Contributor: Megan Hurley, MD

Educational Pearls:

Fevers

• Tylenol

• Up until 20 weeks NSAIDs are ok but after 20 weeks they are contraindicated

• Can limit the amount of amniotic fluid produced

• Can lead to growth restriction

• Can cause premature closure of the ductus arteriosus

Cough

• Cough drops

• Humidifier

• Guafenesine and dextromethorphan (Mucinex) is not well studied but is probably ok with caution in certain circumstances such as post-tussive emesis causing poor PO intake and weight loss

Congestion

• Flonase (Fluticasone nasal spray)

• Nasal rinses

• Humidifier

• 1st generation anti-histamines (Diphenhydramine, Doxylamine, etc.)

• However, these tend to have more side effects such as fatigue, drowsiness, and dizziness

• Concider switching to a 2nd generation (Cetirizine, Loratidine, etc.) during the day

Disease specific treatments

• Flu (A and B) gets tamiflu (Oseltamivir)

• Covid gets paxlovid (Nirmatrelvir/ritonavir)

• Antibiotics for suspected pneumonia

Additional recommendations

• Elevating the head of bed

• Nasal strips

• Stay well hydrated

• Tea

• Ice chips

• Echinacea

• Zinc

• Rest

Avoid

• NSAIDs

• Pseudophedrine

• Afrin (Oxymetazoline)

• Combined meds in general

References

1. Antonucci, R., Zaffanello, M., Puxeddu, E., Porcella, A., Cuzzolin, L., Pilloni, M. D., & Fanos, V. (2012). Use of non-steroidal anti-inflammatory drugs in pregnancy: impact on the fetus and newborn. Current drug metabolism, 13(4), 474–490. https://doi.org/10.2174/138920012800166607

2. Black, E., Khor, K. E., Kennedy, D., Chutatape, A., Sharma, S., Vancaillie, T., & Demirkol, A. (2019). Medication Use and Pain Management in Pregnancy: A Critical Review. Pain practice : the official journal of World Institute of Pain, 19(8), 875–899. https://doi.org/10.1111/papr.12814

3. D'Ambrosio, V., Vena, F., Scopelliti, A., D'Aniello, D., Savastano, G., Brunelli, R., & Giancotti, A. (2023). Use of non-steroidal anti-inflammatory drugs in pregnancy and oligohydramnios: a review. The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians, 36(2), 2253956. https://doi.org/10.1080/14767058.2023.2253956

Summarized by Jeffrey Olson MS3 | Edited by Meg Joyce, MS1 & Jorge Chalit, OMS3