Everything Women Should Know About the Common Cold and Pregnancy

There’s so much to look forward to when you’re pregnant, especially if it’s your first time. You eagerly wait to see if your hair grows as thick and healthy as everyone says it will. You start saving nursery-decor inspo pics and browsing the baby-clothes section, and look forward to the day you require stretchy waistbands 24/7. You get so excited the first time someone notices your bump and offers you a seat on the subway, or when a stranger asks when you’re due (so much attention!) Of course, there are also plenty of things not to look forward to while pregnant, like waking up several times a night to hit the bathroom, noticing new stretch marks, and experiencing what it’s like to have a cold as a pregnant woman.

It’s true, even the common cold hits differently when you’re expecting. Not only can symptoms be more intense—and annoying, when you’re already fatigued and achy—the remedies you’ve relied on in the past aren’t always an option. For example, some of the over-the-counter medications you’ve popped without a second thought might not be the safest choice for a developing fetus. Having someone else’s health in your hands in this new way can be stressful, especially when you’re not feeling well. So before cold and flu season ramps up, here’s a quick overview of what pregnant women need to know when it comes to coping with the common cold.

It’s normal for colds to feel worse when you’re pregnant.

If you’ve historically ridden out cold and flu season like it’s no big deal, you might be in for a surprise—but if your symptoms make you feel like you got hit by a literal truck, that’s no reason to panic. In fact, it’s totally normal. During pregnancy, your immune system might not be as invincible (it shifts gears to protect the baby), so you might catch a cold more easily and feel it more intensely, possibly for a longer duration of time. During your second and third trimesters, your expanding uterus can also make breathing a bit more labored when you’re congested. To help avoid all this, it pays to make extra effort to wash your hands frequently and avoid germs to every extent possible.

Home remedies can really make a difference.

Maybe you usually reach for decongestants right away, but when you’re pregnant, it’s smart to try drug-free remedies as a first measure. Time-tested home remedies really can help with cold symptoms and don’t come with any worrisome potential side effects. For example, to soothe a sore throat, you can gargle with warm salt water, which helps draw germy fluids out of throat tissue, break up mucus, and ease inflammation. Honey makes a great natural throat soother, whether you add it to tea or take a spoonful straight-up. When you have a stuffy nose, don’t underestimate the difference a good humidifier can make, and try a steamy shower as a great way to loosen nose and chest congestion. Another medication-free hack: Nose strips designed for snoring can open your nasal passageways for better nighttime breathing during a cold. If you develop body aches, it’s safe to apply a heating pad to sore areas; just keep it on the lowest temperature as a precaution and stick to 20 minutes or less per session (and obviously don’t put it right on your belly). Finally, take the whole “plenty of fluids” thing seriously, whether it’s water with lemon or honey or chicken soup. It really can make you feel better, and dehydration can lead to serious complications during pregnancy. Aim to drink enough that your urine stays pale yellow to clear.

You need to read what’s in your over-the-counter pain reliever.

When your headache, sore throat or body aches are keeping you up all night or causing major discomfort, you can take an OTC pain reliever, but pay close attention to what’s in it—and always run medications by your healthcare provider first. Many recommend avoiding medications during the first trimester. Among pain relievers, acetaminophen (like brand-name Tylenol) has long been considered the safest option during pregnancy, but recent research has led to increased caution. As for common non steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil, Motrin) and naproxen (Aleve), these are not recommended for use during pregnancy, as they may cause congenital defects, low amniotic fluid, and other serious complications (some studies have also linked them to miscarriage). Aspirin (acetylsalicylic acid—also a NSAID) is another common OTC pain reliever to avoid when you’re expecting, as it may increase the risk of pregnancy loss during the first trimester and complications during delivery. However, healthcare providers may recommend low-dose aspirin to pregnant women at risk of preeclampsia and in other specific medical situations.

OTC cold medicines can get complicated.

The OTC cough syrups, nasal sprays and other remedies many of us desperately reach for when dealing with a nonstop runny nose or painfully clogged sinuses often contain a cocktail of different drugs that don’t mix with a common cold and pregnancy. That’s why they can relieve multiple symptoms at once, making us feel better, but it’s also why choosing a safe one for pregnancy is tricky (and better avoided, when you can find single medications that work for you). Obviously, you need to avoid using anything with NSAIDs on the label (per the previous paragraph). The common decongestant pseudoephedrine is another medication that many healthcare providers advise pregnant women to avoid entirely, particularly in the first trimester. Cough suppressants like dextromethorphan and expectorants like guaifenesin are widely considered safe during pregnancy, although some research indicates it’s best to avoid them during the first trimester due to increased risk of certain birth defects. In the category of nasal sprays, versions using salt water/saline are a safe and effective option during pregnancy. Nasal sprays with triamcinolone and oxymetazoline are not recommended, since studies link these drugs to certain birth defects. Compared to other cold medications, candy-like throat lozenges may seem totally innocuous, but many contain alcohol, corn syrup, and ingredients like herbs, menthol, and benzocaine that are better to avoid, due to lack of evidence about their safety for developing babies. You’re safe sticking to the type that use honey and glycerin to soothe a sore throat, or sipping some hot water with honey instead.

You might want to wear a pad.

If you haven’t experienced this yet, pregnancy can make you pee a little (or more than a little) when you cough or sneeze. That’s because your growing baby puts increasing pressure on your pelvic floor—the muscles that support your bladder—even as increased progesterone levels are gradually softening those muscles. Sorry to say, the leakage issue will get worse, not better, after childbirth. A backup pad helps relieve the stress of this unpleasant side effect of a common cold and pregnancy.

It’s extra-important to get your flu vaccine.

If you think having a cold while pregnant is rough, the flu can be much worse. Maybe you often forget your flu vaccine, but when you’re pregnant, it’s crucial to take this precaution; a high fever can potentially harm your developing baby, leading to an increased risk of neural tube defects (when the spinal cord or brain does not form properly), heart defects, and other birth defects. Having the flu when pregnant also increases the risk of miscarriage, premature birth, and low birth weight. An added benefit to flu vaccination during pregnancy: You pass on antibodies to your baby, protecting him/her for months after birth (and can continue to pass on antibodies via breastfeeding). All of this also applies to getting a covid vaccine during pregnancy; they’ve been shown safe and may protect you and your baby from serious complications.

If this feels like more than the common cold, see a healthcare provider.

Sneezing and a headache is one thing. If you develop a rash, a throat so sore it’s hard to swallow, a cough or mild sore throat that lasts more than 10 days, and/or a fever (over 100) during pregnancy, call your healthcare provider. A high fever—above 102—requires immediate treatment. If your symptoms turn out to be due to the flu, they may prescribe an antiviral medication (like oseltamivir, brand name Tamiflu); these have been shown to be safe and effective during all trimesters and can help mange symptoms and shorten the duration of your illness. The Center for Disease Control and Prevention recommends prompt use of antiviral therapy for pregnant women, saying that the benefits outweigh any potential risks, and available data suggests no increased risk of birth defects.

When it comes to the common cold, though, you’ll mostly just need to wait it out—you should be feeling better in 10 to 14 days. The good news is that your baby doesn’t feel any of your discomfort as you sneeze the night away. Try to relax and rest up, because soon you might get to experience the next-level challenge—being sick with the common cold when you have a newborn (and getting a good night’s sleep is a distant dream).