Safe Treatments for Cold Symptoms During Pregnancy

First-Line Safe Treatments

Saline nasal rinses are safe and effective for nasal congestion and sore throat during pregnancy, according to the American Academy of Otolaryngology 1
Acetaminophen is the preferred medication for pain and fever control during pregnancy, as recommended by the American College of Obstetricians and Gynecologists 2
Intranasal corticosteroids, such as budesonide, may be used safely for persistent nasal symptoms during pregnancy, with a moderate strength of evidence 3

Topical nasal decongestants may be used for short-term relief (up to 7 days maximum) but should be used cautiously to avoid rebound congestion, as advised by the American Academy of Allergy, Asthma, and Immunology 4
Second-generation antihistamines, such as cetirizine or loratadine, can be considered for allergic symptoms during pregnancy, with a low strength of evidence 3, 4
Montelukast can be continued if the patient has shown a favorable response prior to pregnancy, particularly for those with coexisting asthma, according to the American Thoracic Society 1, 3

Oral decongestants should be avoided, especially during the first trimester, due to potential risks including fetal gastroschisis and maternal hypertension, as warned by the American College of Obstetricians and Gynecologists 1, 5
First-generation antihistamines should be avoided due to their sedative and anticholinergic properties, as recommended by the American Academy of Pediatrics 1, 5
NSAIDs, except for non-selective NSAIDs before 32 weeks, should generally be avoided during pregnancy, according to the American College of Rheumatology 1
Aspirin is considered category D in pregnancy and should be avoided, as classified by the FDA 1

For bacterial infections, such as sinusitis or tonsillitis, beta-lactam antibiotics are considered safe with appropriate dose adjustments, as recommended by the Infectious Diseases Society of America 2
Immunotherapy for allergic rhinitis may be continued during pregnancy but without dose escalation, as advised by the American Academy of Allergy, Asthma, and Immunology 3, 4