Comparison · Pregnancy Smart
What cold medicine is safe in the third trimester?
How do the options compare?
Options are compared on ACOG or MotherToBaby endorsement, size and quality of pregnancy-specific studies, dosing predictability, time-to-effect, and side-effect profile: the same axes an obstetric clinician would use.
| Option | Studied pregnancy dose | Guideline support | Notes |
|---|---|---|---|
| Acetaminophen (fever, aches) | Per the product label, used only as needed and at the lowest effective dose | At recommended dosages, acetaminophen has not been shown to increase the chance of birth defects, and most providers consider it the fever reducer of choice during pregnancy | It hides inside many combination cold products, so check every label you take that day to avoid doubling up |
| Ibuprofen and other NSAIDs | Not used after week 20 unless your provider specifically recommends it | FDA recommends not using NSAIDs after week 20 of pregnancy | Later-pregnancy use might affect fetal kidneys and lower amniotic fluid, and might close the ductus arteriosus early, which can raise blood pressure in the fetal lungs |
| Guaifenesin (chest congestion) | Per the product label, with a full glass of water | Guaifenesin is not expected to greatly increase the chance of birth defects | An expectorant that thins and loosens mucus. It is also sold combined with other drugs, so plain single-ingredient boxes are the cleaner choice |
| Dextromethorphan (dry cough) | Per the product label | Taken as directed for cough in pregnancy, dextromethorphan is not expected to increase the chance of birth defects | Some over-the-counter liquid products containing it also contain alcohol, so the ingredient list matters as much as the active panel |
| Pseudoephedrine (nasal congestion) | Per the product label, and not in the first 3 months | Most studies have not found an increased chance of birth defects, though ACOG does not recommend pseudoephedrine for the first 3 months of pregnancy | Some studies found a small increased chance of gastroschisis. It is behind the pharmacy counter, which makes it easy to ask a pharmacist first |
| Phenylephrine (nasal congestion) | Per the product label | Studies of more than 1,500 pregnant people who took phenylephrine in the first trimester did not show an increased chance of birth defects | Taking it could raise your blood pressure, which matters if you have hypertension in pregnancy. One study found a slightly higher chance of minor differences of the eyes or ears |
- FDA recommends not using NSAIDs after week 20 of pregnancy unless a healthcare provider specifically recommends it, because use in the second half of pregnancy might affect fetal kidneys and lower amniotic fluid, and might close the ductus arteriosus early. 1
- At recommended dosages acetaminophen has not been shown to increase the chance of birth defects, and it appears in many combination products, so every label needs checking to avoid taking it twice. 2
- Most studies have not found an increased chance of birth defects with pseudoephedrine, though some found a small increased chance of gastroschisis, and ACOG does not recommend it for the first 3 months of pregnancy. 3
- Taken as directed for cough, dextromethorphan is not expected to increase the chance of birth defects, but some over-the-counter liquid products that contain it also contain alcohol. 4
- Guaifenesin is an expectorant that thins and loosens mucus and is not expected to greatly increase the chance of birth defects, and it is also sold in combination with other medications in over-the-counter cough and cold preparations. 5
Which option makes sense?
A comparison can include options that should be avoided or considered only in specific circumstances. Please consult your healthcare provider about the findings and cautions that apply to you.
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
Why should you avoid NSAIDs in the third trimester?
Two separate reasons. NSAIDs in the second half of pregnancy might affect the fetal kidneys and lower amniotic fluid, which can lead to poor lung development, stiff joints, or early delivery. They might also close the ductus arteriosus early, raising blood pressure in the fetal lungs. FDA sets the line at week 20.
Is Sudafed safe in the third trimester?
The specific concern ACOG raises about pseudoephedrine, gastroschisis, is a first-trimester one, and ACOG advises against it in the first 3 months. Most studies overall have not found an increased chance of birth defects. Third-trimester use is a conversation with your provider, especially if your blood pressure is being watched.
Can I take Mucinex in the third trimester?
Plain Mucinex is guaifenesin, which MotherToBaby says is not expected to greatly increase the chance of birth defects. The D and DM versions add a decongestant or a cough suppressant, so the letters after the name change the answer. Read the active ingredient panel, then ask your provider.
Can I take a combination cold product like Tylenol Cold?
The problem with multi-symptom boxes is that you are taking four drugs for two symptoms, and acetaminophen is in many of them. MotherToBaby's standing advice is to always check labels to see if they contain acetaminophen. Single-ingredient products for the symptoms you actually have are easier to reason about.
When should I call my provider about a cold?
Fever is the usual trigger. A fever is a temporary rise in body temperature over 101°F (38.3°C), and providers should decide whether a fever from an infection needs medication. Trouble breathing, symptoms that keep worsening past a week, or reduced fetal movement all warrant a call regardless of temperature.
Related in the library
Comparisons
Best pregnancy-safe cold medicine
Comparisons
Best cold and flu remedies in the first trimester
Symptoms
Colds during pregnancy
Is it safe?
Is Sudafed safe during pregnancy?
Is it safe?
Is Mucinex safe during pregnancy?
Is it safe?
Is acetaminophen safe during pregnancy?
Comparisons
Antibiotics for a sinus infection in pregnancy
References
Ibuprofen: MotherToBaby Fact Sheet
MotherToBaby · https://mothertobaby.org/fact-sheets/ibuprofen/
Acetaminophen: MotherToBaby Fact Sheet
MotherToBaby · https://mothertobaby.org/fact-sheets/acetaminophen/
Pseudoephedrine: MotherToBaby Fact Sheet
MotherToBaby · https://mothertobaby.org/fact-sheets/pseudoephedrine/
Dextromethorphan: MotherToBaby Fact Sheet
MotherToBaby · https://mothertobaby.org/fact-sheets/dextromethorphan/
Guaifenesin: MotherToBaby Fact Sheet
MotherToBaby · https://mothertobaby.org/fact-sheets/guaifenesin/
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.