is such a lack of evidence on things like this.

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 weigh 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 good 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 for dealing with cold and flu symptoms.

Homeopathy

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. 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 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 many 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.

Viruses 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.

Your prenatal vitamin should include 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. One of the easiest sources 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 symptom you may experience during your pregnancy that can get confused as a cold 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.

Sore Throat

If you have a sore throat, you can 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 to try are gargling with warm salt water, sucking on throat lozenges, or drinking hot water with lemon juice and honey added to it.

Fatigue

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 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 a challenge when 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 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 struggling with being sick later.

Fever

A fever is generally a temperature over 37.5-38.3 Celsius or 99.5-100.9 Fahrenheit. This is a part of your body’s immune response and is more common with the flu and COVID-19 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.

Asking for Help

If you are not feeling well, please ask for help with things friends or family can do 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, and if you have someone you can ask for help from, please do.

If you have a partner, lean on them for some help. Let them know what is helpful and what isn’t. If you want your partner to baby you when you are sick, let them know. 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.

My Go-To

Lastly, if there is something that is your go-to 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. 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

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 are persisting and not getting better. If you cough 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 your symptoms or recovery. Be sure to talk to your doctor or midwife about any meds, including over-the-counter drugs, homeopathic products, and additional supplements.

 

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