Comparison · Pregnancy Smart
Cold vs flu vs COVID during pregnancy
How do the options compare?
Each illness is compared on whether a vaccine exists and when it is given, the pregnancy-specific complications named in the fact sheets, the symptoms that distinguish it, and what passes to the baby.
| Option | Studied pregnancy dose | Guideline support | Notes |
|---|---|---|---|
| Common cold | No vaccine exists; non-drug measures are saline rinse, humidifier, honey and warm tea, rest and fluids | No pregnancy-specific severe outcomes are named in the fact sheets, unlike flu and COVID | The illness where the decision is really about symptom relief and route: a nasal spray exposes the baby less than an oral decongestant, and saline exposes them not at all. |
| Influenza | Inactivated flu shot, recommended in the first, second or third trimester | Complications in pregnancy include respiratory distress, preterm delivery before week 37, and death | The live attenuated nasal spray vaccine is not used in pregnancy. Vaccination passes antibodies that help protect your baby through their first 6 months, and vaccination plus breastfeeding can lower their chance of influenza by up to 60 percent. |
| COVID-19 | Staying up to date with recommended COVID-19 vaccines | Higher chances of hospitalization, ICU admission and death, plus preterm delivery, stillbirth, preeclampsia, blood clots and emergency c-section | New loss of taste or smell is the symptom most specific to this column. The virus can pass to the fetus during pregnancy but this appears to be rare, and it has not been found to pass into breast milk. |
- COVID-19 carries a higher chance of severe illness in pregnancy. Studies have shown higher chances of hospitalization, admission to intensive care and death, along with preterm delivery, stillbirth, preeclampsia, blood clots and the need for an emergency c-section. 1
- For the cold column, the measures with no exposure attached are the same in every trimester: nasal irrigation uses only water and saline with no medication involved, humidifiers add moisture to the air, nasal strips contain no medication, and honey with warm tea may relieve a sore throat and thin mucus. 2
- The body can have a harder time fighting infections during pregnancy, and influenza complications named include respiratory distress, preterm delivery before week 37, and death. Major medical groups recommend the flu shot in the first, second or third trimester. 3
- The injected flu shot is an inactivated vaccine containing no live flu virus, while the nasal spray is a live attenuated vaccine and is not recommended during pregnancy. Vaccination in pregnancy passes antibodies to the baby that help protect them through their first 6 months. 3
- Acetaminophen covers the fever and aches across all three illnesses: at recommended dosages it has not been shown to increase the chance of birth defects, and the guidance is to use it only as needed at the lowest effective dose. It hides inside many combination products, so labels need adding up. 4
Which option makes sense?
The cold is the only one of the three without a vaccine and without named pregnancy complications. Flu and COVID both have both, which is why the useful question is not which one you have but how fast you tell your provider.
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
How do I know if it is a cold or the flu while pregnant?
Symptom lists overlap enough that self-sorting is unreliable, which is the honest answer. What separates them in practice is severity and speed: fever, body aches and feeling knocked flat point away from a cold, and both flu and COVID have specific pregnancy complications behind them, so that is a call to your provider rather than a guess.
Is the flu more dangerous during pregnancy?
Yes. The body can have a harder time fighting infections during pregnancy, and the named complications include respiratory distress, preterm delivery before week 37, and death. That risk difference is the reason the flu shot is recommended in every trimester.
What are COVID symptoms in pregnancy?
The most common are fever, cough and shortness of breath. Others include chills, muscle or body aches, headache, sore throat, new loss of taste or smell, runny nose, nausea or vomiting, and diarrhea. Nausea in particular can be hard to read against ordinary pregnancy nausea.
When should I go to the doctor for flu in pregnancy?
Early rather than late. MotherToBaby's general advice is to discuss your symptoms with the provider who knows you, and with flu the pregnancy-specific complications named are serious enough that waiting to see how it goes is the wrong default.
Does pregnancy make colds worse?
Pregnancy makes it harder for the body to fight infections, which is the same reason flu hits harder. Congestion is also amplified by pregnancy rhinitis, so an ordinary cold can feel heavier than the same cold would have felt a year ago.
Related in the library
References
COVID-19: MotherToBaby Fact Sheet
MotherToBaby · https://mothertobaby.org/fact-sheets/covid-19/
When The Sniffles Strike During Pregnancy: Cold Meds and Your Questions Answered
MotherToBaby · https://mothertobaby.org/baby-blog/when-the-sniffles-strike-during-pregnancy-cold-meds-your-questions-answered-2/
Seasonal Influenza Vaccine (Flu Shot): MotherToBaby Fact Sheet
MotherToBaby · https://mothertobaby.org/fact-sheets/seasonal-influenza-vaccine-flu-shot-pregnancy/
Acetaminophen: MotherToBaby Fact Sheet
MotherToBaby · https://mothertobaby.org/fact-sheets/acetaminophen/
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.