Safe OTC Medications for Cough, Congestion, and Upper Respiratory Infections During Pregnancy

First-Line Safe Treatments

The American College of Obstetricians and Gynecologists recommends saline nasal rinses as the safest and most effective treatment for nasal congestion in pregnant women, with no systemic absorption and zero fetal risk 1, 2, 3
The American Academy of Family Physicians suggests acetaminophen as the preferred medication for pain and fever control during pregnancy, to be used at the lowest effective dose for the shortest possible time 3
Intranasal corticosteroid sprays, such as budesonide, are safe for persistent congestion in pregnant women, with minimal systemic absorption 1, 2, 3, 4, 5

The American College of Allergy, Asthma, and Immunology recommends albuterol as the preferred treatment for asthma-related cough in pregnant women, with extensive safety data and no evidence of fetal injury 5, 4, 6
Ipratropium bromide may be used for non-asthmatic cough in pregnant women, as the only recommended inhaled anticholinergic in pregnancy 6
Second-generation antihistamines, such as cetirizine or loratadine, can be considered for allergic symptoms in pregnant women, but only when symptoms significantly impact quality of life 3

The American College of Obstetricians and Gynecologists advises against the use of oral decongestants, such as pseudoephedrine and phenylephrine, in pregnant women, especially in the first trimester, due to the risk of fetal gastroschisis and maternal hypertension 1, 2, 3
First-generation antihistamines, such as diphenhydramine and chlorpheniramine, should be avoided in pregnant women due to their sedative and anticholinergic effects 1, 2, 3
Aspirin and NSAIDs, such as ibuprofen and naproxen, are contraindicated in pregnant women due to the risk of fetal complications, especially after 32 weeks 1, 3

The American College of Obstetricians and Gynecologists states that inadequately controlled respiratory symptoms pose a greater risk to the fetus than the medications used to treat them, and that maternal hypoxia from severe symptoms is more dangerous than appropriate medication use 6, 5
The American Academy of Family Physicians recommends never withholding necessary respiratory medications due to pregnancy concerns, and to evaluate for asthma, bacterial infection, or other serious causes if symptoms persist 6

Budesonide has the most safety data during pregnancy and is classified as Category A by the Australian TGA, indicating its compatibility during pregnancy 7

The Centers for Disease Control and Prevention recommends against using influenza antivirals without clear indication, as these should only be used if potential benefit justifies potential risk to the fetus 8, 9, 10, 11