What are the best ways to manage a dry cough during pregnancy?

Managing Dry Cough During Pregnancy

For pregnant women with dry cough, saline nasal rinses and topical corticosteroid nasal sprays are the safest and most effective first-line treatments, with acetaminophen recommended for symptomatic relief. 1, 2

Initial Assessment

• Determine if the cough is associated with specific symptoms that might indicate a serious underlying condition (specific cough pointers) or if it's a non-specific dry cough 1
• Evaluate for common causes of dry cough during pregnancy:
  • Gastroesophageal reflux (present in up to 97% of pregnant women with cough) 3
  • Asthma (may worsen in approximately one-third of pregnant women) 4, 5
  • Allergic rhinitis 1, 3
  • Upper respiratory tract infections 1, 6

First-Line Management for Dry Cough in Pregnancy

Non-Pharmacological Approaches

• Increase fluid intake to help thin secretions 1
• Use saline nasal rinses to reduce postnasal drip, which is safe during pregnancy 1
• Elevate the head of the bed to reduce reflux symptoms if GERD is suspected 1
• Avoid known triggers (smoke, allergens, irritants) 4

Safe Pharmacological Options

• Acetaminophen for symptomatic relief (FDA approved during pregnancy with healthcare provider consultation) 2, 7
• Topical nasal corticosteroids for cough related to allergic rhinitis or postnasal drip 1
• First-line approach for asthma-related cough: short-acting beta-agonists (preferably albuterol) 8

Treatments to Avoid During Pregnancy

• Oral decongestants should not be used due to risk of fetal gastroschisis and maternal hypertension 1
• First-generation antihistamines should be avoided due to sedative and anticholinergic properties 1
• Anti-leukotriene medications should generally be avoided for cough management during pregnancy 1
• Tetracyclines, aminoglycosides, trimethoprim-sulfamethaxazole, and fluoroquinolones should not be used 1

When to Consider Additional Evaluation

• If cough persists beyond 2-4 weeks despite first-line treatment 1
• If accompanied by fever, shortness of breath, chest pain, or hemoptysis 1, 9
• Consider pertussis testing if cough is paroxysmal with post-tussive vomiting (vaccination between 27-36 weeks is recommended for prevention) 6, 10

Special Considerations

• Asthma symptoms may worsen during the second and third trimesters of pregnancy 4, 5
• Uncontrolled respiratory symptoms during pregnancy can increase risks of preterm birth, low birthweight, and pre-eclampsia 4, 8
• Monthly monitoring of persistent respiratory symptoms is recommended throughout pregnancy 4
• For cough due to reflux, dietary modifications and avoiding eating before bedtime should be tried before medications 1, 3

Common Pitfalls to Avoid

• Discontinuing necessary medications due to unfounded safety concerns 8
• Failing to recognize that dry cough may be the only symptom of conditions like asthma or GERD during pregnancy 1, 3
• Delaying treatment of persistent cough, which can lead to complications for both mother and fetus 4, 8