This health topic is an expert opinion about treating the common cold during pregnancy and lactation.
* The information provided is the expert opinion of the First Exposure Medical Advisors. It is for informational purposes only and does not replace medical care and advice from a healthcare provider. Please contact your healthcare provider if you have any concerns or wish to discuss any questions that you believe may be relevant to you or your baby. In case of emergency, please go to the emergency room or call 911.
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Clinical scenario:
I am pregnant with my second baby. My older child is in daycare and is often coming home with a runny nose or cough. I am now experiencing symptoms of a cold and wondering which over-the-counter cold medication can I take during pregnancy. What about if I was nursing?
Q. What is the common cold?
A. Upper respiratory tract viral infections (URTIS), also known as the common cold, usually starts with symptoms of headache, sneezing, and sore throat and later symptoms of a runny or stuffy nose, cough, and general feelings of discomfort (malaise). The common cold is caused by several types of viruses, with rhinoviruses being the most common, and is usually self-limiting, resolving on its own. This is in contrast with the Flu (caused by the Influenza virus), which usually starts with sudden fever, headache, cough, sore throat, muscle aches, nasal stuffiness, weakness, and loss of appetite. See the links to the Centre for Disease Control (CDC) to help tell the difference between the common cold and the Flu [CDC Cold vs Flu] as well as the Flu and COVID-19 [CDC Flu vs COVID 19]. A review on Influenza (the Flu) and the Flu vaccine in pregnancy is discussed in a separate Health Topic.
Please reach out to a health care provider when feeling unwell, especially if your symptoms get worse, do not resolve in a few days, you develop a fever, your phlegm turns yellow/green or you develop a persistent cough.
Q. Are you more likely to get the common cold during pregnancy?
A. Being pregnant does not increase the chances of catching the common cold. Symptoms are similar to those experienced by non-pregnant adults. There are immune and physical changes in pregnancy (e.g. as the baby grows the uterus pushes up against the diaphragm and lungs which can make it harder to breathe). Due to these changes, some cold symptoms might feel worse in pregnancy (e.g. cough and nasal congestion).
Q. What are the most common treatments for cold symptoms in non-pregnant and pregnant people?
A. Rest, hydration (drinking water or other non-alcoholic beverages), and other conservative treatments such as steam inhalation, warm liquids, and honey are often recommended for the common cold. Honey (pasteurized and non-pasteurized) is safe for use in pregnancy, as well as a saline nasal spray. Throat lozenges are not expected to be a concern, however, be sure to follow directions on the package and avoid excessive use. Acetaminophen (e.g. Tylenol) can be used as needed (without exceeding the doses recommended on the package) and is considered the first-line option for treating pain or fever in pregnancy.
Treatment for the common cold is aimed at symptom relief. There are a wide variety of over-the-counter (OTC) products for the common cold. Most products contain at least one of five common ingredients, either alone or in combination:
*Click on the specific drug to review its Drug Form and to read information on its safety in pregnancy and/or lactation.
Cough suppressant to stop/decrease a cough: dextromethorphan
Decongestants for stuffy nose/nasal congestion: phenylephrine, pseudoephedrine, oxymetazoline, xylometazoline
Antihistamines for runny nose, itchy or watery eyes: diphenhydramine, chlorpheniramine, pheniramine
Expectorant to help make mucus thinner so it is easier to cough out: guaifenesin
Analgesic for pain and fever: acetaminophen
With respect to decongestants, the FDA has conducted a review and stated “that the current scientific data do not support that the recommended dosage of orally administered phenylephrine is effective as a nasal decongestant”.
There does not appear to be increased risks to the pregnancy with short-term use of these medications. For details on each medication, including information on miscarriage, pregnancy outcomes, and birth defects, please refer to specific Drug Pages. In pregnancy, it is best to take a medication that has the fewest ingredients and if possible, only ingredients that address the specific symptom. If purchasing a cough syrup, it is also important to choose one that does not contain alcohol (ethanol). Be sure to read labels on all products and if you have any questions or concerns, talk to a pharmacist, pregnancy care provider, or another healthcare provider. Please refer to our resource page on How to Find Active Ingredients on products and to check our Exposures A to Z page for available information on the ingredient(s).
Q. Can OTC treatments for the common cold be used while trying to get pregnant?
A. OTC treatments for the common cold, specifically the common medications above, are not expected to make it harder to get pregnant.
Q. Does using OTC treatments for the common cold in pregnancy increase the chance of a miscarriage?
A. Miscarriage occurs in approximately 15-20% of all pregnancies (1-in-5 pregnancies). None of the medications above are known to increase the chance of miscarriage above the baseline risk.
Q. Does taking OTC treatments for the common cold in pregnancy increase the chance of a birth defect?
A. The baseline risk of major birth defects in Canada is 3-5%. This means that 3-5 out of 100 babies born in the general population in Canada will be born with a major birth defect. Based on several studies, treatments for the common cold are not expected to increase the risk of birth defects above the baseline risk. Risks specific to each drug will be reviewed in detail separately in each Drug Page.
Q. Does using OTC treatments for the common cold in pregnancy increase the risk of any other harmful outcomes?
A. There are no data indicating increased risk of harm for outcomes such as miscarriages, prematurity (delivery before 37 weeks of pregnancy) or stillbirth (loss of a baby before or during delivery) from use of these treatments in pregnancy. Decongestants can constrict blood vessels (make them smaller). It is unknown whether this might cause decreased blood flow to the placenta. Therefore, regular (long-term) use should be avoided.
Q. Can OTC treatments for the common cold be used while nursing?
A. The short-term use of treatments for the common cold are not known to be harmful to the nursing infant. However, decongestants (phenylephrine, pseudoephedrine) when taken orally (by mouth), may decrease milk supply. Therefore, it may be best to avoid use of decongestants in the first 1-2 months of lactation, as milk supply can be affected, and in those who are concerned about their milk supply.
Q. Are there ways to prevent the common cold in pregnancy?
A. The best ways for preventing the common cold include handwashing, avoid touching one’s face and if possible, avoiding others who are sick.
Q. Advice for specific populations?
A. Access to healthcare and treatment can vary widely among different populations, leading to disparities in the management of common cold symptoms in pregnancy. Addressing equity issues requires efforts at multiple levels to ensure all pregnant individuals have access to appropriate care and treatment.
Key References:
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National Center for Immunization and Respiratory Diseases (NCIRD). Cold Versus Flu: Centers for Disease Control and Prevention; 2022 [updated September 29, 2022; cited 2023 September 19]. Available from: https://www.cdc.gov/flu/symptoms/coldflu.htm#print
Aselton P, Jick H, Milunsky A, Hunter JR, Stergachis A. First-trimester drug use and congenital disorders. Obstet Gynecol. 1985;65(4):451-5.[PMID: 3982720].
Cao Y, Rhoads A, Burns T, Carnahan RM, Conway KM, Werler MM, et al. Maternal use of cough medications during early pregnancy and selected birth defects: A US multisite, case-control study. BMJ Open. 2021;11(12):e053604.[PMID: 636846595].
Drugs and Lactation Database (LactMed®) [Internet]. Bethesda (MD): National Institute of Child Health and Human Development; 2006-. Pseudoephedrine. [Updated 2020 Apr 20]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK501085/
Einarson A, Lyszkiewicz D, Koren G. The safety of dextromethorphan in pregnancy : results of a controlled study. Chest. 2001;119(2):466-9.[PMID: 11171724].
Heinonen OP, Slone D, S. S. Birth defects and drugs in pregnancy. Littleton, Massachusetts, USA: Publishing Sciences Group Inc; 1977.
Hernandez RK, Mitchell AA, Werler MM. Decongestant use during pregnancy and its association with preterm delivery. Birth Defects Res Part A Clin Mol Teratol. 2010;88(9):715-21.[PMID: 20672347].
Kerr S, Heinke D, Yazdy MM, Mitchell AA, Darling AM, Lin A, et al. Use of vasoactive medications in pregnancy and the risk of stillbirth among birth defect cases. Birth Defects Res Part A Clin Mol Teratol. 2022;114(8):277-94.[PMID: 35238183].
Lind JN, Tinker SC, Broussard CS, Reefhuis J, Carmichael SL, Honein MA, et al. Maternal medication and herbal use and risk for hypospadias: data from the National Birth Defects Prevention Study, 1997-2007. Pharmacoepidemiol Drug Saf. 2013;22(7):783-93.[PMID: 23620412].
Parker SE, Lijewski VA, Janulewicz PA, Collett BR, Speltz ML, Werler MM. Upper respiratory infection during pregnancy and neurodevelopmental outcomes among offspring. Neurotoxicol Teratol. 2016;57:54-9.[PMID: 27343815].
The Society of Obstetricians and Gynaecologists of Canada, Hutson JR, Smith GN, Codsi E, Garcia-Bournissen F. Statement on the use of acetaminophen for analgesia and fever in pregnancy 2021 [updated November 8th, 2021; cited 2023 September 19]. Available from: https://sogc.org/en/en/content/featured-news/Statement_on_the_use_of_acetaminophen.aspx.
Werler MM, Sheehan JE, Mitchell AA. Maternal medication use and risks of gastroschisis and small intestinal atresia. Am J Epidemiol. 2002;155(1):26-31.[PMID: 11772781].
Yau WP, Mitchell AA, Lin KJ, Werler MM, Hernández-Díaz S. Use of decongestants during pregnancy and the risk of birth defects. Am J Epidemiol. 2013;178(2):198-208.[PMID: 23825167]
U.S. Food & Drug Administration. FDA clarifies results of recent advisory committee meeting on oral phenylephrine Washing, D.C.: United States. Food and Drug Administration; 2023 [cited 2023 September 21]. Available from: https://www.fda.gov/drugs/drug-safety-and-availability/fda-clarifies-results-recent-advisory-committee-meeting-oral-phenylephrine.
Disclaimer
First Exposure does not offer health care treatment. If you have an urgent question about your pregnancy or your baby’s health, you should contact your health care provider directly. If you don’t have a health care provider and you live in Ontario, you have a variety of health care options. In the case of an emergency, visit a hospital emergency room or call 911.