Over-the-Counter Cold Medicines and Pregnancy

A cold can be an annoyance or a major misery, depending on its severity. But if you catch a cold when you're pregnant, you may well wonder how the over-the-counter (OTC) cold remedies you usually reach for could affect your baby. Are they safe?

Unfortunately, for many OTC medicines, we just don't know the answer. It would be unethical to use pregnant women as guinea pigs, so researchers rely on animal testing and other techniques to estimate the effect medicines may have on your unborn baby. That's why it's important to check with your doctor before you take any OTC medicine -- no matter whether you've taken it safely dozens of times before when you weren't pregnant.

Easing fever and pain

When you find yourself with a fever, headache, or the aching muscles that often come with a cold or flu, your best option is acetaminophen or regular-strength Tylenol, according to the American Academy of Family Physicians (AAFP). These are effective against pain and fever, widely used, and haven't caused harmful effects when used by pregnant women.

You'll definitely want to steer clear of regular aspirin unless your doctor tells you to take it for a specific condition. (Sometimes doctors prescribe low-dose aspirin to prevent pregnancy-induced high blood pressure or other problems.) Aspirin can cause serious bleeding problems in both you and your baby.

Also avoid taking NSAIDs unless your doctor has given you the green light, and never use them during your last trimester, advises the AAFP. NSAIDs include ibuprofen (Advil, Motrin), ketoprofen (Orudis), and naproxen (Aleve). These medicines can cause blood-flow problems in your baby when taken in the last three months of your pregnancy, and problems with labor and other damage if used close to delivery.

For pain relief without the pills, try applying an ice pack or a heating pad to sore muscles. (Just be careful not to expose your skin to a hot or cold treatment for more than 20 minutes at a time.) If you have a fever, drinking plenty of liquids may help keep it down. Sometimes you can bring down a fever by taking a lukewarm shower or bath, but check with your doctor if your fever is high or if non-medical remedies don't work. A prolonged fever higher than 102 degrees can harm your baby, and your doctor may prefer that you take an OTC medicine to control it.

Cold and cough remedies

Cold remedies generally fall into three categories>

Decongestants.When your head feels stuffed with cotton and you can't breathe through your nose, decongestants offer relief. Antihistamines help get rid of itchy, watery eyes, a runny nose, and sneezing. Expectorants help loosen the mucus in your lungs so you can cough it up more easily. The tricky part is, many OTC cold medicines address more than one symptom, so it's very important to read the label carefully and only buy a product that treats the symptom that's bothering you. Also, some cold products contain aspirin or aspirin-like products -- just what you want to avoid, unless your doctor advises you otherwise. Aspirin may be listed as acetylsalicylic acid, acetylsalicylate, sallicyclic acid or salicylate on the label.

It's important to be able to breathe easily when you're pregnant because each breath you take is supplying oxygen to your baby as well. However, it's not a good idea to take decongestants for more than a few days unless your doctor gives you the go ahead. A report in the American Family Physician says your best choice is pseudoephedrine (found in Novafed and other products). But don't take it during the first three months of your pregnancy because it can cause developmental abnormalities in your baby's stomach. Also be wary of pseudoephedrine if you have high blood pressure, because this medicine can make it worse.

Aside from the common cold, hormonal changes during pregnancy can cause the mucous membranes in the nasal passages to swell. This makes some pregnant women feel like they have a slight cold that lasts their entire pregnancy. Of course you don't want to take decongestants the whole time you're pregnant, so here are some things you can try to help ease congestion and make it easier to breathe:

  • Drink plenty of water every day -- it will help keep nasal secretions thin.
  • Use saline (saltwater) nasal spray or drops.
  • Avoid cigarette smoke and other air pollutants (and, of course, never smoke during pregnancy).
  • Use a facial steamer (available at your local drugstore) or take a hot shower and let the steam open congested nasal passages.
  • Smear a dab of Vicks under your nose.
  • Try using a room vaporizer.

Antihistamines. If persistent sneezing and itchy, watery eyes are making you miserable, an antihistamine can help. According to the American College of Obstetricians and Gynecologists and the American College of Allergy, Asthma, & Immunology, the safest OTC choice is a product with chlorpheniramine (such as Chlor-Trimeton). If you are in your second or third trimester, some experts say that loratadine (in products like Claritin) is a safe choice. Medicines with the ingredient diphenhydramine (such as Benadryl) have been linked to uterine contractions when taken in high doses.

Cough suppressants and expectorants. Coughing is your body's way to get rid of chest congestion, so stopping a cough isn't always the best way to go. If you have a dry cough, an expectorant can be helpful in loosening chest mucus so you can expel it more easily. In your second and third trimesters, a cough medicine with guaifenesin may be a good bet, but don't take it in your first three months because it can cause developmental defects in your baby.

Experts at the American College of Chest Physicians say that cough medicines don't do all that much anyway, so they recommend trying easy home remedies such as using a humidifier or vaporizer, drinking plenty of water, and sucking on hard candies.

The bottom line

Any time you take medicine, you should weigh the benefit to risk ratio. If the risk is small and the benefit great, taking the medicine is probably the right choice. Your doctor can help you decide. Here are some other guidelines to keep in mind:

  • Do not use aspirin unless it's specifically recommended by your doctor, since it can cause bleeding in the mother and the developing baby.
  • Always check to see what the "active ingredient" in a medicine is -- it may not contain what you're expecting.
  • Read labels carefully and follow your doctor's recommendations exactly when taking any OTC medicine. If you take less than your doctor recommends, it may not be effective, and taking more means your baby is getting more medicine as well. Your baby's liver and kidneys are not as well developed as yours, so he'll have a harder time ridding his body of the medicine.
  • Don't use extra-strength or long-acting medicines. Always choose the lowest dosage that will provide the relief you need.
  • Avoid combination products such as cough medicines that are also decongestants, or multiple-symptom cold remedies. Choose single-ingredient products to treat the specific symptom you are experiencing.
  • Avoid taking several different medicines at the same time -- a medication that is safe when taken alone may be riskier when combined with another medicine.
  • Unless your doctor recommends something (like prenatal vitamins, calcium, or iron), try not to take any OTC medicine in your first trimester, when the risk to your developing baby is greater.
  • Don't use herbal remedies unless your doctor says they're ok. Some may not be safe for your baby or may interact with other medicines you're taking.

Finally, always check with your doctor to find the safest treatment for your symptoms. That way you can feel better and feel confident that your baby will be healthy, too.

References

OTC and Certain Patient Groups : Pregnancy. American Academy of Family Physicians. 2010.

Wigle, P.R. et al. Pregnancy and OTC cough, cold, and analgesic preparations. US Pharm. 2006. 3:33-47.

William Sears, M.D., and Martha Sears, R.N. The Pregnancy Book.

Pregnancy and Medicines. U.S. Department of Health and Human Services. Office on Women's Health. www.4woman.gov/faq/pregmed.htm.

Coughs and Colds in Pregnancy. DrSpock.com. www.drspock.com/article/0,1510,5985,00.html.

Mayo Clinic. Back pain during pregnancy. www.mayoclinic.com/health/pregnancy/HQ00302.

Park Nicollet. The Rice Method: Rest, Ice, Compression, Elevation. www.parknicollet.com/healthadvisor/firstaid/rice.cfm

Healthy Pregnancy. Staying Healthy and Safe. Womenshealth.gov U.S. Department of Health & Human Services. http://www.womenshealth.gov/pregnancy/you-are-pregnant/staying-healthy-safe.cfm#d

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