Amos Grünebaum, MD FACOG
Obstetrician & Gynecologist and Maternal-Fetal Medicine Specialist

As common as colds are, it's no surprise that you stand a good chance of getting one while pregnant. The only thing is, when you're expecting, weathering a cold or a nagging cough goes beyond the simple logistics of seeking relief from your symptoms--after all, now you have a baby and his health to think about as well. For a rundown on the available treatment options that can keep both you and your baby comfortable during cold season, read on.

Symptoms
In general, coughs and colds are not dangerous conditions. They might be annoying and make you feel awful, but neither presents a real risk to your health or the health of your baby. If you are ill for more than a few days, develop a high fever, have a severe sore throat, or are worried that your symptoms seem unusual, you may have strep throat or a sinus infection and should see your doctor.
Sinus infections are relatively common in pregnancy because of the increased nasal congestion, and fighting one may require the use of antibiotics. Women with asthma should pay special attention to their breathing and see their practitioner without delay if they are having difficulty.
If you develop a severe cough, rest assured that the fetus is protected inside your uterus--you cannot cough so hard that you miscarry or go into labor. However, the loss of urine is, unfortunately, pretty common. Probably the best thing you can do about stress urinary continence is to empty your bladder frequently and practice your kegel exercises.

Nonmedical treatments
Coughs and colds are usually caused by viruses, which do not benefit from antibiotics, and so must run their course. Medical treatment can relieve symptoms so that you feel better, but it won't make you get better any faster. Except for treating fever, it often is fine to simply tough it out if you don't want to take any medications. Here are tips to help you alleviate some of the discomfort that can accompany a cold.

• Drink plenty of fluids, as this will help to thin secretions. Water, chicken soup (Jewish Penicillin), juices, and warm tea are good sources.
• Use a humidifier. Place it close to your face when you sleep. During the day, you can make a tent out of a sheet draped over your head. Stay under the tent for 15 minutes, three or four times a day.
• Rub a mentholated product (like Vicks Vaporub) on your chest according to package instructions.
• For nasal stuffiness, use saline drops. You can buy these at drugstores or prepare a solution at home. Just dissolve 1/4 teaspoon salt in 8ounces of water. Place a few drops in each nostril, wait 5 to 10 minutes, and then gently blow your nose.
• To make breathing easier, sleep in a recliner or prop up your head with lots of pillows so that you are in a semi-upright position.
• Take a warm shower. This can help clear nasal stuffiness and mucus.
• Get plenty of rest.
   

Medications
While it is generally best to avoid exposing a fetus to medications, especially in the first trimester when its organs are forming, sometimes drugs are necessary either for medical reasons or for symptom relief. (For more information, see the article Medications in Pregnancy: General Principles, which explains the FDA's safety classes for medicines.
 

• Decongestants. This group of medications is used to treat colds or allergies. Pseudoephedrine (Sudafed), an FDA category C drug (to be used only if the benefits outweigh the risks), can be bought over the counter and is present in antihistamines as well as in cold remedies. These medications are not recommended for anyone who has high blood pressure, pregnant or not. If possible, avoid taking pseudoephedrine in the first trimester.
• Cough suppressants and expectorants. Dextromethorphan, a common ingredient found in cough and cold medications (such as Robitussin), is probably safe for use in pregnancy. While the FDA has labeled it category C, some large studies suggest that it does not cause any increase in birth defects or complications of pregnancy. Guaifenesin is an expectorant in many cough and cold medicines. It, too, is listed under category C but is probably safe as well.

Treating pain and fever.
Pain is bad because it hurts. Fever is bad because it overheats the fetus. Fever is unhealthy for the fetus throughout pregnancy, but high fever in the first trimester is thought to be responsible for certain birth defects, including problems in brain and spine development. It's generally best to follow this rule: If you get a fever in pregnancy, take medications to bring it down, and if you cannot reduce your temperature, call your doctor.

• Fever also increases sweating and fluid loss, so be sure to drink lots of cool fluids when you have a high temperature. Most pregnant women can take acetaminophen (Tylenol) throughout the pregnancy without a problem. If you are a heavy drinker (three or more drinks a day), you need to discuss this with your practitioner, not only because alcohol and acetaminophen can be a lethal combination, but also because drinking while pregnant has health implications for your baby. Ibuprofen is probably safe to take in the first and second trimesters, but it may cause problems for the baby's circulation after 32 weeks' gestation. Aspirin is usually not recommended in pregnancy.

A persistent fever or severe illness in pregnancy always warrants a call to your doctor.

• Zinc lozenges. Zinc lozenges (and more recently, nasal sprays) have been used to speed recovery from the common cold. Lower doses of Zinc are safe, but I'm not aware of any good information about the safety of using zinc lozenges while pregnant.
• Echinacea tea. One study that looked at the use of echinacea during the first trimester found no increase in birth defects. It's generally considered safe for use in pregnancy, but you should be aware that it has not been tested extensively.

What over-the-counter medicines are considered safe during pregnancy?

Cold symptoms and hay fever: (If you have high blood pressure, talk to your doctor first)

• Chlor-Trimeton - antihistamine
• Sudafed - decongestant
• Actifed - antihistamine and decongestant
• Read the label and follow directions for use and dosage

Cough symptoms:

• Robitussin or Robitussin DM

Constipation:

• Docusate (Colace) 100 mg twice a day
• Metamucil - 1-2 teaspoon with 8 oz juice or water
• Milk of Magnesia - 1-2 Tablespoon every evening
• Do not use mineral oil.

Minor headache or body ache:

• Tylenol or any acetaminophen preparations, 2 tablets or 650 mg every 4 hours.

Do not take aspirin during your pregnancy unless instructed to do so by your physician. Aspirin may interfere with blood clotting and cause problems during labor and delivery.  Do not take ibuprofen (such as Advil or Motrin) unless instructed by your physician.

If headache persists for more than 24 hours, call the office.

Heartburn:

• Amphogel
• Gelusil
• Maalox
• Do not use baking soda or Pepto bismol.

Fever or chills
Take your temperature if you feel unusually hot or cold. If you do not have a thermometer try to get one so you can tell the doctor or nurse what your temperature is. If your temperature is above 100.5 call the office. If your temperature is less than 100.5 take Tylenol 650 mg every 4 hours. If your fever lasts longer than 48 hours call the office.