Comparison · Pregnancy Smart

Best cold and flu remedies in the first trimester

Assigned clinical reviewerMichael Yuzefovich· MD, FACOGDraft · pending clinical reviewUpdated September 18, 2026

How do the options compare?

Each option is placed by what the first trimester specifically changes about it: the week-12 caution, the week-20 line, and how fast you have to move once symptoms start.

Option	Studied pregnancy dose	Guideline support	Notes
Acetaminophen	The lowest effective dose, used only as needed	Considered by many healthcare providers and organizations to be the pain reliever and fever reducer of choice during pregnancy	Add up the acetaminophen across every product you take in 24 hours, since it hides inside combination cold boxes.
Pseudoephedrine, the decongestant in '-D' products	Not recommended for the first 3 months	ACOG does not recommend pseudoephedrine for the first 3 months of pregnancy	Some studies found a small increased chance of gastroschisis, small intestinal atresia, and hemifacial microsomia.
Ibuprofen and other NSAIDs	If a provider does recommend one after week 20, the lowest dose for the shortest time	The FDA recommends not using NSAIDs after week 20 unless a healthcare provider specifically recommends it	A few studies suggest first-trimester use carries a small increased chance, under 1%, of gastroschisis.
Oseltamivir, for flu rather than a cold	Started within 48 hours of your first symptoms, the earlier the better	Oral oseltamivir is the CDC's preferred option during pregnancy	Studies have not found a higher chance of miscarriage or birth defects with oseltamivir during pregnancy.

Getting a fever down quickly matters more right now than at any other point in pregnancy, since a high fever before 12 weeks, and especially before week 6, has been linked to a small rise in neural tube defects and a few other birth defects. 1
Acetaminophen is still the go-to choice for pain or fever in the first trimester, and typical doses haven't been linked to a higher chance of miscarriage or birth defects. 2
Skip pseudoephedrine, the decongestant behind most cold products labeled '-D,' until after week 12, since ACOG advises against it for the first three months and a few studies have tied early use to a small rise in certain birth defects. 3
Ibuprofen and other NSAIDs are worth skipping in the first trimester too, since studies suggest a possible link to miscarriage with use around conception and a small increased chance of certain birth defects like gastroschisis. 4
If your symptoms turn out to be the flu rather than a cold, starting an antiviral like oseltamivir within the first two days works better than waiting, and it hasn't been linked to a higher chance of miscarriage or birth defects. 5

Which option makes sense?

Acetaminophen at the lowest effective dose is the pick for aches or a fever over 101 degrees Fahrenheit, pseudoephedrine and NSAIDs are the two to hold off on before week 12, and anything that reads more like flu than a cold is a same-day call because the antiviral window is 48 hours.

Disclosure: Pregnancy Smart makes supplements in this category. The comparison above is written to inform, not to steer readers toward or away from our brand.

Frequently asked questions

What should I try first for a cold or flu in my first trimester?

Start with the basics: fluids, rest, a humidifier, and a saline rinse for a stuffy nose. These don't add any medicine exposure and often help enough on their own. Reach for acetaminophen if you need something for aches or a fever, and check in with your provider for anything beyond that.

Which cold medicines should I avoid before week 12?

Pseudoephedrine, the decongestant in most '-D' products, and ibuprofen or other NSAIDs are the two worth skipping in your first trimester. Both carry an early-pregnancy caution in the research, and acetaminophen is the better-studied swap for either one. Confirm any exception with your provider.

Why does a fever matter more right now than later in pregnancy?

A high fever before 12 weeks, and especially before week 6, has been linked to a small rise in neural tube defects and a few other birth defects in some studies. Bringing it down quickly with acetaminophen and calling your provider is worth doing sooner rather than later, even though most fevers turn out fine.

How do I know if it's a cold or the flu, and does that change what I should do?

Flu symptoms tend to come on faster and harder, with a higher fever and more body aches than a typical cold. If it looks like the flu, call your provider quickly, since an antiviral like oseltamivir works best when started within the first two days of symptoms.

References

Fever/Hyperthermia: MotherToBaby Fact Sheet
MotherToBaby · https://mothertobaby.org/fact-sheets/hyperthermia-pregnancy/
Acetaminophen: MotherToBaby Fact Sheet
MotherToBaby · https://mothertobaby.org/fact-sheets/acetaminophen-pregnancy/
Pseudoephedrine: MotherToBaby Fact Sheet
MotherToBaby · https://mothertobaby.org/fact-sheets/pseudoephedrine/
Ibuprofen: MotherToBaby Fact Sheet
MotherToBaby · https://mothertobaby.org/fact-sheets/ibuprofen-pregnancy/
Antiviral Medications to Prevent/Treat Influenza (the Flu): MotherToBaby Fact Sheet
MotherToBaby · https://mothertobaby.org/fact-sheets/antiviral-medications-treatprevent-influenza-the-flu-pregnancy/

These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.