Dr. Ross suggests:
Common Cold Medicine and Pregnancy: What’s Safe? If you can't get enough relief from those home remedies, it’s possible to use common cold medicines with a few precautions. First, guidelines say it’s best to avoid all medication during the first trimester. "In the first 12 weeks the baby is making its organs, and so in general, if people don't need to take something during that time it would be great if they didn’t," says Dr. Ross. “[There are] more serious consequences at the beginning of the pregnancy." Next, Ross says the safest bet is to look for medications with the fewest ingredients possible. "The main thing about [common cold] medicine is it’s best to take the ingredient you need for the symptom and not the combination, one-size-fits-all," says Ross. "It's better to separate your ingredients and take the ones that you need at a usual adult dose." There are also specific medicines to avoid during pregnancy:
Herbal medications in particular aren't regulated, so it's difficult to know exactly what ingredients they contain and whether they're safe. Herbs can cross the placenta and reach the baby, so it's best to avoid them. Common Cold Medicine and Pregnancy: The Safe List The best option is always to talk to your doctor before taking any medication during your pregnancy, but here are some medications that have been found to be generally safe for pregnant women:
Of these possibilities, Ross recommends Sudafed the most for the common cold. "Sudafed is okay for a decongestant after the first trimester unless the woman has high blood pressure," says Ross. "Sudafed sometimes is the medication that packs the most bang for its buck." Remember, the simpler the better. Ross recommends that pregnant women steer clear of products that contain multiple ingredients or tackle a combination of symptoms, such as Nyquil, Robitussin DM, and Claritin-D. A bad cough is certainly annoying, but you might also be concerned that you will cough so hard it will hurt the baby, or that your water will break. Ross says there's no need to worry — your baby will be fine. Common Cold Medicine and Pregnancy: Check With Your Doctor Ross cautions pregnant women to be careful not to assume that what you have is the common cold. If it’s actually an illness like the swine flu, it can pose a much more serious problem for pregnant women. If you experience fever and muscle aches, or if symptoms don't subside within about 10 days, see your doctor to see if it's an illness that requires special treatment. Yes, many over-the-counter cough and cold medications are considered safe for pregnant women and their developing babies. But that doesn’t mean you should just grab something at the drugstore and take it. Call your doctor before you take anything, even if you think it's safe. Can Fam Physician. 2008 May; 54(5): 687–689. Language: English | French QUESTION Many of my pregnant
patients inquire as to what medication they can use when they experience symptoms of the common cold, such as cough, congestion, sneezing, and fever. I am hesitant to recommend over-the-counter cold remedies because I have heard conflicting information regarding the safety of these products. What is known about the safety of cold medications during pregnancy? ANSWER Although there are many over-the-counter brands of cold medications, most products are quite
similar, with some containing up to 5 medicinal ingredients. The evidence-based information for all these ingredients suggests no increased risk with short-term use. However, pregnant women should read labels carefully and, when necessary, consult with pharmacists to ensure they are not taking medicine they do not require. QUESTION Plusieurs de mes patientes enceintes
me demandent quels médicaments prendre lorsqu’elles souffrent de symptômes du rhume, comme la toux, la congestion nasale, les éternuements et la fièvre. J’hésite à leur recommander des médicaments en vente libre contre le rhume, parce que j’ai entendu des renseignements contradictoires quant à leur innocuité. Que sait-on de la sécurité des médicaments contre le rhume durant la grossesse? RÉPONSE Même si les marques de médicaments en vente libre contre le rhume
sont nombreuses, la plupart des produits se ressemblent beaucoup et certains contiennent jusqu’à 5 ingrédients médicinaux. Les renseignements fondés sur des données scientifiques ne font pas valoir de risque accru avec un usage de courte durée. Par ailleurs, les femmes enceintes devraient lire attentivement les étiquettes et consulter leur pharmacien au besoin pour s’assurer de ne pas prendre de médicaments dont elles n’ont pas besoin. Symptoms such
as cough, nasal stuffiness, discharge, sneezing, and sore throat can be due to a mild upper respiratory illness also known as the common cold. It is caused by numerous viruses and is usually a self-limiting illness. However, sometimes the infection spreads to other nearby organs, leading to a serious bacterial infection.1 Because of immunologic changes
during pregnancy, pregnant women are susceptible to many infections.2 Although there are many over-the-counter (OTC) medications that help to relieve symptoms of the common cold, there are only a few medicinal ingredients in these products. Analgesics commonly found in OTC cold medications are
acetaminophen, ibuprofen, and acetylsalicylic acid (ASA). The safety of acetaminophen in pregnancy is well documented. The Collaborative Perinatal Project monitored 50 282 mother-child pairs, 226 of which had first-trimester exposure to acetaminophen and 781 of which had been exposed anytime during pregnancy.3 In a surveillance study involving 229 101 completed pregnancies,
9146 newborns had been exposed to acetaminophen in the first trimester.4 In addition, as part of a larger study, 697 women who had used acetaminophen with or without codeine in the first trimester were assessed following delivery and there was no increased risk of major malformations among their
offspring.5 Ibuprofen and ASA are both nonsteroidal anti-inflammatory drugs (NSAIDs). In the same surveillance study as above, 3178 newborns were exposed to ibuprofen in the first trimester and there was no association with an increased risk of birth defects.4 A meta-analysis conducted by the Motherisk Program found no evidence of an overall increase in the risk of major malformations associated with ASA use during the first trimester.6 In 2001, a study of 1462 women who had received prescriptions for NSAIDs 30 days before conception or during pregnancy did not find associations between NSAIDs and congenital birth defects, preterm delivery, or intrauterine growth retardation. However, they did find a statistically increased risk of spontaneous abortion (SAB) when compared with a nonexposed group. It is important to note that although an association with SABs was found, both the NSAID group and the comparison group in this study had substantially lower rates of SABs than is expected in the general population.7 Acetylsalicylic acid use has been associated with delivery complications and adverse effects in newborns; therefore, use in analgesic doses is not recommended in late pregnancy.8,9 Low doses of ASA (40 to 150 mg) have not been associated with concerns at any stage of pregnancy.10,11 However, the use of NSAIDs, other than low-dose ASA, in the third trimester is associated with premature closure of the ductus arteriosus and should be avoided if possible.12 Cough suppressantsDextromethorphan (DM) is a cough suppressant commonly found in OTC cold medications. There are a number of human studies on the use of DM during pregnancy that did not find an association between this drug and an increased risk of birth defects. The Collaborative Perinatal Project, for example, followed 300 mother-child pairs who took DM during the first trimester and 580 mother-child pairs with exposure anytime during pregnancy.3 A prospective comparative study, which was conducted by researchers in the Motherisk Program, investigated pregnancy outcomes in 184 women exposed to DM.13 Another group investigated 59 pregnancies exposed to DM in the first trimester.14 Neither group documented an increased risk of major malformations above the baseline. DecongestantsPseudoephedrine and phenylephrine are the most common oral decongestants in OTC cold medications. In some studies, decongestant use in the first trimester has been associated with a small increase of defects thought to arise, in some instances, from vascular disruption, such as gastroschisis, small intestinal atresia, and hemifacial microsomia.14 However, there are several cohort and case-control studies that failed to show any increased risk of malformations when oral decongestants were used during pregnancy.15,16 In addition, there was no increased risk for malformations in a recent Swedish population-based case-control study involving 2474 women exposed to oral decongestants during the first trimester and 1771 women exposed at the end of pregnancy.17 Xylometazoline and oxymetazoline are inhaled decongestants, which are also available OTC. Xylometazoline is absorbed systemically after topical use (American Medical Association Council on Drugs, unpublished data, 1994); however, the extent of systemic absorption and whether or not it crosses the placenta are unknown. The results of one human study of 207 women who used xylometazoline in the first trimester of pregnancy failed to show any increase in incidence of birth defects.14 Oxymetazoline was evaluated in human pregnancies, and a single dose given to each of 12 pregnant women did not alter maternal or fetal circulation.18 It is important to note that although OTC inhaled decongestants are considered relatively safe for use during pregnancy, women should be cautioned regarding rebound effects from overuse of these products. AntihistaminesDiphenhydramine and chlorpheniramine are the most commonly used antihistamines in cold preparations. These first-generation antihistamines are associated with drowsiness but have not been found to increase the risk of malformations above baseline.19,20 ExpectorantsGuaifenesin is an expectorant also found in many cold medications. There have been several studies involving hundreds of pregnant women that did not report increased risk of major malformations.3,14,21 ConclusionPregnant women suffering from the common cold can be reassured about the safety of short-term use of OTC cold medications. These drugs, however, should not be used indiscriminately or for extended periods of time. In addition, use should be confined to only those products that are appropriate for the symptoms. FootnotesCompeting interests None declared References2. Cunningham FG, Gant NF, Leveno KJ, Gilstrap LC, III, Hauth JC, Wenstrom KD. Williams obstetrics. 22. New York, NY: McGraw Hill; 2005. pp. 130–1.pp. 1276 [Google Scholar] 3. Heinonen OP, Slone D, Shapiro S. Birth defects and drugs in pregnancy. Littleton, MA: Publishing Sciences Group; 1977. pp. 286–95. [Google Scholar] 4. Briggs GG, Freeman RK, Yaffe SJ. Drugs in pregnancy and lactation. 7. Philadelphia, PA: Lippincott Williams & Wilkins; 2005. p. 800. [Google Scholar] 5. 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What cold and cough medicines are safe during pregnancy
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