Is cold medicine safe during pregnancy?

With all of the other changes going on in your body, you’d think that maybe nature would lay off with the colds and stuffy noses during pregnancy. But in fact, changes to your immune system mean that colds and flus could hit you harder than usual.

At the same time, your usual ways of dealing with colds might be off the table, as many over-the-counter medications aren’t safe during pregnancy. The best way to address this would, of course, be not to get sick at all, which is why it’s recommended that all pregnant women stay up-to-date on vaccines for things like flu and COVID. Unfortunately, we know vaccines aren’t 100% effective at preventing illness, and we don’t have a vaccine for the common cold yet!

So what can you do if you catch one of these and feel miserable but can’t use your usual relief strategies?

Over-the-counter cold medicine

An important thing to know about medication in pregnancy is that, generally, most haven’t been rigorously studied for safety in pregnancy. Some are “assumed safe” because they’ve been used commonly without apparent issues in many people over long periods. However, some have very little safety data during pregnancy, and we just don’t know for sure if they are or aren’t completely harmless to the baby and the pregnancy. In many cases, when taking medication during pregnancy, even over the counter, it is important for you to weigh the risks of taking it with the benefits you may get from it.

Many cold medicines are specifically not safe to take during pregnancy for a variety of reasons. Some can raise your blood pressure and are meant to restrict blood vessels (not something you want during pregnancy). Some have substances in them that haven’t been confirmed to be safe for a growing baby. Cold medications are often combination drugs meant to treat several symptoms at once, so it’s essential to read labels and be extra cautious to confirm you have the correct version of a medication. During pregnancy, it’s often recommended you take single medications to treat specific symptoms and stay away from combination medications to reduce your and your baby’s exposure to unnecessary or potentially risky medication.

In general, it’s important to talk to your doctor before taking any over-the-counter medication during your pregnancy.

There are still a few over-the-counter medications your healthcare provider is more likely to recommend, as they’re generally thought to be reasonably safe during pregnancy. Here is a look at what we know about several popular cough/cold medications available over the counter.

  • Acetaminophen, the active ingredient in Tylenol, may be beneficial in specific circumstances. It is often the preferred fever-reducer used in pregnancy. Some studies suggest there may be a risk of asthma or other breathing problems in children whose mothers took Tylenol regularly during pregnancy, as well as some potential link to hyperactivity and attention issues in children under the age of 7.
  • Guaifenesin: Commonly found in pharmacies under the label Mucinex, this medication is meant to break up mucus to help reduce coughing by getting rid of the cause. It is not a cough suppressant. There are many options with the label Mucinex. Some contain multiple active ingredients, and others are simply guaifenesin. According to some data, there is potential concern that taking this in the first trimester could slightly raise the risk of birth defects, but more data needs to be collected to support or refute that. And guaifenesin hasn’t been studied to determine if there are risks to the baby’s health or the health of the pregnancy from taking it after the first trimester.
  • Pseudoephedrine: Many colds cause congestion and sinus pain. Pseudoephedrine is the active ingredient in many decongestants, such as Sudafed. Some studies have noted a very small potential increase in certain birth defects when taken in the first trimester. More studies are needed to tell if it risks the baby’s health or the health of the pregnancy when taken later on. It is known to cause constriction of blood vessels and can increase blood pressure. So, it should be avoided in those with high blood pressure.
  • Diphenhydramine: A common medication used to reduce allergy symptoms like sneezing and itching, and for reducing nausea and helping with insomnia among other uses, this is most commonly found under the brand name Benadryl. When used as directed occasionally during pregnancy, it has not been shown to increase the risk of birth defects, pregnancy complications, or impact baby’s health. When taken in higher-than-recommended doses and for long periods of time, there is an increased risk of complications and, in some cases, infant withdrawal in the days and weeks after birth. Note it does cause significant drowsiness.
  • Dextromethorphan: Dextromethorphan is a cough suppressant commonly found in Robitussin or Delsym. It is not well studied in pregnancy, but the small studies that have been done do not indicate increased risk with use in pregnancy. So, it may be an option to discuss with your provider.
  • Natural remedies: Herbs and supplements can be just as powerful as medications, which means they can sometimes cause side effects, risks, and medication interactions. Therefore, it’s super important to check with your provider before trying any “natural” remedies because they require safety considerations as well! For some, the unknowns of taking medication and supplements during pregnancy feel like too much of a risk. For others, the benefits outweigh the potential risks. Wherever you land, it’s most vital that you make informed decisions that feel the best to you.
  • If you’re looking for non-drug, non-herbal methods for getting a little relief from cold symptoms, there are several that are worth a shot.
    • A humidifier, especially in your bedroom at night, can help relieve chest congestion and avoid dry, cracked nasal passages.
    • Gargling with hot salt water can help bring relief to a sore throat.
    • Cough lozenges that do not contain medication can soothe cough or throat pain as well as offer some clearing of the nasal passages.
    • Honey is another very effective remedy for cough and throat pain that’s easy and tasty. Put it in a cup of hot tea or swallow a spoonful by itself.

If your cold symptoms last longer than a few days or get in the way of eating, staying hydrated or sleeping, your healthcare provider will probably want to know. It’s always smart to speak with your healthcare provider before taking any medications during pregnancy.

Reviewed by the Ovia Health Clinical Team

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