Home Cold, Flu and Respiratory Health Flu During Pregnancy: Risks, Treatment Options, and When to Seek Care

Flu During Pregnancy: Risks, Treatment Options, and When to Seek Care

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Getting the flu while you are pregnant can feel different than it did before—more intense fatigue, faster dehydration, and a deeper sense of “I need to take this seriously.” That instinct is useful. Pregnancy changes the immune system, heart, and lungs in ways that can make influenza more likely to cause complications, especially in the second and third trimesters and the early postpartum weeks. The good news is that you have several proven tools: vaccination to lower the odds of severe illness, early antiviral treatment to reduce the risk of worsening disease, and practical home strategies that protect both you and your baby while you recover. This guide explains why flu risk is higher in pregnancy, how to recognize and test early, what treatments are typically recommended, and the specific warning signs that should move you from “monitor at home” to “call now” or “go to the ER.”

Essential Insights for Pregnant Patients

  • Start care early: if flu is suspected, contacting your prenatal provider the same day can open a short window where antivirals help most.
  • Treat fever and dehydration promptly, because both can worsen how sick you feel and can stress your body during pregnancy.
  • Avoid “combo” cold medicines unless your clinician approves them; duplicate ingredients and certain decongestants can be risky.
  • If you have breathing trouble, chest pain, confusion, signs of dehydration, or decreased fetal movement, do not “wait it out”—seek urgent care.

Table of Contents

Why pregnancy raises flu risk

Pregnancy is not an illness, but it is a major physiologic redesign. To support a developing baby, the immune system shifts toward tolerance, the heart pumps more blood, and the lungs work with less “spare room.” Those normal changes can make influenza harder on your body—and can narrow the margin between “unpleasant” and “needs medical attention.”

Immune, heart, and lung changes matter

Several pregnancy adaptations can amplify flu severity:

  • Immune system modulation: Your immune response is recalibrated so you can carry a genetically distinct fetus. This can change how efficiently you clear viral infections and how strongly your body inflames in response.
  • Higher oxygen demand: Pregnancy increases oxygen needs. If influenza inflames the airways and lowers oxygen exchange, you may feel short of breath sooner.
  • Less lung capacity: As the uterus grows, the diaphragm rises. You still breathe effectively, but there is less reserve if congestion, bronchitis, or pneumonia develops.
  • Cardiovascular load: Blood volume and heart rate rise in pregnancy. Fever and dehydration can push that system harder, leading to dizziness, palpitations, or faintness.

These factors are why clinicians often treat pregnant patients as a higher-risk group when influenza is suspected—especially if symptoms are moderate to severe or rapidly worsening.

What “risk” means for you and the baby

Most pregnant people recover from flu without lasting problems, but complications are more likely compared with nonpregnant adults. Influenza can trigger:

  • Lower respiratory involvement (wheezing, bronchitis, pneumonia)
  • Dehydration (from fever, low intake, vomiting, or diarrhea)
  • Worsening of chronic conditions (asthma, diabetes, heart disease)
  • Pregnancy stress responses such as contractions in some patients

Flu-related fever can also make you feel profoundly unwell. While a single fever does not automatically mean harm to the fetus, persistent high temperatures and poor hydration can strain the body’s balance. That is why fever control and hydration are treated as practical priorities—not just comfort measures.

Who should be especially cautious

Any pregnancy warrants extra attention with flu symptoms, but risk rises further if you have asthma, obesity, diabetes, hypertension, immune suppression, significant anemia, multiple gestation, or a history of preterm birth. In those settings, early clinical contact is not an overreaction—it is good planning.

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Symptoms and early testing

Influenza often starts suddenly. Many people can name the hour they went from “fine” to “flattened.” In pregnancy, that abrupt shift can feel even more dramatic, and it can be hard to tell flu apart from other respiratory infections without testing.

Common flu symptoms in pregnancy

Typical influenza symptoms include:

  • Fever or chills (not always present)
  • Body aches, headache, and deep fatigue
  • Sore throat and cough (often dry at first)
  • Nasal congestion or runny nose
  • Shortness of breath with exertion (sometimes from congestion, sometimes from lower airway involvement)
  • Nausea, vomiting, or diarrhea (more common in some flu strains and can overlap with pregnancy symptoms)

Flu tends to cause more pronounced body aches and exhaustion than a routine cold. COVID-19 and RSV can overlap heavily with flu symptoms, so testing matters when treatment decisions depend on the result.

When testing is most useful

Testing is most helpful when it will change what you do next. In pregnancy, it often does—because antivirals are time-sensitive and because clinicians use results to guide monitoring. Consider contacting your prenatal provider promptly if you have a sudden onset of fever, cough, and body aches, especially if symptoms began within the last 48 hours.

Testing may also be especially useful if:

  • You have close household exposure to someone with confirmed flu
  • You have asthma or other chronic lung disease and are wheezing
  • You are in late pregnancy and breathing feels “tight” or shallow
  • You are immunocompromised or have significant medical comorbidities
  • Your symptoms are worsening after a brief improvement

Practical testing options

Many clinics and urgent care settings offer rapid influenza tests, and some use PCR-based tests that are more sensitive. Ask what the test is and how quickly results return. If you are also at risk for COVID-19 exposure, clinicians may recommend testing for both viruses, since symptoms can be indistinguishable.

One important point: if you are pregnant and your clinician strongly suspects influenza based on symptoms and local activity, they may recommend starting treatment without waiting for confirmation—particularly when you are early in illness or symptoms are significant. The goal is to avoid losing the period when antivirals help most.

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Antiviral treatment and timing

Antiviral medications do not “cure” the flu overnight, but they can reduce how long you are sick and lower the risk that illness becomes severe—especially when started early. In pregnancy, the threshold to treat is typically lower because the cost of waiting can be higher.

The timing rule that matters most

Antivirals work best when started as soon as possible, ideally within the first 48 hours after symptoms begin. That said, pregnancy changes the risk calculation: if you are very sick, have signs of complications, or require hospitalization, antivirals can still be recommended even if you are outside the 48-hour window. The key message is not “don’t bother after two days,” but rather “do not delay the call.”

Which antivirals are commonly used

For pregnant patients, clinicians commonly choose a neuraminidase inhibitor (often oseltamivir). Typical considerations include:

  • Preferred option and experience: Some antivirals have more pregnancy safety data and wider clinical experience.
  • Severity and setting: Hospitalized patients are usually treated promptly; outpatient treatment may depend on timing and risk factors.
  • Side effects: Nausea and vomiting are common, which can be challenging in pregnancy. Taking medication with food and prioritizing hydration can help.
  • Kidney function and dosing: Some patients need dose adjustments for kidney disease.

If you are breastfeeding, antiviral choices and timing can also be tailored to support continued feeding when possible.

Do not self-prescribe leftover antivirals

Using leftover medication can lead to incorrect dosing, expired drugs, or mismatched treatment (for example, taking an antiviral that is not recommended for pregnancy or for your symptom pattern). It can also mask worsening illness. If you suspect flu, the safer path is quick clinical guidance and a plan that includes hydration, fever control, and clear follow-up steps.

Exposure prophylaxis is sometimes considered

If you are pregnant and have close exposure to someone with confirmed influenza—especially a household member—your clinician may discuss preventive antiviral medication in some situations. This is not automatic for every exposure, but it can be an option for people at higher risk or those who cannot be vaccinated or were vaccinated very recently (before antibodies have time to develop).

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Safe fever and symptom relief

When you are pregnant, symptom relief is not just about comfort. Fever, dehydration, and uncontrolled coughing can drain you quickly, disturb sleep, and worsen lightheadedness. The safest plan is usually simple: treat fever, protect hydration, and avoid multi-ingredient products unless you know exactly what is inside.

Fever control: focus on one main medication

Many prenatal clinicians recommend acetaminophen for fever and pain relief in pregnancy when used as directed. Fever reduction can improve how you feel and can help stabilize hydration needs. Practical tips:

  • Follow the dosing instructions on the label or your clinician’s plan.
  • Avoid “stacking” acetaminophen unknowingly by combining it with cold-and-flu products that also contain it.
  • If fever persists or keeps returning despite appropriate dosing, treat that as a reason to call your prenatal team—especially if you also have worsening cough, shortness of breath, or dehydration.

Medications like ibuprofen and other NSAIDs may be discouraged in pregnancy, particularly later in pregnancy, unless a clinician specifically advises them for your situation.

Cough, congestion, and sore throat comfort

Non-drug tools are often surprisingly effective and low-risk:

  • Warm fluids, broth, and frequent sips of water
  • Saline nasal spray or rinses for congestion
  • Humidifier or steamy shower for airway comfort
  • Honey in warm water or tea for cough (not for infants, but fine for adults)
  • Throat lozenges and saltwater gargles

If medication is needed, ask your clinician or pharmacist what is safest in your trimester and with your health history. Some decongestants are not ideal for certain patients (for example, those with high blood pressure) or at certain points in pregnancy. The safest approach is to choose single-ingredient products so you know exactly what you are taking.

Watch out for these common pitfalls

  • Combo products: They may include acetaminophen plus a decongestant, cough suppressant, antihistamine, and sometimes caffeine-like stimulants—too many variables at once.
  • Herbal “immune boosters”: Many have limited safety data in pregnancy, and some can affect blood pressure, bleeding risk, or medication metabolism.
  • Over-sedation: Antihistamines or nighttime cold formulas can cause dizziness, which is risky if you are already dehydrated.

When in doubt, bring the product name (or a photo of the label) to your clinician or pharmacist and ask for a pregnancy-specific recommendation.

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Home care and monitoring baby

A thoughtful home plan can shorten the “hardest” days and help you notice early if illness is drifting into danger territory. Think in three buckets: hydration and calories, breathing and rest, and pregnancy-specific monitoring.

Hydration and nutrition: make it easy to succeed

Fever increases fluid needs, and pregnancy already raises baseline hydration demands. Aim for steady intake rather than big gulps. Helpful strategies include:

  • Keep a cup or bottle within reach and sip every few minutes while awake.
  • Use oral rehydration solutions or electrolyte drinks if you are sweating heavily or not eating much.
  • Choose easy calories: soups, yogurt, smoothies, rice, bananas, toast, or whatever your stomach tolerates.
  • If nausea is prominent, try small, frequent bites and bland foods; dehydration can worsen nausea, creating a spiral.

Signs you are falling behind include very dark urine, urinating only a few times per day, dry mouth, dizziness when standing, and inability to keep fluids down.

Breathing support and rest

Rest is not optional during influenza; it is part of recovery. To reduce strain:

  • Sleep with your head slightly elevated if congestion is severe.
  • Use a humidifier at night and consider nasal saline before bed.
  • Avoid heavy exertion even if you feel “a little better” for a few hours.

If you have a home pulse oximeter and know how to use it, it can be a helpful extra data point—but it should not replace how you feel. Worsening shortness of breath, chest pain, or persistent rapid breathing deserves medical evaluation regardless of device readings.

Pregnancy-specific monitoring

Depending on gestational age, your clinician may want you to pay attention to:

  • Fetal movement: If you are far enough along to track consistent movement patterns, a noticeable decrease should prompt a call.
  • Contractions or cramping: Illness and dehydration can trigger uterine irritability. Persistent contractions, tightening, or period-like cramps—especially with back pain or pressure—should be assessed.
  • Vaginal bleeding or fluid leakage: These are urgent symptoms, whether or not you have flu.

Finally, if you have underlying conditions such as asthma, use your prescribed inhalers as directed and contact your clinician early if wheezing increases. Influenza can inflame airways quickly.

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When to call your ob and when to go to er

One of the hardest parts of being sick in pregnancy is deciding what is “normal sick” and what is “this needs urgent help.” A clear threshold reduces anxiety and can prevent dangerous delays.

Call your prenatal provider the same day if

Even if symptoms feel manageable, same-day contact is wise when you are pregnant and suspect flu, because treatment decisions are time-sensitive. Call promptly if you have:

  • Sudden onset of fever, chills, cough, and body aches
  • Symptoms within the past 48 hours (treatment window)
  • Close exposure to confirmed influenza
  • Asthma, diabetes, heart disease, immune suppression, or other major medical risks
  • Persistent vomiting, diarrhea, or signs of dehydration
  • Worsening symptoms after initial improvement

Ask what your clinic wants you to do about testing, antivirals, and follow-up. It can help to have a short script ready: when symptoms started, highest temperature, breathing symptoms, fetal movement changes, and any chronic conditions.

Go to urgent care or the emergency room now if

Seek urgent evaluation for any of the following:

  • Trouble breathing, rapid breathing, or breathing that feels labored at rest
  • Chest pain or pressure
  • Bluish lips or face, severe weakness, or inability to stay awake
  • Confusion, fainting, or severe dizziness
  • Signs of severe dehydration: cannot keep fluids down, very little urination, or repeated vomiting
  • Persistent high fever that does not improve with appropriate fever control, or fever plus a stiff neck, severe headache, or worsening rash
  • Severe or worsening cough with new wheeze, coughing up blood, or suspected pneumonia

Pregnancy-specific reasons to go now include:

  • Decreased fetal movement compared with your normal pattern (in a pregnancy where movement is usually regular)
  • Regular painful contractions, significant pelvic pressure, or suspected preterm labor
  • Vaginal bleeding or leaking fluid
  • Severe abdominal pain or sudden severe swelling with headache and vision changes (even if you think it is “just the flu”)

If you are unsure, treat uncertainty as a symptom. Influenza can escalate quickly, and being evaluated early is often simpler than trying to catch up after you have become severely dehydrated or short of breath.

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Prevention and postpartum protection

Prevention is not only about avoiding a miserable week. In pregnancy, it is also about lowering the odds of respiratory complications, protecting newborns who cannot be vaccinated immediately, and reducing the chance of household spread when sleep and recovery are already in short supply.

Vaccination in pregnancy protects two people

Seasonal flu vaccination is generally recommended during pregnancy and can be given in any trimester. A practical benefit that is easy to overlook: antibodies generated during pregnancy can help protect the baby for the first months of life. That matters because young infants are more vulnerable to severe flu and are too young for certain preventive options early on.

If you are vaccinated and still get the flu, vaccination may still reduce severity. No vaccine is perfect, but it can shift odds in your favor, especially in seasons when influenza activity is high.

Household prevention is part of prenatal care

If you live with other people, “cocooning” strategies can reduce exposure:

  • Encourage household members and close caregivers to get the flu shot.
  • Improve airflow at home when feasible (opening windows briefly, using exhaust fans).
  • Wash hands before meals, after coughing or sneezing, and after public outings.
  • Consider masking in crowded indoor settings during peak flu activity, especially if you have other risk factors.

Small changes matter because influenza spreads efficiently—often before someone realizes they are sick.

If you get flu near delivery or postpartum

If illness occurs close to delivery, coordinate early with your obstetric team. They can help plan for symptom control, antiviral timing, and newborn protection. Postpartum individuals are still considered higher risk for severe flu for a period of time, and the exhaustion of recovery can make dehydration and sleep disruption more intense.

If you are breastfeeding, you can often continue with careful hygiene—handwashing and masking if you are coughing—unless your clinician advises otherwise. Breast milk can pass helpful antibodies, and maintaining feeding can support infant hydration and comfort.

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References

Disclaimer

This article is for general educational purposes and is not a substitute for individualized medical care. Pregnancy changes how respiratory infections can affect the body, and treatment choices depend on gestational age, medical history, symptom severity, and local influenza activity. If you are pregnant and think you have the flu, contact your prenatal clinician promptly for personalized guidance. If you have trouble breathing, chest pain, confusion, severe dehydration, vaginal bleeding, leaking fluid, regular contractions, or decreased fetal movement, seek urgent or emergency care right away.

If you found this helpful, please consider sharing it on Facebook, X (formerly Twitter), or any platform you prefer so others can recognize flu warning signs early and get appropriate care.

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