Getting sick during pregnancy is common and usually manageable at home, but it does require more caution than usual. Your immune system naturally shifts during pregnancy, making you more susceptible to colds, flu, and stomach bugs. The most important first steps are managing any fever quickly, staying hydrated, and knowing which medications are safe to take.
Bring Down a Fever First
Fever during pregnancy, defined as a body temperature above 101°F (38.3°C), is the single symptom that deserves the most attention. Untreated fever before week 12 of pregnancy has been linked to a small increased chance of neural tube defects, heart defects, and oral clefts. Later in pregnancy, the underlying infections causing fever can raise the risk of preterm delivery or low birth weight. A few studies have also found associations between untreated maternal fever and a slightly higher chance of attention deficit disorder and autism in children.
Acetaminophen (Tylenol) is the go-to medication for reducing fever during pregnancy. Its safety profile in pregnancy is well documented. Take it at the standard dose on the package and monitor your temperature. If your fever doesn’t come down, stays above 101°F for more than 24 hours, or climbs higher, call your OB or midwife.
Medications That Are Safe
For a standard cold or upper respiratory infection, several over-the-counter active ingredients have been studied in pregnant women without evidence of increased birth defect risk:
- Acetaminophen for pain and fever reduction
- Dextromethorphan (DM) for cough suppression, found in many cough syrups labeled “DM”
- Guaifenesin to loosen chest congestion
- Diphenhydramine or chlorpheniramine for runny nose and sneezing (both can cause drowsiness)
- Saline nasal sprays for congestion, with no medication concerns at all
Medicated nasal sprays containing oxymetazoline or xylometazoline are considered relatively safe but should only be used for a day or two. Overuse causes rebound congestion that makes things worse.
Medications to Avoid
The biggest category to steer clear of is NSAIDs, which includes ibuprofen (Advil, Motrin) and naproxen (Aleve). The FDA recommends avoiding all NSAIDs from 20 weeks of pregnancy onward because they can cause kidney problems in the developing baby, leading to dangerously low amniotic fluid levels. After 30 weeks, NSAIDs carry the additional risk of prematurely closing a critical blood vessel in the baby’s heart. Even before 20 weeks, most providers recommend acetaminophen instead as the safer choice.
The one exception is low-dose aspirin (81 mg), which some providers prescribe for specific pregnancy complications like preeclampsia prevention. That’s a medical decision, not something to start on your own for a cold.
Home Remedies That Actually Help
Non-drug approaches can do a lot for cold and flu symptoms, and they carry zero risk:
- Warm salt water gargle for sore throat and cough
- Honey in warm tea with lemon to soothe a cough (honey is a surprisingly effective cough suppressant in studies)
- A humidifier or hot shower to breathe warm, humid air and loosen congestion
- Hot or cold packs on your sinuses for facial pressure and pain
- Rest, and more of it than you think you need
These remedies won’t shorten your illness, but they’ll make the days of it considerably more bearable.
Staying Hydrated When You Feel Awful
Pregnant women need roughly 3 liters (about 12.5 cups) of total fluid per day under normal conditions. When you’re sick, especially with fever, vomiting, or diarrhea, your needs go up. Dehydration during pregnancy can contribute to low amniotic fluid, urinary tract infections, and constipation.
Water is the foundation, but if you’re struggling to keep anything down, alternate with small sips of an oral electrolyte drink, diluted juice, or broth. Milk and milk-based drinks also contribute meaningfully to hydration. The practical test: if your urine is dark yellow or you’re urinating much less often than usual, you need more fluids. If you cannot keep any liquids down for more than a few hours, that’s a reason to call your provider, because IV fluids may be necessary.
Stomach Bugs Need Extra Caution
Most vomiting and diarrhea during pregnancy comes from ordinary viral gastroenteritis, which is miserable but resolves in one to three days. The real concern is distinguishing a routine stomach bug from something more dangerous, particularly Listeria infection.
Listeria is a bacterial infection from contaminated food (soft cheeses, deli meats, smoked fish, pre-made salads). What makes it uniquely dangerous in pregnancy is that your symptoms may be mild, just a low fever with muscle aches and fatigue, while the infection can cause miscarriage, stillbirth, premature delivery, or life-threatening illness in the newborn. Symptoms of invasive Listeria infection typically appear within two weeks of eating contaminated food.
Contact your provider if you develop fever with flu-like muscle aches after eating any food that’s been recalled or linked to an outbreak. Mention specifically what you ate. If you ate something potentially contaminated but feel fine, most experts say no testing or treatment is needed.
Warning Signs That Need Immediate Attention
Most colds and mild stomach bugs will pass on their own. But certain symptoms during any illness in pregnancy warrant a same-day call or visit:
- Fever above 101°F that doesn’t respond to acetaminophen
- Decreased fetal movement, meaning your baby has stopped moving or is moving noticeably less than usual
- Shortness of breath that comes on suddenly or worsens over time, feeling like you can’t get enough air
- Persistent dizziness or fainting
- Inability to keep fluids down for several hours
- Symptoms lasting longer than 10 days or getting worse after initially improving, which can signal a secondary bacterial infection like sinusitis or pneumonia
Flu and COVID During Pregnancy
Influenza and COVID-19 both carry higher risks of severe illness during pregnancy than in the general population. If you suspect either, contact your provider early. Antiviral treatments are most effective when started within the first 48 hours of symptoms, and your provider can determine whether treatment is appropriate for your situation.
Prevention is the strongest tool here. The American College of Obstetricians and Gynecologists recommends that all pregnant individuals receive an annual flu vaccine during flu season and an annual COVID-19 vaccine. There is no evidence of adverse fetal effects from inactivated or mRNA vaccines given during pregnancy, and real-world safety data continues to support their use. A Tdap vaccine (for whooping cough) is also recommended during each pregnancy, ideally between weeks 27 and 36, which passes protective antibodies to the baby before birth.