Getting a cold during pregnancy is one of those experiences that sounds minor but quickly becomes complicated when you discover that your usual remedies are off limits. The medicines that would normally see you through a cold in three days are either not recommended or require careful consideration. Meanwhile the cold itself tends to feel worse than usual because your immune system is already working differently during pregnancy.
This guide covers what is safe, what to avoid, and what actually helps when you have a cold in pregnancy.
Why Colds Are More Common and Often Feel Worse in Pregnancy
The immune system in pregnancy makes specific adjustments to prevent the body from rejecting the developing baby. One effect of these adjustments is a reduced ability to fight off some common viruses, which is why many pregnant people find they catch colds more frequently than before pregnancy and recover more slowly.
There is also the practical reality that when you are pregnant, particularly in the first trimester, symptoms that overlap with pregnancy (nausea, fatigue, feeling generally awful) are already part of daily life. A cold landing on top of those symptoms can feel disproportionately miserable even when it is medically straightforward.
What Is Safe to Take for a Cold in Pregnancy
Paracetamol
Paracetamol is the recommended first-line pain and fever reliever throughout pregnancy. It has been used by pregnant women for decades and is considered safe at recommended doses.
Use the standard adult dose (typically 500mg to 1000mg every four to six hours, not exceeding 4000mg in 24 hours). Do not take paracetamol for longer than three days without consulting your GP.
A note of caution: some cold and flu products such as Lemsip and Beechams contain paracetamol alongside other ingredients. If you are taking a combination product, check the total paracetamol dose carefully to avoid accidentally exceeding the maximum.
Saline Nasal Spray or Drops
Saline nasal spray or rinse is one of the safest and most effective remedies for nasal congestion during pregnancy. It contains no medication, only salt and water, and it works by thinning mucus and flushing out the nasal passages.
It can be used as frequently as needed and is available without prescription at any pharmacy. Some people find it more effective when combined with steam inhalation.
Steam Inhalation
Breathing steam from a bowl of hot water, or sitting in a steam-filled bathroom, helps loosen mucus and relieve congestion. It is safe, free and genuinely effective. Adding a small amount of menthol or eucalyptus to the water can help open the airways further.
Honey and Lemon
Honey and lemon in hot water is an effective throat soother. The honey coats the throat and has mild antibacterial properties. There is reasonable evidence that honey is at least as effective as over-the-counter cough suppressants for soothing a cough. Use pasteurised honey only.
Ginger
Ginger tea made from fresh ginger root is both safe in pregnancy and useful for any nausea that accompanies a cold. It has mild anti-inflammatory properties and is a traditional remedy in multiple cultures for cold and flu symptoms.
Throat Lozenges
Sugar-free throat lozenges and some medicated lozenges are generally considered safe in pregnancy. Check the ingredients: lozenges containing only anaesthetic (like benzocaine) or antiseptic ingredients (like cetylpyridinium chloride) in small amounts are typically considered low risk. Avoid lozenges with high doses of zinc, which is sometimes found in cold-remedy lozenges.
Rest and Hydration
Not glamorous advice, but genuinely the most effective management for a cold. The immune system requires energy and fluid to fight infection. Prioritising sleep, drinking plenty of water, and eating easily digestible foods shortens recovery time more reliably than most over-the-counter products.
What to Avoid When You Have a Cold in Pregnancy
Ibuprofen and Aspirin (NSAIDs)
Ibuprofen (Nurofen, Advil) is not recommended during pregnancy, particularly from 20 weeks onward. From 20 weeks, ibuprofen can affect the kidneys of the developing baby and reduce amniotic fluid levels. Before 20 weeks it should also be avoided unless specifically advised by a doctor. Aspirin at full therapeutic doses is similarly avoided during pregnancy.
If you are in pain or have a fever and paracetamol is not sufficient, speak to your GP before taking any NSAID.
Decongestants (Pseudoephedrine, Phenylephrine)
Over-the-counter decongestants including pseudoephedrine (found in Sudafed) and phenylephrine (found in many cold and flu products) are generally not recommended during pregnancy. These ingredients work by constricting blood vessels, which can reduce blood flow to the placenta and the developing baby.
Some formulations of Sudafed contain different active ingredients. Always check the specific product and confirm with your pharmacist before taking any decongestant.
Most Cough and Cold Combination Products
Products like Night Nurse, Day Nurse, Benylin, Actifed and most branded cold and flu sachets contain combinations of ingredients, some of which are not suitable for pregnancy. Rather than trying to evaluate each one individually, the safest approach is to avoid multi-ingredient cold products during pregnancy and treat symptoms individually with the safe single-ingredient options above.
Zinc Lozenges at High Doses
Some cold remedies (including some forms of Cold-Eeze) use high-dose zinc as the active ingredient. High doses of zinc are not recommended in pregnancy, so these should be avoided.
High-Dose Vitamin C Supplements
Food sources of vitamin C are safe and beneficial in pregnancy. Very high-dose vitamin C supplements (above 1000mg per day) are not recommended.
What About Cough Medicines in Pregnancy?
Cough medicines require careful attention because they vary significantly in their ingredients.
Glycerol-based cough medicines (such as simple linctus) are generally considered safe. These work by coating the throat rather than by pharmacological action.
Pholcodine-based cough suppressants are generally avoided in pregnancy.
Guaifenesin (an expectorant found in some cough medicines) has limited safety data in pregnancy. Some sources consider it low risk in the second and third trimesters but advise caution in the first trimester.
Dextromethorphan (a cough suppressant found in many combination products) has limited safety data. It is not specifically contraindicated but is generally advised to avoid, particularly in the first trimester.
If you have a persistent, disruptive cough and are unsure what to take, asking your pharmacist is the most practical approach. NHS pharmacists can advise on specific products based on your trimester and overall health.
When to See a Doctor About a Cold in Pregnancy
Most colds in pregnancy are viral and resolve on their own within a week to ten days. However, see your GP or midwife, or call 111, if you experience:
- A temperature above 38 degrees Celsius that does not respond to paracetamol
- Difficulty breathing or shortness of breath
- Chest pain
- A cough that produces yellow, green or brown mucus (which can indicate a secondary bacterial infection)
- Symptoms that worsen significantly after initially improving
- Reduced fetal movement alongside cold symptoms
- Symptoms lasting more than ten days without improvement
- Any concerns about flu (influenza), which carries specific risks in pregnancy and for which antiviral treatment is available
A Note on Flu vs a Cold
Flu is significantly different from a cold in pregnancy. Influenza can cause serious complications in pregnant people, including preterm labour and pneumonia. The flu vaccine is free for all pregnant women at any stage of pregnancy through the NHS and is strongly recommended. If you think you have flu rather than a cold (sudden onset, high fever, severe muscle aches, significant prostration rather than just a stuffy nose) contact your GP or 111 promptly.
Quick Reference Summary
| Remedy | Safe in Pregnancy? |
|---|---|
| Paracetamol | Yes, at recommended doses |
| Saline nasal spray | Yes |
| Steam inhalation | Yes |
| Honey and lemon | Yes (pasteurised honey) |
| Ginger tea | Yes |
| Simple throat lozenges | Generally yes, check ingredients |
| Ibuprofen | No |
| Aspirin (full dose) | No |
| Decongestants (pseudoephedrine, phenylephrine) | No |
| Night Nurse / Day Nurse | No (combination product) |
| High-dose zinc lozenges | No |
