Is That a Sniffle?

As we know, pregnancy generally lasts around nine months. Unfortunately, this means that almost all expectant moms will be pregnant during cold and flu season. Although these illnesses are usually harmless, self-limited and treatable easily, it’s important to spot some of their early warning signs so you can start managing symptoms before they lead to full-blown illness.

Even more importantly, being pregnant puts you at a slightly increased risk of suffering from larger complications from upper respiratory illnesses, due to some particular changes in your physiology and breathing capacity. Fortunately, in many cases, treating these types of illnesses early on will result in a reduction of both the length and severity of the illness.

Upper Respiratory Illnesses
In general, upper respiratory illnesses (such as the common cold) have what healthcare providers refer to as “an insidious onset.” Patients often won’t be able to pinpoint exactly when they first began to feel ill with most of their symptoms. For example, they may say, “I started feeling a little tired on Tuesday. Then on Wednesday I started having a sore throat, and on Thursday I began coughing.”

Although most patients may not pay much attention to such detail, it’s important as it may help to distinguish between an upper respiratory infection and the flu (which tends to come on much more quickly).

Upper respiratory illnesses also usually share the following features: No fever is present (temperature is below 100.5 ° F), but there is a cough (frequently producing phlegm) and fatigue (although generally mild).

In general, most simple upper respiratory infections will improve on their own within about ten days. However, some unlucky patients will have a cough that tends to linger even after the illness has gone. This is especially common in those who have a history of asthma.

For symptoms that are particularly bothersome, there are some medications thought to be safer than others during pregnancy. Symptoms of upper respiratory illnesses and some of the medications that are safe for treating them — along with which to avoid — follow.

Note that if you are pregnant, it’s important to talk to your healthcare provider about any medications you take or wish to use during pregnancy.

• For runny nose/sneezing/throat pain: saline nasal irrigation or spray, aesthetic lozenges such as benzocaine, cromolyn sodium nasal spray.

• For fever: acetaminophen. Although not yet proven conclusively, it’s best to avoid NSAIDs such as ibuprofen during pregnancy unless otherwise directed by your provider.

• For a cough: Unfortunately, there is not enough evidence to show that any particular cough medicine is especially safe during pregnancy. Ones to avoid for certain would be those containing codeine.

• For congestion: decongestants — intranasal inhalers for patients with particularly bothersome symptoms only; avoid pseudoephedrine, as it can cause problems during pregnancy and in the baby after pregnancy. Avoid phenylephrine during pregnancy as well for the same reasons.

Influenza
Unfortunately, the flu tends to cause bigger problems in women who are expecting than in those who are not pregnant. The increased severity is due, in part, to the changes that occur in a women’s body when she is pregnant. For this reason, it’s important to pay close attention to possible changes during flu season and to seek care immediately if you have any of the above symptoms.

Also note that the Centers for Disease Control and Prevention (CDC) recommends that pregnant women receive a flu shot during any trimester of pregnancy to protect themselves and their newborn babies from the flu (although the vaccine will not prevent illness a hundred percent).

In contrast to upper respiratory illnesses, the flu tends to come on much more rapidly. Patients may say, “I wasn’t feeling well when I was at work this morning, so I cam home. When I got home, I took a nap because I felt so tired. When I woke up, I had a headache, fever, body aches and a really bad sore throat.”

This reaction is different from that of upper respiratory illnesses, which frequently take two to three days for the development of all of their symptoms. When patients come down with the flu, they often feel extremely ill. Symptoms of the flu usually include a fever higher than 100.5° F, a sore throat, no cough (or, if present, a dry cough) and body aches. 

Since the flu vaccine isn’t perfect, it is important to keep a close eye on possible symptoms so treatment can be started right away if you do contract the flu. The reason that is so important is that the medications that treat the flu, such as oseltamivir, are significantly more effective if begun within two days of the beginning of symptoms.

Antiviral medications like oseltamivir work by preventing the replication of the flu. You need to start them as early as possible, so the virus doesn’t have too much time to reproduce inside of you. However, even if you miss the symptoms early on and are concerned you may have the flu, there are still benefits to starting anti-flu medications even after two days of symptoms.

Common Allergies
The first step in treating allergies is preventing exposure to the allergen (the cause of the allergy) — particularly important in pregnant women since there really aren’t too many types of treatment recommended for allergy control. In addition, if you have had severe allergic reactions in the past, it may be a good idea to tell your provider so formal allergy testing can be performed, ideally before becoming pregnant. That way, you’ll know exactly what you should try to avoid. However, it’s not always possible to avoid all types of allergens all the time during pregnancy. A few treatment options follow. Non-pharmacologic (non-medicinal) treatment is recommended first, since it’s always best to avoid medication whenever possible.

Non-pharmacologic Options

• Nasal saline rinses (particularly useful for seasonal allergies to antigens like pollen and grass).

• Nasal dilator strips.

• Exercise (yes, believe it or not, regular exercise has actually been shown to reduce allergies by resulting in a process known as vasoconstriction of nasal blood vessels).

• Keeping the head of your bed elevated at around 30 to 45 degrees.

Pharmacologic Options

• Intranasal cromolyn sprays (especially useful for allergic rhinitis).

• Oral antihistamine medications such as loratadine.

Pharmacologic Drugs to Avoid

• Oral decongestants such as pseudoephedrine, especially during first trimester of pregnancy, as it may cause a slight increase in blood pressure.

• Intranasal steroid sprays (it’s best to avoid triamcinolone during the first trimester).

Shane Drahos, MD, is a primary care physician currently at Stanford University completing a fellowship in sleep medicine.