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Pregnancy and the flu

During pregnancy, it is harder for a woman's immune system to fight infections. This makes a pregnant woman more likely to get the flu and other diseases.

Pregnant women are more likely than nonpregnant women their age to become very ill if they get the flu. If you are pregnant, you need to take special steps to stay healthy during the flu season.

This article gives you information about the flu and pregnancy. It is not a substitute for medical advice from your health care provider. If you think you have the flu, you should contact your provider's office right away.

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WHAT ARE THE SYMPTOMS OF FLU DURING PREGNANCY?

Flu symptoms are the same for everyone and include:

• Cough
• Sore throat
• Runny nose
• Fever of 100°F (37.8°C) or higher

Other symptoms may include:

• Body aches
• Headache
• Fatigue
• Vomiting, and diarrhea

SHOULD I GET THE FLU VACCINE IF I AM PREGNANT?

If you are pregnant or thinking about becoming pregnant, you should get the flu vaccine. The Centers for Disease Control and Prevention (CDC) considers pregnant women at a higher risk for getting the flu and developing flu-related complications.

Pregnant women who get the flu vaccine get sick less often. Getting a mild case of the flu is often not harmful. However, the flu vaccine can prevent the severe cases of the flu that can harm mother and baby.

Flu vaccines are available at most provider offices and health clinics. There are two types of flu vaccines: the flu shot and a nose-spray vaccine.

• The flu shot is recommended for pregnant women. It contains killed (inactive) viruses. You cannot get the flu from this vaccine.
• The nasal spray-type flu vaccine is not approved for pregnant women.

It is OK for a pregnant woman to be around somebody who has received the nasal flu vaccine.

WILL THE VACCINE HARM MY BABY?

A small amount of mercury (called thimerosal) is a common preservative in multidose vaccines. Despite some concerns, vaccines that contain this substance have NOT been shown to cause autism or attention deficit hyperactivity disorder.

If you have concerns about mercury, ask your provider about a preservative-free vaccine. All routine vaccines are also available without added thimerosal. The CDC says pregnant women may get flu vaccines either with or without thimerosal.

WHAT ABOUT SIDE EFFECTS OF THE VACCINE?

Common side effects of the flu vaccine are mild, but can include:

• Redness or tenderness where the shot was given
• Headache
• Muscle aches
• Fever
• Nausea and vomiting

If side effects occur, they most often begin soon after the shot. They may last as long as 1 to 2 days. If they last longer than 2 days, you should call your provider.

HOW DO I TREAT THE FLU IF I'M PREGNANT?

Experts recommend treating pregnant women with flu-like illness as soon as possible after they develop symptoms.

• Testing is not needed for most people. Providers should not wait for results of testing before treating pregnant women. Rapid tests are often available in urgent care clinics and provider's offices.
• It is best to start antiviral medicines within the first 48 hours of developing symptoms, but antivirals can also be used after this time period. A 75 mg capsule of oseltamivir (Tamiflu) twice per day for 5 days is the recommended first choice antiviral.

WILL ANTIVIRAL MEDICINES HARM MY BABY?

You may be worried about the medicines harming your baby. However, it is important to realize there are severe risks if you do not get treatment:

• In past flu outbreaks, pregnant women who were otherwise healthy were more likely than those who were not pregnant to become very sick or even die.
• This does not mean that all pregnant women will have a severe infection, but it is hard to predict who will become very ill. Women who become more ill with the flu will have mild symptoms at first.
• Pregnant women can become very sick very fast, even if the symptoms are not bad at first.
• Women who develop a high fever or pneumonia are at higher risk for early labor or delivery and other harm.

DO I NEED AN ANTIVIRAL DRUG IF I HAVE BEEN AROUND SOMEONE WITH THE FLU?

You are more likely to get the flu if you have close contact with someone who already has it.

Close contact means:

• Eating or drinking with the same utensils
• Caring for children who are sick with the flu
• Being near the droplets or secretions from someone who sneezes, coughs, or has a runny nose

If you have been around someone who has the flu, ask your provider if you should take an antiviral drug.

WHAT TYPES OF COLD MEDICINE CAN I TAKE FOR THE FLU IF I'M PREGNANT?

Many cold medicines contain more than one type of medicine. Some may be safer than others, but none are proven 100% safe. It is best to avoid cold medicines, if possible, especially during the first 3 to 4 months of pregnancy.

The best self-care steps for taking care of yourself when you have the flu include rest and drinking plenty of liquids, especially water. Tylenol is most often safe in standard doses to relieve pain or discomfort. It is best to talk to your provider before taking any cold medicines while you are pregnant.

WHAT ELSE CAN I DO TO PROTECT MYSELF AND MY BABY FROM THE FLU?

There are many things you can do to help protect yourself and your unborn child from the flu.

• You should avoid sharing food, utensils, or cups with others.
• Avoid touching your eyes, nose, and throat.
• Wash your hands often, using soap and warm water.

Carry hand sanitizer with you, and use it when you are unable to wash with soap and water.

References

Committee on Obstetric Practice and Immunization and Emerging Infections Expert Work Group, American College of Obstetricians and Gynecologists. ACOG Committee opinion no. 732: Influenza vaccination during pregnancy. Obstet Gynecol. 2018;131(4):e109-e114. PMID: 29578985 pubmed.ncbi.nlm.nih.gov/29578985/.

Centers for Disease Control and Prevention (CDC) website. Recommendations for obstetric health care providers related to use of antiviral medications in the treatment and prevention of influenza. www.cdc.gov/flu/professionals/antivirals/avrec_ob.htm. Updated September 15, 2022. Accessed September 27, 2023.

Duff WP. Maternal and perinatal infection in pregnancy: bacterial. In: Landon MB, Galan HL, Jauniaux ERM, et al, eds. Gabbe's Obstetrics: Normal and Problem Pregnancies. 8th ed. Philadelphia, PA: Elsevier; 2021:chap 58.

Ison MG, Lee N. Influenza. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 332.

Review Date: 8/23/2023  

Reviewed By: LaQuita Martinez, MD, Department of Obstetrics and Gynecology, Emory Johns Creek Hospital, Alpharetta, GA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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