Is tylenol cold and flu severe safe during pregnancy

One of the things I love most about the medical community is our desire to continually find better answers and care methods through research. But occasionally, sharing the findings of a new study can lead to unnecessary concern and confusion – particularly if the results are not clearly communicated.

Such is the case with recent recommendations on acetaminophen use during pregnancy. Acetaminophen, also called paracetamol, is a mild pain-relieving drug commonly found in over-the-counter pain and cold medications such as Tylenol. It has generally been considered safe to use during pregnancy.

But in September 2021, a consensus statement urging caution on the use of acetaminophen during pregnancy was published in Nature Reviews Endocrinology.

Drafted by an international team of obstetricians, pediatricians, neurologists, and scientists with expertise in fetal development, toxicology, and endocrinology, the statement specifically recommends that pregnant patients:

• Do not take acetaminophen, unless medically indicated
• Consult with their provider if unsure about taking acetaminophen
• Take the smallest dose for the shortest time

These guidelines are no different from what we’ve already been telling patients. Whether we’re prescribing medication or performing ultrasounds, our advice during prenatal care is always to use the least amount of exposure (to any drug or sound waves) to get the necessary benefits.

The authors based their statement on recent studies suggesting that acetaminophen could potentially harm a pregnancy. Understandably, this has caused a wave of concern among pregnant patients – 80% of whom report taking at least one medication while pregnant, with acetaminophen accounting for 65% of medications used.

However, many national Ob/Gyn organizations say there is no evidence to indicate concern.

Related reading: Know the risks of taking ibuprofen, NSAIDs during pregnancy

What prompted the new statement on acetaminophen use?

Previously, the U.S. Food and Drug Administration (FDA) had labeled acetaminophen as “Category B,” meaning no studies had demonstrated it caused birth defects in animals. Like many medications, no specific studies involving pregnant women were performed.

Recent research suggests that prenatal exposure to acetaminophen might alter fetal development and increase the risks of certain neurodevelopmental, reproductive, and urogenital disorders.

Acetaminophen can cross the placenta, meaning it can enter the fetal bloodstream through a patient’s blood when they take the medication. While this was considered harmless in the past, there’s now concern that acetaminophen could act as an endocrine disruptor, potentially interfering with hormonal processes that influence the development of the baby’s nervous and reproductive system.

In some animal studies, acetaminophen exposure was associated with:

• Reduced androgens – hormones that fuel the growth and development of “male” reproductive characteristics
• Irregular development of ovaries

Epidemiologic studies, which analyze patterns and causes of certain conditions in specific populations over a designated time period, also have indicated an association between prenatal acetaminophen exposure and reproductive or nervous system abnormalities.

Scientists observed the reproductive development of several children across the globe whose mothers had taken acetaminophen during pregnancy. Some studies suggested that:

• Male children within this group had a higher likelihood of being born with undescended testicles.
• Female children were more likely to experience early puberty.
• Children of both sexes had an increased risk of behavioral abnormalities such as attention deficit hyperactivity disorder (ADHD).

However, many studies showed no correlation. Those that did were limited by factors such as patient self-reporting and residual confounding – additional factors that could have affected the study results but were not considered.

Most people experience two to three colds during the winter and spring, and pregnant women are no exception. Colds are caused by viruses for which there is no real cure – you can treat the symptoms that make you feel crummy, but medicine doesn’t actually make the cold go away sooner.

Many over-the-counter (OTC) medications you can buy without a prescription come as multi-symptom formulas. These drugs are meant to treat every cold symptom: body aches, congestion, coughing, fever, headache, and sneezing. But not everyone develops every symptom of a cold, and pregnant women should avoid taking unnecessary drugs during pregnancy. 

Instead of reaching for a multi-symptom drug, use the guidelines below to find an effective drug that’s safe for the symptoms you’re facing. And, as always, let your Ob/Gyn or nurse know about any OTC drug you take.

What to take for common cold symptoms

Cough

Dextromethorphan is a cough suppressant used in OTC medications such as Robitussin to reduce coughing. Cough suppressants can come in immediate-release and extended-release preparations. The maximum dose for pregnant women is 120 mg in 24 hours. The multi-symptom preparations that contain dextromethorphan often include “DM” in their name.

Guaifenesin is another medication frequently found in cough medications, such as Mucinex. It is an expectorant, so it helps thin mucus from your chest or throat so you can cough it up easier. It comes in immediate-release or extended-release formulations. The maximum dose you should take is 2,400 mg in 24 hours.

Cold medicines containing codeine were used in the past for cough suppression. I don’t recommend these for pregnant women because studies show they really don’t work well, and the fewer opioid-containing medications in our medicine cabinets, the better. For children, there is some evidence that honey can improve nighttime coughing. I certainly think this is an option for pregnant women as well. If you want to try honey, I suggest a spoonful of the real stuff – it’s not as clear that cold medicine with honey listed as a flavoring or ingredient is as effective. 

Stuffy nose and sinus pressure

Decongestant medications reduce stuffiness and sinus pressure by constricting the blood vessels in your nose, which reduces swelling. Pseudoephedrine and phenylephrine are available over the counter as Sudafed and are safe for many women to use during pregnancy. However, women who have high blood pressure should not take pseudoephedrine without first talking to a doctor. The drug can raise blood pressure and can cause jitters and racing heartbeats. 
Because pseudoephedrine can be used to manufacture methamphetamine, it’s now kept behind the pharmacy counter. You’ll have to provide identification to purchase it, and stores track how much you purchase. The maximum dose of a typical decongestant is 240 mg in 24 hours.

Sneezing, runny nose, and watery eyes

These symptoms are the result of histamine release, which is an immune response to an invading virus. Chlorpheniramine, such as Triaminic Allergy, and diphenhydramine, such as Benadryl, are safe to take during pregnancy. However, both can cause drowsiness, so these are best taken at bedtime. The maximum dosage for chlorpheniramine is 32 mg in 24 hours.

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