When you're pregnant and fighting a cold or the flu, the last thing you want is to take something that could hurt your baby. But you also don’t want to suffer through fever, congestion, or a cough that won’t quit. The truth is, not all over-the-counter meds are created equal when you're expecting. Some are perfectly safe. Others carry real risks - and you might be taking them without even knowing.
What’s Safe to Take
The safest choice for fever and pain during pregnancy is acetaminophen (Tylenol). It’s been studied in more than 50,000 pregnancies, and no link has been found to birth defects, even when used in the first trimester. If you have a headache, sore throat, or body aches, acetaminophen is your go-to. Stick to the lowest dose that works, and don’t take it longer than necessary.
For a cough, dextromethorphan (found in Robitussin DM) is considered safe for short-term use. Studies tracking hundreds of pregnant women who took it in early pregnancy showed no increase in birth defects. Just make sure you’re getting the plain version - avoid anything with alcohol, antihistamines, or decongestants mixed in.
If you’re dealing with thick mucus, guaifenesin (plain Mucinex) helps loosen it up. Again, check the label. Some versions combine it with other ingredients that aren’t safe. Stick to the ones that list only guaifenesin as the active ingredient.
For runny nose or allergies, second-generation antihistamines like loratadine (Claritin) and cetirizine (Zyrtec) are preferred. They don’t cause drowsiness like older options (like diphenhydramine), and research shows they’re unlikely to affect fetal development.
Topical treatments like Vicks Vapor Rub and menthol cough drops are also fine. They work locally and don’t enter your bloodstream in significant amounts. Saline nasal sprays and humidifiers are just as helpful - and completely risk-free.
What to Avoid Completely
Stay away from any medication containing ibuprofen (Advil, Motrin), naproxen (Aleve), or aspirin unless your doctor specifically prescribes it. These are NSAIDs, and they can affect fetal kidney development, reduce amniotic fluid, and even trigger early labor if taken after 20 weeks. Even a single dose in the third trimester can be risky.
Codeine is off-limits. The FDA warned in 2021 that codeine can cause dangerous breathing problems in newborns, especially if taken near delivery. It’s been used for years as a cough suppressant, but it’s no longer considered safe in pregnancy.
Decongestants like phenylephrine (Sudafed PE) and pseudoephedrine (Sudafed) are tricky. Some sources say they’re okay; others say avoid them. The safest approach? Skip them entirely unless your provider says otherwise. Phenylephrine has been linked to rare but serious birth defects in early pregnancy. Pseudoephedrine can reduce blood flow to the placenta, which isn’t worth the risk when you have other options.
And here’s where people get caught: combination cold and flu meds. DayQuil, NyQuil, Mucinex FastMax, and similar products often mix acetaminophen, dextromethorphan, antihistamines, and decongestants - sometimes even alcohol. Even if one ingredient is safe, the others might not be. NyQuil Liquid, for example, contains up to 15% alcohol. That’s not just a little - that’s the equivalent of a drink or two in a single dose. Caplets without alcohol are less risky, but still not ideal. Stick to single-ingredient products so you know exactly what you’re taking.
What About the Flu?
If you think you have the flu - sudden fever, chills, body aches, fatigue - don’t wait. Call your provider right away. The flu is more dangerous during pregnancy. You’re at higher risk for pneumonia, hospitalization, and even ICU admission. The good news? Antivirals work.
Oseltamivir (Tamiflu) is the first-line treatment. Studies show it doesn’t increase the risk of birth defects, and it’s most effective when started within 48 hours of symptoms. But even if you’re past that window, treatment still helps. The CDC and ACOG both say: if you have flu symptoms, treat it - even if you haven’t been tested. Don’t wait for confirmation.
Zanamivir (Relenza) is another option, inhaled rather than taken orally. It’s considered safe, but not everyone can use it if they have asthma or breathing issues. Baloxavir (Xofluza) is not recommended because there’s no safety data yet. Stick with what’s proven.
What About Vaccines?
The best way to avoid the flu and RSV is to prevent them in the first place. The inactivated flu vaccine is safe during any trimester and is recommended for every pregnant person during flu season (October to May). It doesn’t just protect you - it passes antibodies to your baby, giving them protection for the first few months after birth.
There’s also the Abrysvo vaccine, which protects against RSV. It’s recommended for pregnant people between 32 and 36 weeks. RSV can cause severe breathing problems in newborns, and this vaccine reduces that risk by up to 80%. Talk to your provider about timing.
Herbal Remedies and Supplements
Don’t assume “natural” means safe. The FDA doesn’t regulate herbal supplements, so you have no idea what’s actually in them. Echinacea, elderberry, zinc lozenges, and even honey-based cough syrups labeled “pregnancy safe” aren’t backed by solid research. Some herbs can stimulate contractions or interfere with hormones. Stick to what’s been studied - not what’s marketed.
Non-Medication Strategies That Work
Before you reach for a pill, try these:
- Drink plenty of water - dehydration makes congestion worse.
- Rest as much as you can - your body needs energy to fight the virus.
- Use a saline nasal spray or neti pot to clear your sinuses.
- Run a cool-mist humidifier in your bedroom at night.
- Sip warm broth or tea with lemon and honey (honey is safe after 12 weeks).
- Gargle with salt water for a sore throat.
These aren’t just “home remedies” - they’re evidence-backed ways to reduce symptoms without medication. And when you combine them with safe meds like acetaminophen or dextromethorphan, you’re doing everything right.
When to Call Your Provider
You don’t need to panic over every sniffle. But call your doctor if:
- Your fever stays above 101°F for more than 24 hours.
- You have trouble breathing or chest pain.
- You feel dizzy, confused, or notice less fetal movement.
- Your symptoms get worse after 5-7 days.
- You’re not sure whether a medication is safe.
When in doubt, always check. A quick call to your OB or midwife can save you from a risky mistake.
Can I take Tylenol while pregnant?
Yes, acetaminophen (Tylenol) is the safest over-the-counter pain and fever reliever during pregnancy. Studies involving over 50,000 pregnancies have found no increased risk of birth defects, even with use in the first trimester. Stick to the lowest effective dose and avoid long-term daily use unless directed by your provider.
Is NyQuil safe during pregnancy?
No, NyQuil Liquid is not safe during pregnancy because it contains alcohol (up to 15%) and often includes dextromethorphan, antihistamines, and phenylephrine - all of which carry risks. Even NyQuil caplets without alcohol are not recommended because they still contain multiple ingredients that may be unsafe. Use single-ingredient medications instead.
Can I take Sudafed while pregnant?
Pseudoephedrine (Sudafed) is controversial. Some providers say it’s okay in limited doses after the first trimester, but others advise against it due to potential effects on placental blood flow. Phenylephrine (Sudafed PE) is clearly not recommended because of links to rare birth defects. The safest choice is to avoid oral decongestants altogether and use saline sprays or humidifiers instead.
Is it safe to get the flu shot while pregnant?
Yes, the inactivated flu vaccine is safe and recommended during any trimester. It protects both you and your baby. Babies born to vaccinated mothers are less likely to get the flu in their first few months of life. The CDC and ACOG both strongly support flu vaccination during pregnancy.
What should I do if I have the flu while pregnant?
Call your provider immediately. Don’t wait for a test result. Oseltamivir (Tamiflu) is the preferred antiviral and is safe during pregnancy. Starting treatment within 48 hours helps, but even after that, it can still reduce complications. The flu is more dangerous during pregnancy - untreated, it can lead to pneumonia, hospitalization, or preterm labor.
Are herbal cough syrups safe during pregnancy?
No. The FDA does not regulate herbal supplements, so there’s no guarantee of safety, purity, or dosage. Ingredients like echinacea, elderberry, or licorice root may affect hormones or uterine contractions. Stick to proven, single-ingredient medications like dextromethorphan or saline remedies instead.
Final Thoughts
Pregnancy doesn’t mean you have to suffer through every cold or flu. But it does mean you need to be smarter about what you take. The safest strategy is simple: start with rest, fluids, and non-medication remedies. If you need medicine, pick one ingredient at a time. Always check labels. And when you’re unsure - call your provider. There’s no shame in asking. Your baby’s health is worth the extra step.