Most common illnesses during pregnancy, like colds, the flu, and stomach bugs, can be managed safely at home with the right approach. The key differences from your pre-pregnancy routine: some familiar medications are off-limits, fever needs to be treated promptly, and staying hydrated matters more than usual. Here’s how to handle it.
Treat a Fever Quickly
Fever is the single most important symptom to address when you’re sick and pregnant. A temperature of 100.4°F (38°C) or higher counts as a fever, and bringing it down should be your first priority. Sustained high fever, especially above 103°F in the first trimester, has been linked to a more than doubled risk of neural tube defects and may increase the risk of congenital heart defects, cleft lip and palate, and miscarriage. Later in pregnancy, fever can raise the risk of preterm labor.
Acetaminophen (Tylenol) is the go-to fever reducer during pregnancy. The maximum adult dose is 4,000 milligrams per day, but using the lowest effective dose for the shortest time is the safest approach. If you have liver or kidney issues, your limit may be lower.
Medications That Are Generally Safe
You don’t have to white-knuckle your way through a cold or flu. Several over-the-counter options are considered safe during pregnancy:
- Pain and fever: Acetaminophen (Tylenol)
- Cough: Dextromethorphan (Robitussin), but choose an alcohol-free formula
- Chest congestion: Guaifenesin (plain Mucinex)
- Allergies and runny nose: Loratadine (Claritin) or diphenhydramine (Benadryl)
- Sore throat: Mentholated or non-mentholated cough drops
- Chest relief: Mentholated rub (Vicks VapoRub)
When buying combination products (anything labeled “multi-symptom”), check the active ingredients list carefully. Many bundle medications you don’t need or include ingredients that aren’t recommended during pregnancy.
Medications to Avoid
Ibuprofen (Advil, Motrin), naproxen (Aleve), aspirin, and other NSAIDs should not be used at 20 weeks of pregnancy or later. The FDA warns that these drugs can cause kidney problems in the developing baby, leading to dangerously low amniotic fluid levels. After 30 weeks, the risk increases further because NSAIDs can cause premature closure of a blood vessel the baby needs before birth. Even before 20 weeks, acetaminophen is the preferred choice.
High-dose vitamin C and zinc supplements marketed for colds are also not recommended. The doses in cold-specific products exceed what’s considered safe during pregnancy, and the evidence that they shorten colds is weak even for non-pregnant adults.
Drug-Free Ways to Feel Better
For congestion, saline nasal irrigation with a squeeze bottle or neti pot can provide relief without any medication exposure. Use only distilled, sterile, or previously boiled water, and keep the equipment clean. Nasal strips, the adhesive kind that open your nostrils, are also safe and can help you sleep. Running a clean humidifier adds moisture to the air and can ease a stuffy nose and scratchy throat.
For a cough or sore throat, honey is a well-known soother that’s safe during pregnancy. Warm liquids, gargling with salt water, and using a humidifier at night can also help. Rest as much as you can. Your immune system is naturally dialed down during pregnancy, which means illnesses can feel more intense and last a bit longer than you’re used to.
If You Have the Flu
The flu deserves special attention during pregnancy because you’re at higher risk for serious complications. If you develop flu symptoms (sudden fever, body aches, chills, extreme fatigue), contact your provider right away. Antiviral treatment is recommended for all pregnant people with suspected or confirmed flu, in any trimester, and it works best when started within 48 hours of symptom onset. Your provider doesn’t need to wait for a lab test to prescribe it, since rapid flu tests can miss cases.
The standard antiviral course lasts five days. If you’ve been in close contact with someone who has the flu but haven’t developed symptoms yet, preventive antiviral treatment may also be an option, particularly if you weren’t able to get the flu vaccine or have a weakened immune system.
Handling a Stomach Bug
Viral gastroenteritis (the “stomach flu”) brings vomiting and diarrhea, and the biggest concern during pregnancy is dehydration. Focus on replacing fluids and electrolytes with water, clear broths, sports drinks, or oral rehydration solutions. Small, frequent sips are easier to keep down than large amounts at once. Saltine crackers can also help replace electrolytes.
You may have heard of the BRAT diet (bananas, rice, applesauce, toast), but current guidance from the National Institute of Diabetes and Digestive and Kidney Diseases says restrictive diets don’t actually help you recover faster. Once your appetite returns, go back to eating normally, even if diarrhea hasn’t fully resolved. Your body and your baby need the nutrition.
If you can’t keep any fluids down for an extended period, or you notice signs of dehydration like dry mouth, dizziness, or dark urine, that’s a reason to call your provider or head to urgent care. Dehydration during pregnancy can reduce blood flow to the placenta and, in severe cases, trigger contractions.
Warning Signs That Need Immediate Attention
Most illnesses will pass on their own, but certain symptoms during pregnancy signal something more serious. Seek medical care right away if you experience any of the following while sick:
- Fever of 100.4°F or higher that doesn’t respond to acetaminophen
- Severe or persistent vomiting that prevents you from keeping fluids down, especially with dry mouth or confusion
- Decreased fetal movement: a noticeable slowing or stop in your baby’s usual pattern of kicks
- Trouble breathing: sudden shortness of breath, chest tightness, or difficulty breathing while lying down
- Severe headache that won’t go away, gets worse, or comes with blurred vision
- Dizziness or fainting that doesn’t resolve
- Vaginal bleeding or fluid leaking
- Severe belly pain that is sharp, worsening, or cramping
- Swelling, redness, or pain in one leg (usually the calf), which could indicate a blood clot
Some of these overlap with normal cold or flu discomfort, so the distinction is severity and persistence. A mild headache with a cold is expected. A headache that feels like the worst of your life, or one paired with vision changes, is not.