Cold Medicine and Pregnancy: What's Safe?
Cold Medicine and Pregnancy: What's Safe?
Lamaze International
By Sonia Alvarado, Senior Teratogen Information Specialist, MotherToBaby CA
A caller the other day asked the same question most pregnant women ask when sniffles, coughing and feverish symptoms start to arise: 'Can the cold or flu hurt my baby?' Moms, breathe easier because studies have not associated the cold and flu virus with an increased risk for miscarriage or birth defects. While there are viruses that have been associated with birth defects and or congenital infection, (cytomegalovirus, LCMV, Herpes), the viruses that cause flu and cold, have not.
Now before you stop reading and move on to another subject to Google, you should take note of one hot topic: fever. Fever is a symptom of flu, and a high fever is associated with an increased risk for birth defects. Additionally, flu in pregnant women is associated with a higher risk for complications, and even death. We have a fact sheet on influenza that explains in greater detail the issues surrounding flu in pregnancy and the importance of the flu vaccine in preventing flu.
The symptoms of cold and flu are not only very uncomfortable - particularly in the first few days -- but they can limit our normal activities including work, exercise, family and outings...So onto my caller's second question, which happens to be the second most-common question asked among under-the-weather pregnant mamas: 'What can I take?' The following are some ideas for symptom management - as well as some medications to avoid. As always, you want to check with your doctor because they may have a list of approved medications or medications they prefer that you use.
Fever Management/Body Aches
Fever is a concern in pregnancy and studies in both humans and animals have found an association with birth defects. In humans, a high fever, 101 degrees and higher over 24 hours in length, has been associated with an increased risk for defects of the abdomen, heart and spinal cord if the fever occurs at the time in early pregnancy when those organs are forming. The goal then is to reduce and manage fever. Acetaminophen is the most prescribed pain and fever reducer in pregnancy. Taken as directed, fever should be reduced with acetaminophen. If a high fever is not decreasing with taking acetaminophen as directed, the doctor should be called right away or you should go to urgent care for further evaluation. Studies on acetaminophen use during pregnancy have not identified an increased risk for birth defects (see our fact sheet on acetaminophen for more details).
Flu
If flu is suspected, it's important to call your doctors office when your symptoms start and let them know because they will likely want to prescribe you antivirals. Data from the 2009/2010 flu season showed that early treatment of pregnant women with antivirals lessened the severity of the disease, reduced hospitalization and mortality. According to the CDC, antivirals should be started within 48 hours of symptom onset, however, even if given after 48 hours, they show a benefit. Oral oseltamivir (Tamiflu) and zanamivir (Relenza) are antiviral medications that are FDA approved for treatment of influenza (flu). We have a fact sheet on antivirals that goes over the studies and specific recommendations.
Cough: Medication Options
A walk down the pharmacy aisle can be an overwhelming experience! So many choices! Each brand has three or more medication combinations for cold, flu or a combination of the two. In pregnancy, generally, it's preferable to take a medication that has the least number of ingredients, taking ingredients that address the specific symptoms. Also, because most cough syrups can contain up to 10% alcohol, its important to select an alcohol-free version.Cough lozenges and throat lozenges ingredients can vary and may contain a number of medications, menthol, honey or other flavoring, therefore, its important to read the labels. Ingredients can include local anesthetics and cough suppressant. If taking medicated cough and throat lozenges, you want to read the label for dosing directions and check that you are not double-dosing with other medications.
Cold/Flu: Non-medication Options
Honey and warm tea/water may be helpful in relieving a sore throat from coughing and may thin secretions so that the cough is more productive. Concerns about infant botulism and warnings that children under one year of age avoid honey (and honey-containing products) have been misunderstood and many pregnant women think it applies to them as well. The warning against the use of honey only applies to infants less than 1 year of age.
Nasal Congestion: Medication Options
A stuffy nose makes it less enjoyable to eat, impossible to sleep, and causes painful sinuses. The over-the-counter nasal decongestant choices fall into two categories, oral and topical/spray. Oral (pill) decongestants include pseudoephedrine and phenylephrine. Some studies on oral decongestants reported an association with abdominal wall defects, and other studies did not. At this time, it is not known if these medications increase the risk for defects or not. Topical (spray) decongestants limit the exposure of medication to the area exposed (nose), have a lower dose, and are used for a shorter period of time (if you follow directions on the label). These factors limit the potential exposure for the developing pregnancy fetus and as such are a preferable option to oral for congestion from colds during pregnancy.
Nasal congestion: Non-medication Options
Nasal irrigation (bulb syringe, squeeze bottle, or neti pot): Studies of nasal irrigation have not shown a proven benefit on the duration or severity of colds, however, there are individual users that are committed to this treatment for colds and swear by its benefits. For pregnant women the most reassuring part is that it uses only water (use only previously boiled, distilled or sterile water to irrigate) so there is no medication involved and no exposure to the pregnancy.
Shower tablets/vaporizer: Effervescent shower vapor tablets have become quite popular as they often provide temporary congestion relief. These tablets are dropped into the shower and as the warm water reaches the tablet it dissolves, emitting a vaporizer-like effect. Typically these shower tablets contain sodium carbonate and sodium bicarbonate (baking soda) and essential oils (peppermint, rosemary, eucalyptus and lavender). While there are no studies on the use of shower tablets during pregnancy, the ingredients are used in many candles, lotions and many other home products so exposure is likely already quite extensive. To date, information has not suggested that there would be a concern with use of shower tablets during pregnancy.
Humidifier: The humidifier is used to add moisture to the air and relief sinus pressure, dry skin and throat. It uses only water so there is no medication exposure.
Nasal strips: Nasal strips, also called nasal dilator strips, are marketed to individuals who have difficulty sleeping due to snoring and claim to help with congestion from colds. Although the websites do not include studies that demonstrate that these products help with colds, there is some evidence that they may help with snoring. Nasal strips do not contain medication and work by spreading the nose and widening the air passage, therefore a concern does not exist for use in pregnancy.
Electric blankets and heating pads: These are sometimes used by people experiencing body chills from flu and cold. Electric blanket use in pregnancy is seen as controversial by some as some studies have suggested that there could be a risk from the heat or from the electricity. There is a theoretical concern that as with fever, if use of the heat source raised body temperature to 101 F or higher for an extended period of time during early pregnancy, there might be an increased risk for birth defects. The studies on electric blanket use during pregnancy have many limitations and have not consistently shown an adverse effect to pregnancy.
Remedies to Avoid
Non-steroidal anti-inflammatory drugs (NSAID): For most healthy pregnant women, over-the-counter pain relievers such as ibuprofen, naproxen and aspirin are generally not recommended during pregnancy. However, there are pregnant women who continue to take these medications at specific doses under doctor's supervision due to an underlying medical condition, and they benefit by taking them.
There was a study that suggested ibuprofen and naproxen could be associated with an increased risk for miscarriage. Additional studies are needed to continue to evaluate this concern.
NSAIDs are associated with a risk for premature closure of the ductus arteriosus (a heart and lung condition) in the baby if the medication is used in late pregnancy, at higher doses.
The most concerning aspect of flu is the fever and the goal in pregnancy is to reduce and manage the fever. Due to the known concerns with NSAIDs, acetaminophen is the first choice and preferred drug for reducing fever. If the acetaminophen does not work, its important to reach out to the physician about taking other medications and possibly NSAIDs.
Vitamins or minerals: These are added to some cough syrups, lozenges and sprays. Many pregnant women take prenatal vitamins and get vitamins from many foods that are supplemented, therefore additional vitamins and minerals may not be necessary or beneficial. As we do not know the effect of over-supplementing on vitamins during pregnancy, and it has not been proven that any specific vitamin can prevent or shorten colds, it's important to read the product labels and follow the recommended dietary allowance for pregnancy.
Herbal combinations in high doses have not been studied in pregnancy, therefore benefit and risk are not known, and regulation of dose per tablet has not been established. Echinacea has been promoted as a cold remedy however a Cochrane Review of over 24 double-blind trials with over 4,000 participants did not find that it shortened the duration of colds compared to placebo.
Prevention
Hand washing and hand sanitizer: Studies conducted in work places, colleges and other locations have shown that frequent hand washing and regular use of alcohol containing hand sanitizer reduces the spread of the viruses that cause upper respiratory tract infections (colds). The key is to wash the hands regularly, throughout the day, and avoid touching your nose, mouth and eyes. Studies show that with common colds, the hands are the most common vehicle for self-infecting and that flu is more likely spread from droplets in the air.
Antiviral-Kleenex tissues: These have not been studied well enough to suggest that they prevent colds, however, they do contain layers of antivirals. Until more information is available, it's important to wash your hands after blowing your nose regardless of the tissue type used to prevent spreading the infection to others.
Bottom-line: it's no fun being sick, especially when you're pregnant! I get several questions from pregnant callers regarding cold and flu season, and one of my most important questions is, 'Are you taking it easy?' Rest is key to a healthy pregnancy, and while our busy lives can often get in the way, remember that you're growing a human! So put your feet up and take a few moments for yourself. Sometimes a little "R&R" can be your best medicine.
Sonia Alvarado is a bilingual (Spanish/English) Senior Teratogen Information Specialist with MotherToBaby California, a non-profit that aims to educate women about medications and more during pregnancy and breastfeeding. Along with answering women's and health professionals' questions regarding exposures during pregnancy/breastfeeding via MotherToBaby's toll-free hotline, email and private chat counseling service, she's provided educational talks regarding pregnancy health in community clinics and high schools over the past decade.
MotherToBaby is a service of the international Organization of Teratology Information Specialists (OTIS), a suggested resource by many agencies including the Centers for Disease Control and Prevention (CDC). If you have questions about beauty products, medications or other exposures, call MotherToBaby toll-FREE at 866-626-6847 or visit MotherToBaby.org to browse a library of fact sheets and find your nearest affiliate.
References:
Botto LD, Lynberg MC, Erickson JD. Congenital heart defects, maternal febrile illness, and multivitamin use: A population-based study. Epidemiology 2001;12:485-90. Centers for Disease Control and Prevention. (2014). Seasonal Flu. Retrieved from http://www.cdc.gov/flu/professionals/antivirals/avrec_ob.htm
Chambers CD, Johnson KA, Felix RJ, Dick LM, Jones KL. Hyperthermia in pregnancy: a prospective cohort study. Teratology 1997;55:45.
Hubner, N-O., Hubner C., Wodny M., Kampf G., Kramer A. (2010). Effectiveness of alcohol-based hand disinfectants in a public administration: Impact on health and work performance related to acute respiratory symptoms and diarrhea. BMC Infectious Diseases.Retrieved from http://www.biomedcentral.com/1471-2334/10/250
Karsch-Völk, M., Barrett B., Kiefer D., et al. (2014).Echinacea for preventing and treating the common cold.The Cochrane Database of Systematic Reviews, 2014. DOI: 10.1002/14651858.CD000530.pub3