A cough during pregnancy is common, but treatment requires careful consideration to ensure the well-being of both the expectant mother and the developing fetus. Physiological changes during pregnancy can sometimes prolong the duration of a cold or flu. Before introducing any medication, even those available over-the-counter, consulting with a healthcare provider is the most important step. Treatment should focus on minimizing exposure to unnecessary substances while prioritizing safety for the pregnancy.
Non-Pharmacological Relief Strategies
The safest initial approach for managing a cough involves drug-free, supportive measures. Increasing fluid intake, such as water, warm teas, and clear broths, helps thin mucus secretions in the respiratory tract. Thinner mucus is easier to expel, which reduces the frequency and severity of coughing spells.
Using a humidifier, especially overnight, introduces moisture into the air, soothing irritated airways. Inhaling steam from a hot shower or a bowl of hot water helps loosen congestion in the chest and nasal passages, making the cough more productive. Saline nasal rinses or sprays can alleviate post-nasal drip, a frequent cause of chronic cough, by flushing irritants and excess mucus from the sinuses.
Honey is a simple, effective remedy that acts as a demulcent to coat the throat, calming nerve endings that trigger the cough reflex. Take one to two teaspoons of honey directly or mix it into warm water or decaffeinated tea. Elevating the head of the bed with extra pillows while sleeping helps prevent mucus from pooling in the throat. This position minimizes nighttime coughing caused by post-nasal drip or reflux.
Over-the-Counter Medications Generally Considered Safe
When non-drug methods do not provide sufficient relief, some over-the-counter active ingredients are considered low-risk for use during pregnancy, but only after consulting a healthcare professional. Dextromethorphan (DM) is a cough suppressant that manages dry, hacking coughs by acting on the cough center in the brain. Studies indicate that DM has an established safety profile and is the preferred antitussive agent.
Guaifenesin is often recommended as an expectorant to thin and loosen mucus, which is helpful for a wet or productive cough. While generally considered safe, some earlier studies suggested a possible association with the rare birth defect, the inguinal hernia. Due to this conflicting data, it is recommended to use guaifenesin sparingly and ideally after the first trimester, when the major organs of the fetus have developed.
For any medication, the guiding principle is to use the lowest effective dose for the shortest period necessary to relieve symptoms. Liquid formulations should be checked to ensure they do not contain alcohol or other contraindicated substances. Choosing a product with only one active ingredient, such as plain Dextromethorphan, is better than using a multi-symptom formula.
Medications and Ingredients to Avoid
Certain common cold and cough ingredients carry known risks and should be avoided during pregnancy unless specifically directed by a doctor. Decongestant ingredients like pseudoephedrine and phenylephrine are linked to a potential risk of vascular disruptions, which is why they are often contraindicated, particularly in the first trimester. These ingredients can also affect blood flow, which is a concern for those with high blood pressure.
High-dose aspirin should not be used to treat a cough or cold. Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen should be avoided, especially after 20 weeks of gestation. NSAID use in the second half of pregnancy can cause kidney problems in the fetus. In the third trimester, they can lead to premature closure of the ductus arteriosus, a blood vessel in the baby’s heart.
Many liquid cough and cold formulations contain alcohol, often used as a solvent or preservative. Since no amount of alcohol consumption is considered safe during pregnancy, read labels carefully and choose products explicitly marked as alcohol-free. Combination cold remedies should be avoided because they expose the fetus to multiple drugs that may not be needed for the primary symptom. Specific herbal remedies, including high-dose supplements like echinacea or elderberry, lack sufficient safety data for use during pregnancy and should also be avoided.
When a Cough Requires Medical Attention
While most coughs are caused by common, self-limiting viruses, certain symptoms indicate a more serious underlying condition that requires immediate medical evaluation. Contact your healthcare provider without delay if you experience a fever of 100.4°F (38°C) or higher that does not respond to a safe fever reducer like acetaminophen. A persistent fever can pose risks and should be professionally managed.
Shortness of breath, difficulty breathing, or wheezing are serious warning signs that suggest a respiratory complication, such as pneumonia or an asthma exacerbation. Chest pain, rapid breathing, or a cough that produces blood or thick, discolored sputum also necessitate an urgent medical assessment. If a cough persists for longer than seven to ten days despite consistent home treatment, it may indicate a bacterial infection or another condition requiring prescription treatment.