How to treat your cold and flu while pregnant

Having the cold and flu while pregnant is the worst. What medications can you safely take?

Photo: Stocksy

You know that unpasteurized brie is a no-go during pregnancy, and those double martinis and oysters on the half shell are strictly verboten. But what about cold and flu medications? When you inevitably come down with a hacking cough, myriad aches and pains, and a serious case of the sniffles, what can you take? Here, our guide to navigating cold and flu season with a baby on board.

Get the vaccine
First things first: It’s strongly recommended that pregnant women get the flu shot.

Influenza—a severe respiratory illness that causes fever, cough and congestion—is not something to be trifled with. (And it’s not to be confused with “stomach flu,” a distinct and less serious infection.) As Laura Magee, an obstetrician and clinical associate professor at the University of British Columbia, says, “women who are pregnant and have the flu are at an increased risk of serious complications.” And that list of potential repercussions includes pneumonia, kidney failure, swelling of the brain, premature labour and even death. An estimated 10 to 20 percent of Canadians becomes infected with influenza each year, causing upwards of 12,000 hospitalizations and 3,500 deaths.

The good news is the vaccine is safe throughout pregnancy. Be sure, however, to request the injection, which is made from an inactivated virus, and not the nasal-spray vaccine, as that’s made from a live virus and not recommended for use by pregnant women.

While it can be impossible to ward off illness (especially when, say, a co-worker sneezes directly on you in the elevator), you can take steps to protect yourself. Get plenty of rest and wash your hands often throughout the day. If a lot of your colleagues are still coming in sick, ask if you can work from home.

Know what you’re dealing with
You’re sneezing, coughing and aching all over. Is it a cold or the flu?

A cold is a mild respiratory illness, and the symptoms (typically coughing, sore throat and congestion) tend to appear gradually. With influenza, the symptoms (which include a sore throat, loss of appetite, fever, congestion, cough and aches) come on quite suddenly. You could have a high fever for three or four days and extreme tiredness for several weeks. In contrast, fever and extreme exhaustion are less common with a cold.

Children who have the flu can experience nausea, vomiting and diarrhea, but these symptoms are rare in adults. If you are enduring a variety of unpleasant gastrointestinal issues, chances are you have the “stomach flu,” which is caused by other viruses or bacteria, not influenza.

See your care provider if…
While most colds do not pose any risk for an unborn child, the flu should be taken more seriously. “Pregnant women should contact their midwife or doctor if they have a fever that lasts longer than two days, can’t keep food down or are coughing excessively,” says Abigail Corbin, a registered midwife with the Community Midwives of Halton. It’s best to double-check with your care provider immediately so you know exactly what you have and how to best proceed.

Most people with the flu become only mildly ill and start to feel better in seven to 10 days. But if a case of influenza is confirmed, and it’s early enough in its onset, you may be prescribed an antiviral medicine, such as Tamiflu, which shortens the duration of flu symptoms and has been shown to be safe during pregnancy.

Pick the right over-the-counter medications
“I find the biggest barrier to treating colds and flus is misinformation,” says Corbin. “There’s an idea out there that pregnant women shouldn’t use any over-the-counter medication, so a lot of women suffer unnecessarily.”

It’s true that researchers don’t conduct randomized, controlled trials—the gold standard of scientific studies—on pregnant women. But they have been able to collect solid data from cohort studies, in which they follow hundreds or, in some cases, thousands of patients’ health over many years. Motherisk, a clinical, research and teaching program at SickKids hospital that’s also affiliated with the University of Toronto, has good long-term data that shows there is no increased risk to a pregnant woman or her baby with short-term use of many over-the-counter medications for the common cold.

“It’s important, though, to read labels carefully to make sure you’re taking only the medications you need to treat your symptoms,” says Corbin, as there are certain ingredients you need to look out for. “When in doubt, ask the pharmacist.”

Pain and fever
Read the fine print to see which pain reliever your OTC medication contains.

Acetaminophen (Tylenol) has long been considered one of the few drugs safe to take during pregnancy, but a 2016 study in the International Journal of Epidemiology found a link between acetaminophen and autism. While studies like this are scary, it doesn’t mean women shouldn’t take Tylenol. “It’s not a warning that women should stay completely clear of acetaminophen,” says David Olson, a professor of obstetrics and gynecology, pediatrics and physiology at the University of Alberta. As with all medications during pregnancy, women should take the lowest dose possible of for the shortest period of time.

However, ibuprofen (Advil) is not recommended for women who are in their last trimester, as research has shown it can lower levels of amniotic fluid, affect the development of your baby’s heart and delay the onset of labour. And women should avoid taking acetylsalicylic acid (Aspirin) during their second and third trimesters, as it inhibits platelet function and can contribute to maternal and fetal bleeding. Motherisk has found no overall increase in the risk of major malformations when ASA is taken during the first trimester.

Coughing
There have been a number of studies on the effect of dextromethorphan, which is a cough suppressant commonly found in OTC cold medications, and no association was found between this drug and an increased risk of birth defects.

Sniffling and sneezing
None of the older first-generation antihistamines (brompheniramine, chlorpheniramine, diphenhydramine, doxylamine, hydroxyzine and pheniramine) have been shown to increase the likelihood of birth defects when used at any point in pregnancy. Newer antihistamines (including cetirizine, desloratadine, fexofenadine and loratadine) are often preferred by women because they don’t cause drowsiness. “There’s relatively less research on their use during pregnancy,” says Corbin. “But the research that has been done is reassuring, with no associated increase risk of birth defects.”

Stuffy nose
Motherisk reports that decongestants, like pseudoephedrine and phenylephrine, are considered safe when taken for a few days—no more than a week. There are several cohort studies that failed to show any increased risk of birth defects when oral decongestants were used during pregnancy. Nasal sprays are considered relatively safe when used under the direction of a doctor, but women should be cautioned against taking them longer than three days, as prolonged use can actually worsen congestion.

Ease your symptoms
Pregnancy already takes a huge toll on your body, so being sick on top of that can really affect how you feel. “Although it sounds obvious, some of the best ways to ease symptoms are to rest and eat nourishing food,” says Corbin. “That’s why it’s important to listen to your body and take extra time to practise self-care.”

Drink lots of warm beverages to stay hydrated and lessen your congestion. While it seems like an old wives’ tale, it actually works. A study from Cardiff University in Britain showed that warm beverages are markedly better at providing relief from a runny nose, a cough, sneezing, a sore throat, chills and tiredness compared with drinks that are room temperature.

Read more:
Important precautions for a healthy pregnancy
Pregnancy food guide: Truth about what you can eat (+ cheat sheet)
Exercise: Myths about working out during pregnancy

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