Getting a cold during early pregnancy is common, and for most people it’s harmless to both you and the developing baby. The cold itself, caused by rhinoviruses and similar bugs, typically lasts 5 to 7 days and resolves on its own. The real concern isn’t the cold. It’s fever, which has been linked to a small but measurable increase in certain birth defects when it occurs in the first trimester.
Why Colds Feel More Common in Early Pregnancy
Your immune system doesn’t shut down during the first trimester, but it does shift priorities. The early weeks of pregnancy are actually a proinflammatory phase, meaning your immune system is busy securing the implantation site, repairing uterine tissue, and establishing the placenta. The placenta even produces its own antiviral compounds to protect the developing embryo. But this intense local activity can leave you slightly more vulnerable to everyday respiratory viruses circulating in your environment.
Many people also notice they feel more run down in the first trimester due to fatigue, nausea, and hormonal shifts. That general sense of being “off” can make a mild cold feel worse than it normally would, or make you more aware of symptoms you’d typically power through.
Cold Symptoms vs. Pregnancy Rhinitis
Before assuming you have a cold, it’s worth knowing that pregnancy itself causes nasal congestion in many people. Pregnancy rhinitis is a stuffy or runny nose that isn’t caused by a virus, allergy, or sinus infection. It’s driven by increased blood volume and hormonal changes that swell the nasal passages.
The key differences: a cold comes with a sore throat, sneezing, coughing, muscle aches, and sometimes mild fever, and it resolves within a week. Pregnancy rhinitis is just congestion and a runny nose, with no other symptoms, and it lingers for weeks. It’s most common in the third trimester and can persist until about two weeks after delivery, though some people notice it earlier. If your only symptom is a stuffy nose that won’t quit, it’s likely pregnancy-related rather than viral.
The Fever Risk in the First Trimester
A cold without fever poses no documented risk to fetal development. A large CDC-supported study spanning 1997 to 2011 found that mothers who reported a cold or flu without fever had no increased risk of any birth defects studied. But when fever accompanied the illness, the picture changed. Fever during early pregnancy was significantly associated with eight specific birth defects, including neural tube defects like spina bifida, cleft lip, and limb reduction defects. The elevated risk ranged from 1.2 to 3.7 times the baseline, depending on the defect.
The critical finding: it was the fever itself, not the illness, that drove the excess risk. This means the priority when you catch a cold in early pregnancy is keeping your temperature down. A temperature of 100.4°F (38°C) or higher warrants prompt attention. Most common colds produce only very mild fever or none at all, which is reassuring.
Safe Ways to Manage Cold Symptoms
Treating cold symptoms won’t shorten the illness, but it can make you more comfortable. Rest, fluids, and honey for a sore throat are the simplest starting points. Saline nasal spray helps with congestion and carries zero risk.
For over-the-counter medications, acetaminophen (Tylenol) has the strongest safety record in pregnancy and is the go-to for reducing fever and relieving aches. Older-generation antihistamines like diphenhydramine and chlorpheniramine, found in many cold preparations, have not been found to increase the risk of birth defects. Short-term use of these medications is generally considered safe, though you should stick to products that target only the symptoms you actually have rather than taking multi-symptom formulas with ingredients you don’t need.
Oral decongestants are a different story. Some studies suggest they can be harmful to the fetus, particularly in the first trimester. Avoid products containing pseudoephedrine or phenylephrine unless specifically cleared by your provider.
Herbal Teas and Natural Remedies
The first trimester is the most sensitive period for herbal products because rapid cellular development during organ formation can be disrupted by bioactive compounds. Peppermint tea is classified as safe in moderate amounts, but excessive use in early pregnancy is discouraged because it can stimulate uterine activity. Ginger, commonly used for first-trimester nausea, should also be kept to limited amounts. Chamomile tea has been associated with a higher incidence of preterm labor with regular use and is generally considered unsafe during pregnancy. Fennel has shown toxic effects on fetal cells in lab studies.
The bottom line with herbal remedies: occasional, moderate use of peppermint or ginger tea is likely fine. Treating them as medicine and consuming large quantities is not.
Can a Cold Virus Reach the Baby?
Common cold viruses (rhinoviruses) primarily infect the upper respiratory tract and don’t typically enter the bloodstream in a meaningful way, which means they don’t reach the placenta. This is fundamentally different from viruses like influenza, which can spread through the bloodstream to the placental tissue and cause direct damage. First-trimester flu infections have been linked to higher risks of preterm birth and low birth weight. RSV can also potentially reach fetal circulation from the mother’s respiratory tract.
This distinction matters. A standard cold, the kind that gives you a stuffy nose and scratchy throat for a week, is not in the same risk category as influenza. If your symptoms are severe, include high fever, or involve significant body aches and fatigue beyond what a typical cold produces, it may not be a cold at all, and getting evaluated quickly is worthwhile.
When Symptoms Need Urgent Attention
Most colds in pregnancy are uneventful, but certain symptoms signal something more serious. Seek medical care if you experience a temperature of 100.4°F or higher, shortness of breath or tightness in your chest or throat, a fast or irregular heartbeat, or dizziness and feeling faint. Difficulty breathing that worsens when lying down, or trouble talking because you can’t catch your breath, are also warning signs that need immediate evaluation. These can indicate that a simple respiratory infection has progressed or that something else is going on entirely.