If you’re pregnant and feeling sick with a cold, flu, or other illness, the priority is managing your symptoms safely while protecting your baby. Most common illnesses like colds resolve on their own, but pregnancy limits which medications you can take and makes certain symptoms more urgent than they’d normally be. Here’s what you need to know to feel better without putting your pregnancy at risk.
Start With Non-Drug Remedies
Before reaching for any medication, simple home remedies can relieve a surprising amount of discomfort. For congestion, a saline nasal spray or rinse is completely safe during pregnancy and effective at clearing your sinuses. A humidifier in your bedroom does the same thing passively while you sleep, and elevating your head with an extra pillow helps mucus drain instead of pooling.
For a sore throat, dissolve half a teaspoon of salt in a cup of warm water and gargle several times a day. Warm herbal tea with honey and lemon soothes both throat pain and cough. Clear broths like chicken soup help with hydration and provide easy calories when your appetite is low.
One caution: not all herbal supplements are safe in pregnancy. Vitamin C, zinc, and elderberry may be fine, but check with your provider before taking anything marketed as a “natural” remedy.
Medications That Are Generally Safe
When home remedies aren’t enough, a few over-the-counter options have a good safety profile in pregnancy.
For pain, headache, or fever: Acetaminophen (Tylenol) is the go-to. Use the lowest dose that works and don’t exceed 4,000 mg in a day. It’s the only recommended option for fever reduction during pregnancy.
For cough: Dextromethorphan, the active ingredient in many cough suppressants, is generally considered safe based on decades of use without observed increases in birth defects.
For congestion and allergies: Second-generation antihistamines like cetirizine (Zyrtec) and loratadine (Claritin) are safe options that can dry up a runny nose and reduce sneezing. Intranasal steroid sprays containing budesonide are the most studied nasal steroid in pregnancy and can help if you’re dealing with ongoing stuffiness.
Medications to Avoid
The biggest category to steer clear of is NSAIDs, which includes ibuprofen (Advil, Motrin), naproxen (Aleve), and aspirin. The FDA warns against using any NSAID at 20 weeks or later in pregnancy because these drugs can cause kidney problems in the baby. Since the baby’s kidneys produce most of the amniotic fluid by that point, impaired kidney function can lead to dangerously low fluid levels, which affects lung development, muscle growth, and the digestive system. After 30 weeks, NSAIDs also carry the risk of prematurely closing a key blood vessel in the baby’s heart. Even in the first trimester, NSAIDs are best avoided. The one exception is low-dose aspirin (81 mg) prescribed by a provider for specific pregnancy conditions like preeclampsia prevention.
Decongestants containing pseudoephedrine or phenylephrine are also concerning, especially in early pregnancy. Multiple studies have linked first-trimester use to increased risks of heart, limb, and gastrointestinal birth defects. Stick with saline rinses and antihistamines instead.
Guaifenesin, the expectorant found in Mucinex, has weak safety data in pregnancy and a possible association with neural tube defects. It’s not clearly dangerous, but it’s not clearly safe either.
Take Fever Seriously
A fever during pregnancy isn’t just uncomfortable. It can pose real risks to your baby. A temperature above 103°F (39.4°C) in the first trimester has been associated with increased risks of autism spectrum disorder, cleft lip and palate, congenital heart defects, and miscarriage. The CDC considers any temperature of 100.4°F (38°C) or higher an urgent maternal warning sign.
If you develop a fever, take acetaminophen promptly, stay hydrated, and contact your provider. Don’t wait to see if it resolves on its own. Bringing the temperature down quickly matters.
If You Have the Flu, Act Fast
Pregnant women are at higher risk for serious flu complications, including pneumonia and hospitalization. If you suspect influenza (sudden onset of high fever, body aches, and exhaustion rather than a gradual cold), call your provider right away. Prescription antiviral treatment is most effective when started within 48 hours of symptom onset.
Data from the 2009 H1N1 pandemic showed that pregnant women treated early with antivirals were less likely to need intensive care and less likely to die. Even women who started treatment later in the course of illness had better outcomes than those who went untreated. If you have flu symptoms, don’t assume it’s just a cold. Getting tested and treated early can make a significant difference.
Staying Hydrated When You Can’t Keep Much Down
Pregnant women need roughly 1.6 liters (about 6 to 8 glasses) of fluid daily under normal circumstances. When you’re sick, especially if you’re vomiting or running a fever, you lose fluid faster and dehydration becomes a real risk. Dehydration during pregnancy can reduce blood flow to the placenta and trigger contractions.
If drinking full glasses feels impossible, take small, frequent sips rather than big gulps. Keep a water bottle within arm’s reach at all times. Popsicles, ice chips, diluted juice, and clear broths all count toward your fluid intake. If you can’t keep any fluids down for an extended period and notice dry mouth, dizziness, or dark urine, that’s a sign you need medical help.
Warning Signs That Need Immediate Care
Most colds and mild illnesses will pass without harming your pregnancy. But certain symptoms cross the line from “ride it out at home” to “get to a doctor now.” The CDC identifies these as urgent maternal warning signs:
- Fever of 100.4°F or higher that doesn’t respond to acetaminophen or keeps returning
- Trouble breathing, including shortness of breath, chest tightness, or difficulty breathing while lying down
- Changes in your baby’s movement, such as decreased kicking or no movement at all
- Severe headache that won’t go away, gets worse, or comes with blurred vision or dizziness
- Severe nausea and vomiting that prevents you from keeping any fluids down, especially with confusion or dry mouth
- Chest pain or a fast, irregular heartbeat
- Extreme swelling in your hands or face
These symptoms can overlap with common illness but may also signal pregnancy complications like preeclampsia or infection that has become systemic. Trust your instincts. Being pregnant and sick is uncomfortable enough on its own, but when something feels wrong beyond a normal cold, getting checked is always the right call.