Safe and Effective Strategies for Cold and Flu in Pregnancy

Along with navigating pregnancy during Covid-19, women who are currently pregnant and recently postpartum may have some additional health concerns on the horizon as we enter traditional “cold and flu” season. Coupled with the potential for increased exposure (due to viruses associated with the common cold and seasonal influenza suddenly circulating at greater rates in our communities), the changes that occur to your immune system during and immediately after pregnancy may also mean the following:

1.       You are more vulnerable to the symptoms associated with these illnesses.

2.       You’re at greater risk for more severe symptoms.

3.       Your symptoms have the potential to last for a greater duration.

The good news about the vast majority of common viral illnesses experienced during pregnancy, including uncomplicated upper respiratory infections and the common cold, is that the risk to your baby during these illnesses is exceedingly low. Rest assured, you may feel like hot garbage, but your baby very likely isn’t feeling a thing.  

The bad news is on top of the general aches, pains, and general discomfort associated with pregnancy, your also potentially dealing with a cough, sore throat, nasal congestion, sinus pain, headaches, poor appetite, (even more!) fatigue, sneezing, a mild fever, and any combination thereof. Even more bad news? Many of the over-the-counter cold and flu remedies we reach for and typically rely on to manage cold symptoms and get us through the day in normal circumstances are not considered safe during pregnancy. But not to worry: here’s your go-to game plan for managing colds and other common viral illnesses this season.

Over the Counter Remedies and Medications

The use of over-the-counter cold, cough, or flu medications should be avoided whenever possible during pregnancy, as limited data or scientific studies quantifying risks to a developing fetus exist on these products. If your symptoms are truly unbearable or particularly persistent, talk to your OBGYN or Certified Nurse-Midwife and get appropriate clearance before stocking up at your local pharmacy.

The same rule of thumb applies to supplements, herbal remedies, and other “natural remedies” that promise to support immunity and shorten the course of viral illnesses. Many of these remedies are not regulated by governmental agencies that typically endorse the safety and efficacy of these products, largely due to the fact that studies demonstrating their efficacy are rarely conducted. Prior to using any such supplements, discuss the benefits and risks with your care team and get their approval before relying on them to get through a cold, flu, or other illness.

Non-Pharmacological Strategies

In lieu of over the counter products, the following non-pharmacological strategies are safe for both mom and baby throughout the course of pregnancy, and have been proven effective in supporting immune health for recovery during viral illnesses:

·       Rest. Keep nights early during and immediately after periods of acute illness and if possible, take naps to further maximize sleep.

·       Stay hydrated. Drinking plenty of water can help replenish fluids you lose rapidly during periods of illness due to coughing, fever, and mucous production. Incorporate orange juice for a boost of naturally-derived vitamin C and extra calories if your appetite is lacking. Try drinking simple broths—full of fat, salt, and other nutrients to further support caloric, hydration, and other dietary needs during illnesses.

·       Use a humidifier. Help keep mucous membranes moist and hydrated, reduce congestion, and soothe a dry, scratchy throat by placing a humidifier in your room during an illness. This is especially relevant during cold and flu season, which generally occurs in colder months when heating systems leave air in many households bone-dry.

·       Sleep elevated. Reduce congestion and nighttime coughing by sleeping slightly elevated using a moveable base (if you have one) or multiple pillows.

·       Gargle with warm salt water. Alleviate a sore throat by dissolving ½ teaspoon of table salt in 8oz of warm water and gargling 2-4x per day. This practice is known to reduce inflammation and irritation by creating a high-salt barrier that draws fluids and viral or bacterial particles from irritated tissues. As a bonus—small studies have demonstrated the practice of gargling salt water or even plain water may be an effective way to prevent viral respiratory illnesses in the first place.  

·       Utilize a saline nasal spray. Similar to the effect of salt-water on the throat, saline nasal spray used 1-2x per day in each nostril is known to reduce inflammation (and therefore, pain and irritation), clear congestion, and moisten mucous membranes of nasal passages and sinuses during colds. (Avoid neti pots, which can spread harmful microbes and lead to secondary infections which are often much more serious than common respiratory illnesses.)

·       Keep eating. Your appetite is likely poor from the cold, and large meals might no longer be tolerable due to your current stage of pregnancy—but keep eating! Focus on small, nutrient dense meals and snacks to help meet you and your baby’s needs and give your immune system the proper fuel it needs to get to work.

·       Go for a walk. It might be the last thing you feel like, but if you’re up for it and able, incorporating some light, pregnancy-safe exercise such as walking helps to further support your immune system, optimize your rest, and keep your lungs as healthy as possible during respiratory infections.

When to Call Your Team

 As with all things in pregnancy, women should never feel like they have to navigate unpleasant symptoms from colds or flu alone. While you may not find it necessary to call your team every time you sneeze (although if you do, by all means, go ahead—they work for you) here are some hard stops that should definitely have you reaching for the phone:

·       You have a fever. A fever is technically define as anything greater than 100.4 (F). If this is you, contact your team to discuss strategies for reducing the fever as quickly and safely as possible. Fevers, especially early in pregnancy, have been previously associated with birth defects and other negative outcomes for a developing fetus. Additionally, in light of the current health crisis, your provider may recommend testing for Covid-19 that, if positive, may mean you are eligible for additional management strategies, such as monoclonal antibody therapy.

·       Your symptoms are getting worse. If after 3-4 days your symptoms are continuing to persist without any improvement or if they are actually getting worse, it’s time to contact your team. They may do specific testing to recommend targeted treatments, or may find something on physical exam (such as acute dehydration) that can be corrected and have you feeling much better.

·       Your symptoms are preventing eating, drinking, or sleeping. While most people can expect to have some degree of appetite suppression, dehydration, or sleep disruption due to illness simply as a result of discomfort; if these mild disruptions have become extreme, it’s time to call your team and be evaluated.

·       You are short of breath, wheezing, or coughing up discolored mucus. Viral respiratory illnesses affect pregnant women differently than their non-pregnant peers (what’s up, Covid?). This means that immune responses even to a common cold, or viral illnesses such as RSV, may trigger inflammation and breathing problems that require medical intervention, such as the use of a prescribed inhaler. These symptoms are also a major red flag for a bacterial respiratory infections, or bacterial or viral pneumonia, which should be treated and properly supervised by your medical team to ensure the safety of you and your baby.While pregnancy brings about some very obvious changes to our bodies, many women are often (unpleasantly) surprised by changes we cannot see, including substantial changes to immune function throughout pregnancy and in the immediate postpartum period. If you are currently pregnant, adopt strategies to avoid illnesses whenever possible: get vaccinated for seasonal flu and Covid-19, wash hands frequently, avoid high-density public places whenever possible, and avoid individuals who are currently ill. It will also be helpful to have a plan for the common colds and other illnesses you may encounter this upcoming season. While experiencing cold and flu symptoms is never pleasant, understanding what practices are safe and effective prior to needing them can help you focus on getting back to optimal health as quickly as possible. Good luck this cold and flu season—you’ve got this, Mama!

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