This will help minimize potential risks from the use of unnecessary medications. Pseudoephedrine and phenylephrine are pregnancy category C in all three trimesters of pregnancy. However, they advise against the use of oral decongestants during the first trimester because of the potential increased risk of gastroschisis an abdominal wall defect.
One prospective study of women using decongestants in their first trimester showed no elevated risk for malformations. Oral decongestants may also result in vasoconstriction, which can induce maternal hypertension and lead to impaired blood flow to the fetus. Since impaired blood flow can hinder fetal growth, the risks of taking oral decongestants in the first trimester may outweigh the benefits.
In the second and third trimesters, pseudoephedrine can be recommended to pregnant patients in appropriate doses. To minimize exposure to the fetus, pregnant patients should take the immediate-release dosage form instead of the extended-release and take the minimum effective dose for the shortest duration possible. They also have sympathomimetic properties and may aggravate some medical conditions, such as diabetes mellitus and hyperthyroidism.
The patient should contact her physician if she has a high-risk pregnancy, a fever, or other signs of infection, if the congestion lasts longer than seven days, or if the medication does not relieve symptoms. The amount of fetal exposure is minimal due to the small amount of medication absorbed systemically. Few studies are available for any of the nasal preparations. However, one prospective study of and 56 women exposed to intranasal oxymetazoline and phenylephrine, respectively, did not show an increased risk for malformations.
Contraindications include a high-risk pregnancy, fever or any other sign of infection, and congestion longer than seven days. These products should be used cautiously, if at all, in patients who cannot take oral decongestants.
The presence of underlying conditions e. An appropriate dose of oxymetazoline is two to three sprays per nostril every 10 to 12 hours maximum two doses per day. It is important that patients be instructed not to use the medication more often than recommended or longer than three days, due to the risk of rebound congestion. If the medication is not effective, the patient should refer to her physician. Expectorants and Antitussives Guaifenesin: Coughing is a protective reflex.
Guaifenesin works to break up the mucus in the patient's chest to make the cough more productive. If the patient is able to cough up more of the mucus, the cough will likely decrease in frequency as the mucus is cleared.
However, guaifenesin has not been proven effective against cough in patients with common cold symptoms. Guaifenesin is considered pregnancy category C. Guaifenesin has not been studied as extensively as other OTC products. In one study of pregnant women, there was an association between guaifenesin exposure in the first trimester and an increased incidence of inguinal hernias.
Fortunately, emphysema, chronic bronchitis, and heart failure are relatively rare in women who are of childbearing age. Furthermore, ACE inhibitor use is also traditionally avoided in this patient subset. See table 3 for specific circumstances when patients should not be self-treated for a cough and should be referred to a physician.
Dextromethorphan: Since coughing may be protective, it should generally not be suppressed except in certain situations. If the cough is not productive and interferes with sleep, or it is severe in nature, it can be suppressed. Similar to guaifenesin, dextromethorphan has not been shown to be effective in patients with common cold symptoms. Dextromethorphan is equipotent to codeine as an antitussive and is a pregnancy category C medication. Dextromethorphan exposure in the first trimester has been studied, and no increased risk of malformations was detected.
In women with a first-trimester exposure to dextromethorphan, there were three major and seven minor malformations versus five major and eight minor malformations in the control group. However, there is still theoretical concern that an antagonist at the N -methyl-d-aspartate receptor might affect fetal brain growth.
To date, this adverse effect has not been studied in humans. Concurrent use of dextromethorphan with central nervous system CNS depressants and monoamine oxidase MAO inhibitors within 14 days should be avoided. It has the same contraindications as guaifenesin therapy. Since the available OTC cough products do not relieve the underlying cause, ACCP advises against the use of cough suppressants and expectorants for cough due to postnasal drip.
For the postnasal drip cough, an antihistamine or decongestant is recommended. Given that guaifenesin and dextromethorphan have questionable efficacy for cough related to the common cold, they should be used sparingly at most in pregnant patients.
Nonpharmacologic measures for cough may prove more effective with less risk to the patient. Thus, loratadine does not treat either rhinorrhea or sneezing from a nonallergic source. Brompheniramine and triprolidine are pregnancy category C. The most common concerns about antihistamine use in pregnancy are cleft palate loratadine and diphenhydramine , polydactyly diphenhydramine , retrolental fibroplasias, and uterine contractions diphenhydramine. An association was found between antihistamine use in the last two weeks of pregnancy and an increased risk of retrolental fibroplasia.
This may cause uterine contractions. In a pinch, carry an alcohol gel with 60 percent alcohol on the label for quick sanitizing on the go. Viruses are almost impossible to avoid, especially in the winter.
And just remember: This, too, shall pass. What to Expect follows strict reporting guidelines and uses only credible sources, such as peer-reviewed studies, academic research institutions and highly respected health organizations. Learn how we keep our content accurate and up-to-date by reading our medical review and editorial policy. The educational health content on What To Expect is reviewed by our medical review board and team of experts to be up-to-date and in line with the latest evidence-based medical information and accepted health guidelines, including the medically reviewed What to Expect books by Heidi Murkoff.
This educational content is not medical or diagnostic advice. Use of this site is subject to our terms of use and privacy policy. Registry Builder New. Colds During Pregnancy. Medically Reviewed by Aaron Styer, M.
Medical Review Policy All What to Expect content that addresses health or safety is medically reviewed by a team of vetted health professionals. During pregnancy, your immune system is usually suppressed — and not all medications are safe to use. Others things you can do to reduce your risk of getting sick include: washing your hands often getting enough sleep eating a healthy diet avoiding close contact with sick family or friends exercising regularly reducing stress.
When should I call my doctor? Although most colds do not cause problems for an unborn child, the flu should be taken more seriously. Flu complications increase the risk of premature delivery and birth defects. Parenthood Pregnancy Pregnancy Health. Medically reviewed by Michael Weber, M. Read this next. Medically reviewed by University of Illinois. Stomach Flu Remedies.
Medically reviewed by Judith Marcin, M. Medically reviewed by Debra Rose Wilson, Ph. Treating the common cold during pregnancy. Canadian Family Physician h54 5 Mayo Clinic. Drugs and supplements, cough and cold combinations oral route : Pregnancy. Silva R, et al. Clinical inquiries. Is guaifenesin safe during pregnancy? Journal of Family Practice 56 8 Wigle PR, et al. Pregnancy and OTC cough, cold, and analgesic preparations. US Pharmacist Treatment of respiratory infections in pregnant women.
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