What is the management of cough and colds in pregnant women?

Management of Cough and Colds in Pregnant Women

For pregnant women with cough and cold symptoms, treatment should prioritize non-pharmacological approaches first, with careful selection of medications when necessary, as maintaining maternal respiratory health is essential for both maternal and fetal well-being.

Non-Pharmacological Management

• Adequate hydration and nutrition should be maintained throughout pregnancy to support overall health and immune function 1
• Saline nasal douching/lavage is safe during pregnancy and can provide relief for nasal congestion 2
• Proper positioning (elevating the head while sleeping) can help reduce congestion and improve breathing 2
• Exercise, as tolerated, may help improve respiratory function and overall well-being 2
• Nasal valve dilators are safe in pregnancy and can benefit patients with rhinitis of any etiology 2

Pharmacological Management

For Nasal Congestion

• Topical corticosteroids are generally safe, with budesonide having the strongest safety profile and recommendations 2
• Oral decongestants should be avoided, particularly in the first trimester, due to potential associations with cardiac, ear, gut, and limb abnormalities 3, 2
• Cromones are considered first-line options for pregnant women with allergic rhinitis with no reported increased risk of teratogenicity 2

For Cough

• For short-term symptomatic relief of cough, peripheral cough suppressants like levodropropizine may be considered for short-term use 1
• Dextromethorphan requires consultation with a healthcare provider before use during pregnancy 4
• Ipratropium bromide is the only recommended inhaled anticholinergic agent for cough suppression 1

For Asthma-Related Symptoms

• Albuterol is the preferred short-acting beta-agonist during pregnancy due to extensive safety data 5
• For asthma exacerbations, albuterol should be administered promptly (2-4 puffs via MDI as needed or 2.5 mg via nebulizer every 20 minutes for 3 doses, then every 1-4 hours as needed) 3, 5
• Inhaled corticosteroids are the preferred long-term control medications for asthma during pregnancy, with budesonide having the most safety data 3, 6

Special Considerations

• Monthly evaluations of respiratory symptoms and pulmonary function are recommended throughout pregnancy for women with chronic respiratory conditions 5, 6
• Inadequate control of respiratory symptoms poses a greater risk to the fetus than the medications used to treat them 1, 5
• For pregnant women with influenza symptoms, prompt antiviral therapy should be initiated as these medications reduce the risk of complications and attenuate potential teratogenic effects of influenza infection 7

Management Algorithm

1. Begin with non-pharmacological approaches (hydration, saline nasal rinses, positioning)
2. If symptoms persist:
   • For nasal congestion: Consider topical corticosteroids (preferably budesonide) 2
   • For cough: Consider ipratropium bromide for short-term relief 1
   • For asthma symptoms: Use albuterol as needed and consider inhaled corticosteroids for persistent symptoms 3, 5
3. Avoid:
   • Oral decongestants, especially in first trimester 3, 2
   • Excessive use of cough suppressants 1, 4
   • Untreated respiratory infections that could compromise maternal and fetal oxygenation 1, 7

Common Pitfalls to Avoid

• Withholding necessary respiratory medications due to pregnancy concerns, as uncontrolled respiratory symptoms pose greater risks to both mother and fetus 1, 3, 5
• Using oral decongestants in early pregnancy due to potential association with rare birth defects 3, 2
• Failing to recognize that allergic symptoms may be either attenuated or worsened during pregnancy 8
• Not reading medication labels carefully to avoid unnecessary drug exposure 9