7 Tips for Combating Cold, Flu, and COVID During Pregnancy

When I was pregnant with my second daughter, my first daughter was in preschool and constantly brought home the dreaded daycare bugs. I experienced multiple colds during pregnancy in addition to having both the flu and COVID while I was pregnant! The coughing caused me to have incontinence, and my pregnancy congestion only worsened.

Respiratory viruses during pregnancy can feel particularly miserable. In addition, certain treatments and medications are inadvisable during pregnancy. So, what can you do to ease your symptoms? In this article, we’ll explore the risks of getting sick while you’re pregnant and share effective strategies to combat the cold, the flu, and COVID-19 during pregnancy.

Pregnancy can affect a mother’s immune system and sometimes worsen the symptoms of viral infections. Therefore, experiencing a cold during pregnancy can be uncomfortable, difficult, and unsettling for many expectant mothers.^1,2 Common colds are upper respiratory infections, meaning the symptoms usually consist of:^1,4

• A runny or stuffy nose
• Sneezing
• A sore throat
• Coughing
• Headaches
• Possibly a low-grade fever and body aches

Luckily, the symptoms of mild colds rarely affect the placenta or fetus during pregnancy, though some cold viruses have been linked to fetal growth restriction.^1,3 More severe complications that are secondary to having a cold (such as sinus infections or pneumonia) could arise from untreated cold symptoms. In fact, one study found that pregnant women with colds were more likely to also experience lower respiratory symptoms such as shortness of breath, lower blood oxygen levels, bluing of the skin, and wheezing.³

Acquiring a cold at some point during the nine months of pregnancy may be unavoidable, as even healthy adults get two to three colds per year.⁴ However, it’s essential to monitor your symptoms and seek medical advice if they worsen. If you experience a high fever while pregnant, it’s particularly important to contact a healthcare provider. A prolonged fever can potentially affect fetal development, especially early in pregnancy, and it’s critical to identify and treat the underlying cause of the fever to prevent any complications.⁵

When treating a cold during pregnancy, try to focus on these nonmedication remedies whenever possible:^6,7,8,9

• Stay hydrated: Drink lots of fluids such as water, juice, tea, and broth to compensate for losing fluid through mucus production. Warm liquids can be especially helpful in relieving congestion and loosening mucus.
• Rest: Adequate sleep can help you get over a cold faster. Aim for eight to 10 hours of sleep per night during your cold, and allow yourself to rest or nap extra when tired. It may also be beneficial to take a few days off from intense exercise during the peak of your cold.
• Ingest honey: Honey may relieve cold symptoms and is especially helpful for suppressing a cough. Honey also has antimicrobial properties that can prevent secondary bacterial infections when you have a cold virus.
• Use a humidifier: A higher moisture content in the air you breathe can help loosen congestion and ease a sore throat. Just be sure to empty and replenish your humidifier daily and clean it as instructed.
• Do a saltwater gargle: Rinsing your throat with saltwater (1 teaspoon of salt per 1 cup of warm water) can loosen mucus in the throat and relieve inflammation and pain.
• Try nasal irrigation: Devices like neti pots or squirt bottles can flush clean saltwater through your nasal passages. This practice can remove thick mucus, decrease viral load in the sinuses, and moisten dry nostrils. To do this, mix 1 teaspoon of salt and 1 teaspoon of baking soda with 1 cup of distilled or boiled then cooled water. Position your head over a sink, use a device to squirt the saltwater up one nostril, and it will come out the other. Blow your nose afterward.

These home remedies for a cold during pregnancy will hopefully have you feeling better in a few days. Cold symptoms typically peak two to three days after onset and usually last about a week.⁴

The flu can pose greater risks than a cold during pregnancy. Typical flu symptoms can be similar to that of a common cold but with a more abrupt onset. Symptoms may be worse than a cold and can include a more significant fever, headaches, and body aches. Vomiting and diarrhea are also possible flu symptoms, though this is more common in children.¹⁰

Pregnant women are more likely than nonpregnant adults to experience severe symptoms and complications from the flu, such as hospitalization and secondary infections like pneumonia. Having the flu while you’re pregnant can also put your baby at risk for stillbirth, miscarriage, and preterm birth.³ If you contract the flu while pregnant, it’s important to contact your healthcare provider for monitoring and treatment as needed.

If you develop flu symptoms while pregnant, contact your healthcare provider right away. Your doctor can order a test for the flu and treat it accordingly, especially if you receive a diagnosis soon after symptom onset.¹¹ Because the flu is more likely to cause severe illness during pregnancy, the Centers for Disease Control and Prevention (CDC) recommends treatment with an antiviral like Tamiflu as soon as you’re diagnosed or suspected to have the flu.^12,34

Similar to a cold, you can manage your flu symptoms by resting, staying hydrated, ingesting honey, breathing humidified air, and doing saltwater gargles and rinses.³⁶ If your symptoms are still unmanageable, check with your doctor about pregnancy-safe medications and read on to see which cold and flu medications you can or cannot take for pregnancy.

Being pregnant may increase your risk of severe illness during a COVID-19 infection by 2.5 times when compared with nonpregnant women of the same age.¹³ In addition, severe illness from COVID-19, when compared to a mild infection, might increase the risk of gestational diabetes and low birth weight in your infant.¹⁴ Research indicates that having COVID-19 while you’re pregnant may also increase the risk of pregnancy and fetal complications, such as preterm birth, stillbirth, and preeclampsia. While most pregnant individuals recover well from COVID-19, vigilance is necessary.^14,15

Maintain regular prenatal checkups during pregnancy and inform your doctor of any symptoms. If you develop COVID-19 symptoms, let your OB-GYN know. COVID-19 symptoms are virtually the same as influenza symptoms, so you can’t tell the difference between them based on symptoms.³⁷ This is why your provider may recommend a test and prescribe the antiviral medication Paxlovid to prevent severe symptoms during pregnancy. You should only use this drug under medical supervision.¹³ Otherwise, treatment for COVID-19 while you’re pregnant generally involves monitoring and managing symptoms like you would with a cold or the flu. Your doctor may also advise that you monitor your blood oxygen levels and blood pressure at home. As always, seek medical advice for severe cases.¹⁶

Which Cold and Flu Medications Can You Take While Pregnant?

Pregnant women often wonder which cold and flu medicines they can take during pregnancy. Medications marketed for the treatment of cold and flu symptoms often contain multiple drugs in one combination formula or pill. It’s essential to examine and consider each active ingredient when determining medication safety in pregnancy. The cold and flu medications you choose should depend on the symptoms you hope to treat.¹⁷ So, always check with your doctor to see which medications they recommend for various symptoms.

For the following symptoms, here are some pregnancy-safe medications to consider:

Acetaminophen (Tylenol) is typically the most recommended medication for pain and fevers in pregnancy. However, you should only take it as needed and at the lowest effective dose.⁵ Some studies have shown a slightly increased risk of preterm delivery, low birth weight, mild developmental delays, and hyperactivity when mothers took acetaminophen during pregnancy, especially with prolonged use. However, these studies were based on maternal reports of taking this medication and didn’t consider the underlying cause for taking it. Other studies haven’t confirmed these findings.¹⁸

Dextromethorphan is a medication that helps suppress a cough, and it’s commonly found in over-the-counter cold medicine. Multiple studies in pregnant women have shown no increased risk to the pregnancy or the baby when this is taken as a cold medicine.¹⁹

Over-the-counter decongestants can help relieve nasal congestion or a stuffy nose, which is a common symptom of colds, flu, and COVID-19.^1,4,10,19,36 Pseudoephedrine (Sudafed) is considered safe in the second and third trimesters, but it may pose a risk for fetal abdominal wall defects in the first trimester, so consult your doctor before taking it. This medication also isn’t safe if you have high blood pressure or a history of heart disease.^17,19 Pseudoephedrine doesn’t require a prescription, but it’s kept behind the counter at pharmacies, and you must show photo identification to purchase it.³⁸

Another nasal decongestant called Oxymetazoline (or Afrin) is applied topically to the nasal passages to open the nose and decrease congestion. Although it’s only applied topically, it can be absorbed systemically. Consistent use isn’t recommended, but a few doses are considered safe in pregnancy.¹⁹

4. Sneezing and Itching

You can use certain antihistamines during a cough or cold to help with the sneezing and itching sensation in the nose. These can also make you drowsy and are often found in nighttime cold medicines to help you sleep. Chlorpheniramine, diphenhydramine, and doxylamine are generally considered safe in pregnancy.^17,19,20

An expectorant medication thins and loosens mucus, making it easier to expel by coughing or blowing your nose. The main expectorant is guaifenesin (or Mucinex), which is generally considered safe in pregnancy.¹⁹

Avoid the following medications and drug classes during pregnancy unless your provider otherwise instructs you to do so:^17,19

• NSAIDs: You should typically avoid nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, naproxen, celecoxib, and aspirin during pregnancy unless your doctor has instructed you to take low-dose aspirin. These pain relief medications can be linked to delivery complications and heart issues in the baby.
• Phenylephrine: This is a decongestant medication alternative to pseudoephedrine. Though commonly mistaken for one another, phenylephrine (Sudafed PE) isn’t the same as pseudoephedrine (Sudafed). Both are marketed as Sudafed, so be sure to read the labels. Phenylephrine isn’t considered safe in pregnancy because animal studies show a potential risk to the baby.¹⁷ Phenylephrine is available off the shelf at pharmacies, but the Food and Drug Administration (FDA) has proposed an order to remove it from sale because it isn’t effective for relieving nasal congestion.^38,39
• Benzocaine: This is a numbing agent that you can find in cough drops or lozenges and throat sprays. It isn’t safe during pregnancy, so make sure to avoid it.
• Codeine: Codeine is an opioid medication that you can use to treat cough and pain. However, you should avoid it during pregnancy.

Remember to always read medication labels and consult a doctor or pharmacist with any medication questions during pregnancy.

To determine a medication’s safety during pregnancy, you must consider all its ingredients. The ingredients in Nyquil include:²¹

• Acetaminophen
• Dextromethorphan
• Doxylamine
• Phenylephrine

This medication includes pain relief, cough suppressant, antihistamine, and decongestant. As mentioned, it may be best to avoid phenylephrine — and, therefore, this Nyquil formulation — in pregnancy. Choosing individual medications to treat their worst symptoms instead may be the easiest way to identify safe cold medicine for pregnant women.¹⁷

The ingredients in Dayquil include:²²

• Acetaminophen
• Dextromethorphan
• Guaifenesin
• Phenylephrine

The first three ingredients are generally considered safe, but again, it’s best to avoid phenylephrine during pregnancy.¹⁷ Therefore, instead of taking Dayquil, consider taking only the specific medications within the formulation that you need based on your most bothersome symptoms.

Theraflu is formulated to temporarily relieve cold and flu symptoms (including pain, cough, and congestion) using the following ingredients:²³

• Acetaminophen
• Dextromethorphan
• Phenylephrine

Similar to Dayquil, Theraflu contains phenylephrine, which you should avoid when pregnant. While it might mean swallowing more pills, taking individual medications instead of combinations like Dayquil and Nyquil may be a good idea. This ensures that you aren’t doubling up on any active ingredients. When in doubt, consult a pharmacist or your provider.¹⁷

According to the CDC, most respiratory viruses are spread through droplets that a sick person releases into the air, especially when they cough or sneeze. These droplets can be in the air or land on surfaces. If you breathe in or touch them and then touch your eyes, nose, or mouth, these viruses can enter your respiratory tract and make you sick.⁴ So, here are some precautions to take after a positive pregnancy test to help you avoid getting sick:

Keeping your body and environment clean is one of the best ways to prevent illness during pregnancy. Handwashing is a huge part of this! You should wash your hands:^24,25

• Before and after preparing food or eating
• After using the bathroom or changing a diaper
• After caring for someone who’s sick or wounded
• After sneezing, coughing, or blowing your nose
• After touching animals, animal waste, or animal food
• After handling trash
• Any time they’ve become visibly soiled

Be sure to scrub all parts of your hands, fingers, and wrists for at least 20 seconds. Soap and water are best, but if they aren’t available, try to use hand sanitizer containing at least 60% alcohol. In addition, here are some other hygiene practices to focus on:^24,25

• Sanitation: In addition to washing your hands regularly, you should frequently sanitize high-touch surfaces like doorknobs, railings, and countertops.
• Cough etiquette: Cover your nose and mouth with your elbow when you cough or sneeze, and teach and encourage those around you (especially children) to do the same. This can help prevent the spread of illness from one person to another.
• No touching the face: Be sure to avoid touching your eyes, nose, and mouth, even if you think your hands are clean!

Can you get the flu shot while you’re pregnant? Yes! The CDC recommends vaccination against both COVID-19 and the flu while pregnant. Per the CDC, you should also make sure the flu vaccine you receive is inactivated, not live or intranasal. Vaccination against COVID-19 and the flu can help protect you from severe illness. Remember that if you contract the flu while pregnant, your chances of requiring hospitalization are higher than when you’re not pregnant. The flu vaccine can decrease your odds of hospitalization due to flu symptoms by about 40%.¹³

Vaccination against these viruses may also protect your baby. Babies born to vaccinated mothers are less likely to be premature or have a low birth weight.^2,13 Receiving vaccination for the flu and COVID-19 while pregnant may also protect your baby from hospitalization due to contracting these illnesses as a newborn.¹³ Infants aren’t eligible for flu or COVID-19 vaccination until they’re around 6 months old, so receiving antibodies during pregnancy or through breastfeeding from maternal vaccination can provide them with some level of protection.³

3. Focus on Diet and Exercise

Maintaining a healthy lifestyle while pregnant can boost your immune system and help your body naturally fight off cold, flu, and COVID-19 viruses. A healthy diet and regular exercise can also help you achieve healthy weight gain during pregnancy. Conversely, being obese or overweight and having poor cardiovascular health makes you more vulnerable to severe illness during a viral infection. Finally, a nutrient-dense diet during pregnancy can ensure you aren’t missing any vitamins and minerals that help your immune system fight disease.^26,27

Although maintaining a healthy, well-rounded, and nutrient-dense diet and taking your prenatal vitamin should provide most of the essential vitamins and minerals your body needs to fight infections, certain immunity supplements are generally safe in pregnancy and may help fight off illnesses. Talk to your doctor before changing your supplement routine, but consider adding these supplements to prevent severe illness:¹⁷

• Vitamin C: This might not prevent you from getting a cold, but when taken regularly, it may shorten the duration of one.²⁸
• Zinc: Similar to vitamin C, zinc supplementation may help reduce the time you’re sick with a cold.²⁹
• Honey: Due to its antimicrobial properties, honey may help you ward off illness. One study showed that a specific type of honey called “manuka honey” inhibited the ability of the flu virus to replicate.^30,35
• Elderberry: Consuming elderberry syrup might reduce the duration and severity of cold and flu viruses.³¹

Many people know they should rest during an illness, and you’re often unable to fight off the fatigue of a cold, flu, or COVID-19 without a nap. But enough high-quality sleep can also help you avoid getting infected with an illness! One study exposed participants to a cold virus, and those with worse quality and quantity of sleep in the weeks leading up to exposure were more likely to become symptomatic and infected. Getting enough quality rest year-round, especially when pregnant, can help you fight diseases before they start.³²

Because some viruses are in the air, it’s important to keep your air quality as clean as possible. Here are a few ways to do so:³³

• Get as much fresh air as you can by being outside often and opening your doors and windows when feasible.
• When using central heat or air conditioning through a system with a filter, set the fan to “on” instead of “auto” to keep the air circulating through the pleated filter. Change the filter as often as the manufacturer recommends or when you notice it’s dirty.
• Run a portable air purifier with a high-efficiency particulate air (HEPA) cleaner.

7. Avoid Sick People and Crowds

Getting sick can feel inevitable after you’ve been around big groups of people or people who are visibly ill. Of course, you may not always have the warning that you’ll be around someone who’s sick or be able to avoid it. But try to avoid large crowds, especially when viral rates are high in your area. If you can’t avoid sick people or crowds, consider wearing a well-fitting KN95 or N95 mask. This can help you protect yourself from inhaling their germs.¹³

Health concerns such as getting the cold, the flu, and COVID-19 while you’re pregnant require awareness and protective measures. By consulting healthcare professionals, using safe remedies and medications, and following preventive strategies, you can protect both your health and your baby’s well-being during this crucial time.