Illness

If you have a pollen allergy, you can continue to treat it during pregnancy. Local symptoms can usually be treated with topical care products (nasal spray, eyedrops), but antihistamines taken by mouth in tablet form are also permissible. See the list below to see which topical care products you can use safely if your symptoms are severe enough to warrant medication. 

Nasal sprays and drops 

Corticosteroids: 

• Beclomethasone 
• Budesonide 
• Fluticasone 
• Mometasone 
• Triamcinolone 

Allergy medications other than corticosteroids: 

• Disodium chromoglycate 

Sodium chloride preparations are safe for treating a nose clogged up by dried nasal secretions. 

If the nasals prays above is not working, you can also use:

• Azelastine
• Levocabastine

Nasal sprays containing olopatadine is not recommended during pregnancy.

Eyedrops 

• Disodium chromoglycate  

If you are using eyedrops that contain another type of allergy drug (azelastine, emedastine, ketotifen, levocabastine, lodoxamide, olopatadine), please double-check with your physician whether it is essential to continue using them to treat your symptoms. At the correct doses, these will only excrete a minimal amount of drug into your bloodstream, but there is limited experience of using them during pregnancy (little for some, none for others). 

Always follow the dosage instructions for your eyedrops. Pull back the lower eyelid and apply the eyedrop there, then press down lightly on the inner corner of the eye (over the tear duct) for 2 minutes.  Also remember to wipe off any eyedrops from your cheeks before they get in to your mouth.  This will enhance absorption of the drug into the eye and prevent it from flowing down into the pharynx.   

Antihistamines taken by mouth 

• Loratadine (and desloratadine) 
• Cetirizine (including levocetirizine) 

Hydroxyzine may be indicated in some cases if the fatiguing effect is particularly desired. Avoid regular use of hydroxyzine close to childbirth. Hydroxyzine use may cause temporary drug symptoms for the newborn infant. There is less experience of the use of other antihistamines during pregnancy. Please consult your physician if you are using some other product.

This is important              

Do not use any products containing pseudoephedrine or phenylpropanolamine during pregnancy. These substances can cause blood vessels to constrict and thus have a harmful effect on circulation in the placenta. 

If you have been using an allergy medication not listed among the acceptable medications here during pregnancy, there is no cause for concern. However, it is recommended that you replace that medication with a better known one; consult your physician about the medication. 

Desensitization therapy 

Please remember to tell your physician if you are planning a pregnancy or if you are already pregnant. We do not recommend beginning desensitization therapy during pregnancy. The risks involved in desensitization therapy during pregnancy have to do with the possibility of an anaphylactic reaction. However, if you have already begun desensitization therapy, this can usually be continued during pregnancy if it has progressed to or almost to the maintenance phase and no adverse impacts have emerged.

EPIPEN 

An epinephrine auto-injector or EPIPEN is used for treating a severe allergic reaction (anaphylaxis) and for prevention of an anaphylactic reaction after exposure for those at risk of an anaphylactic reaction. Please review the indications for use with your physician. You can use this product at any time during pregnancy.

You may use cortisone creams according to their instructions to treat atopy, because absorption through the skin is minimal. Other topical care products for treating atopy may sometimes be indicated (e.g. products containing tacrolimus or pimecrolimus). Please consult your attending physician about how to use these appropriately.

You should remember that your superficial circulation may increase during pregnancy, and drugs may thus be more readily absorbed through the skin. Absorption is also increased by the use of medicinal bandages and if the skin is broken. Only use topical care products on the affected area of skin and for the shortest period possible.

If you are on asthma medication, double-check its appropriateness and dosage with your physician, preferably when you are only just planning your pregnancy, but at the very latest when you become pregnant. Your asthma should be well treated during pregnancy, and it is important that it is well under control. Asthma that is not under control (not in therapeutic equilibrium) represents a clearly elevated risk of complications during pregnancy, particularly premature birth. Usually you will be told to continue on the asthma medication that you had before your pregnancy, if it has been working well for you.

Inhaled asthma medication

Inhaled asthma medication (glucocorticoids and additional anti-inflammatory drugs if necessary) form the basis for asthma treatment. All inhaled asthma medications may be used during pregnancy. Some are more readily absorbed from the lungs into the bloodstream than others (e.g. ciclesonide). Please consult your physician about which would be the best product for you. The asthma medications that are in common use have not been found to elevate the risk of birth defects. Corticosteroids taken by mouth prescribed by your physician for an asthma flare-up are also safe at any point during pregnancy. 

In treating allergy and atopy, the same principles apply during breastfeeding as during pregnancy. 

Allergy 

Topical care products may be used (nasal sprays, eyedrops). Among orally administered antihistamines, loratadine and desloratadine are the primary options during breastfeeding, especially if the infant is small and if the medication is being used for an extended period.  

Cetirizine use should be restricted to a short period of time or temporary use only, although there have been no reports of adverse impacts on breastfeeding infants for this product, and many experts consider it safe to use.  

Long-term use of hydroxyzine should be avoided if possible. If there is a clear indication for its use, the status of the infant should be monitored for fatigue and sleepiness.  

Atopy 

Cortisone creams and other topical care products for treating atopy (tacrolimus, pimecrolimus) may be used during breastfeeding according to your physician’s instructions. 

Asthma 

Asthma medications are generally not a problem for breastfeeding. The exceptions are products taken by mouth containing theophylline or aminophylline (rarely used nowadays), which require close monitoring of the breastfed infant’s wellbeing for irritation and sleep disorders. Infants under the age of 3 months may be particularly susceptible to symptoms.

If I have flu during pregnancy, is there a risk to the fetus?

An ordinary flu, or common cold, poses no risk to the fetus. The flu may be caused by any of hundreds of viruses, most commonly a rhinovirus. The flu typically begins with a sore throat, followed by a runny nose and coughing. Fever and joint ache are also common symptoms. 

How can I safely treat the flu during pregnancy?

Rest, warm drinks, and steam inhalation if necessary to loosen mucus and expand the airways are basic treatments for the flu during pregnancy. If non-medical measures are not enough, you can treat congestion, cough, sore throat, and fever with prescription-free medications available at pharmacies (for details, see below). 

Can I use zinc preparations to treat the flu during pregnancy?

Zinc preparations are not recommended for treating the flu during pregnancy. The recommended daily dose of zinc during pregnancy is 9 mg per day, and research shows that zinc does not have an impact on the duration of a flu unless the daily dose exceeds 75 mg. In other words, the zinc dose that may shorten your flu is many times higher than the recommended daily dose during pregnancy, and there is no information available on such high doses being taken during pregnancy. Because of this, we recommend that you do not take zinc to treat the flu during pregnancy. The zinc contained in multivitamin preparations intended for use during pregnancy does not exceed the recommended amount. 

Can I use nasal sprays to alleviate congestion during pregnancy?

You may use nasal sprays containing xylometazoline or oxymetazoline to alleviate congestion if necessary. However, these medications constrict blood vessels, so you need to follow the instructions precisely. A nasal spray is easier to administer than nasal drops and is thus recommended. Please do not use such medication for longer than recommended in the instructions (3 to 5 days, and in any case no longer than one week).

How can I treat a sore throat during pregnancy? 

During pregnancy, you may use most over-the-counter lozenges for sore throat as instructed in the package. Always check the package insert before using the medicine.

Lozenges with anti-inflammatory analgesics (flurbiprofen or benzydamine) are a secondary option during pregnancy. There is no research data on using these substances during pregnancy. These products are not recommended at all after gestational week 28. 

Can I take cough medicine during pregnancy?

The effectiveness of cough medicines is questionable, and taking cough medicines is generally not justifiable. Many such products contain multiple active ingredients, the majority of which have not been studied for safe use during pregnancy.

If non-medical treatments do not help, you may use prescription-free products containing dextromethorphan to alleviate a dry, irritating cough. For a wet cough, you may use products containing bromhexine to loosen mucus. Always consult the maternity clinic regarding longer-term use of any product. 

What is fever?

Fever is defined as a condition where your body temperature is higher than normal. What is considered normal body temperature for an adult depends to some extent on how it is measured and at what time of day. The upper limit for normal body temperature in most adults is between 36.5 °C and 37.5 °C. A high fever is defined as a body temperature of more than 38 °C. The most common cause of fever is a flu caused by a virus, but fever is a symptom of many other diseases as well. 

Can fever harm the fetus?

A high fever (38.5 °C or more) in early pregnancy may elevate the risk of damage to the fetus. If you develop a fever of over 38 °C, we recommend that you take paracetamol to bring the fever down. You may use paracetamol at any time during pregnancy at the normal doses for adults. However, there must always be a specific reason for taking paracetamol. Products containing acetylsalicylic acid are not recommended for controlling fever at any time during pregnancy. 

Can I breastfeed normally if I have the flu and a fever?

Having the flu or influenza does not prevent breastfeeding. Your antibodies will be excreted into the breast milk, and these antibodies will protect the infant against the disease. However, do practice good hand hygiene. 

Paracetamol and ibuprofen are only minimally excreted into breast milk and are acceptable for controlling a fever during breastfeeding. Products containing acetylsalicylic acid are not recommended for treating fever and flu during breastfeeding. You may use nasal sprays containing xylometazoline or oxymetazoline to alleviate congestion if necessary, following the instructions. While breastfeeding, you may use all over-the-counter lozenges for sore throat as instructed in the package.

What is influenza?

Influenza is a respiratory infection caused by A and B viruses belonging to the orthomyxovirus group. It may be dangerous for at-risk groups of people. A pregnant woman having influenza has not been shown to elevate the risk of birth defects for the fetus, but the risk of miscarriage and premature birth may be elevated. Pregnancy also makes you clearly more susceptible to serious complications of influenza, such as pneumonia. The risk of complications rises as the pregnancy progresses, and influenza in late pregnancy represents a risk of developing viral pneumonia with severe symptoms. 

How can I safely treat influenza during pregnancy?

Influenza during pregnancy is to be primarily treated by treating the symptoms. High fever in early pregnancy may impede the normal development of the fetus, and it is recommended at all stages of pregnancy that you primarily use paracetamol to bring your body temperature down if it is over 38 °C. Viral drugs (oseltamivir) may be used during pregnancy and breastfeeding if your physician so prescribes.

Can I safely have an influenza vaccination during pregnancy?

It is important for pregnant women to protect themselves against influenza. Seasonal influenza vaccines, or ‘flu shots’, have not been found to elevate the risk of birth defects. Influenza vaccines are safe and are recommended during the epidemic season for all pregnant women regardless of where they are in their pregnancy. Influenza antibody formation takes about two weeks from vaccination, and it is thus important to be vaccinated well in advance of the epidemic. You should get a flu shot as soon as it is available.  The influenza vaccines used in Finland do not contain live pathogens. 

You may use a laxative that increases stool mass to treat constipation. Lactulose and macrogol are also suitable for use during pregnancy, as they are hardly absorbed into the body from the bowel at all. Please avoid using senna-based bowel stimulants during pregnancy. Short-term use of bisacodyl may be indicated in complicated situations.

For hemorrhoid symptoms, you may use prescription-free products according to their instructions. Hemorrhoids that are symptom-free do not need to be treated.  

Constipation may be treated by the same principles during breastfeeding as during pregnancy. For hemorrhoids, you may use prescription-free products according to their instructions. 

Food poisoning is an inflammation of the digestive tract caused by bacteria or viruses ingested with food. The most common pathogens causing food poisoning in Finland are norovirus, rotavirus, campylobacter, and salmonella. Staphylococcus bacteria can also secrete toxins in food that may cause food poisoning. Food poisoning contracted abroad is most commonly caused by salmonella. Symptoms generally present within less than a day of the meal in question. The most common symptoms are diarrhea, nausea, vomiting, stomach cramps, and fever. 

Norovirus and rotavirus can be transmitted from human to human, and they typically cause epidemics in late winter. 

An ordinary case of food poisoning or a ‘stomach bug’ pose no risk to the fetus. Such conditions can usually be treated at home by ensuring that you are well hydrated and your salt balance is managed, and that you get enough rest. If you have violent diarrhea or it is accompanied by high fever, or if your stool is bloody to the naked eye, seek treatment. Also go see a doctor if your condition worsens or if the symptoms linger for a long time. 

Please remember to tell your physician if you are planning a pregnancy, if you are already pregnant, or if you are breastfeeding. The primary medication for a migraine attack is paracetamol. You can acceptably use paracetamol for treating migraine attacks at all stages of pregnancy with the same doses as before pregnancy. It is important to comply with the dosage instructions on the package. 

You may use nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or diclofenac for brief periods to treat migraine attacks during the first and second trimesters if paracetamol does not help. Avoid brief and repeated use of NSAIDs from week 28 of your pregnancy, because their use can cause changes in the circulation and kidney function of the fetus. In some cases, using them for as little as two days has caused changes in circulation in the fetus’s heart. If your physician has prescribed you metoclopramide to treat your migraine attacks, you can take it together with paracetamol or an NSAID (see above) during your pregnancy. 

Painkillers in the opioid group (e.g. codeine) have not been shown to be effective in treating migraine headaches, and they are not recommended for pregnant women. 

The use of migraine-targeted drugs should be restricted to situations where the afore mentioned medications are not effective. Among migraine-targeted drugs, sumatriptan is one of which there is a considerable amount of experience concerning occasional use during early pregnancy with no apparent harmful impacts on the pregnancy or the fetus. Experience is scarce concerning repeated sumatriptan use or use of other triptans during pregnancy. Always talk to your physician about the use of migraine-targeted drugs during pregnancy. Prophylactic medication might be considered, if you have migraine attacks two or three times a month.

Prophylaxis will be considered if you are having migraine attacks twice a month or more often. During pregnancy, the prophylactic medication is usually from the betablocker group (metoprolol or propranolol). A betablocker may lower your blood pressure, which should be monitored at the maternity clinic. 

There are also long-standing ‘old school’ antidepressants such as amitriptyline and nortriptyline that may be used during pregnancy.  

• Epilepsy medications must not be used as a migraine prophylactic during pregnancy. 
• Hypertension medications that inhibit the renin–angiotensin system must not be used during pregnancy. 
• Preparations containing ergotamine must not be used during pregnancy.

Paracetamol is an acceptable medication for migraine during breastfeeding. It is also safe to use NSAIDs such as ibuprofen, diclofenac, naproxen, or ketoprofen to treat a migraine attack.  

Please do not use any drugs in the opioid group (e.g. codeine) during breastfeeding. Opioids cause slowed breathing. Repeated exposure to opioids through breast milk can put the infant at risk.  

The primary option among migraine-specific medications is sumatriptan. The medication should be taken directly after breastfeeding, but there is no need for withholding breastfeeding. 

There is less experience about other migraine-specific medication during breastfeeding. However, eletriptan, rizatriptan, zolmitriptan and almotriptan is possible to use occasionally. You should take the medication directly after breastfeeding. Eletriptan do not require withholding breastfeeding, but with the other medications mentioned above wait 4-12 hours after taking the medicine before you start breastfeeding.  Regular use of any migraine-specific medication is not recommended. Always remember to double-check your medication with your physician.  

Recommendations concerning prophylactic medication during pregnancy remain valid during breastfeeding. 

You may use pyrvin to treat pinworms during pregnancy and breastfeeding. This drug is hardly absorbed at all into the body from the gastrointestinal tract. Mebendazol (Vermox) is not recommended as the first choice for treating pinworms during pregnancy, but it may be used during breastfeeding. 

We recommend permethrin (Nix shampoo) as the primary choice for delousing. You may also use dimeticone (Hedrin) available in pharmacies or oils (Paranix) or willow bark shampoo (Rausch), although the efficacy of the latter has not been proven. Delousing may be performed by the same principles during breastfeeding as during pregnancy. 

Nix emulsion cream (permethrin) is convenient to use during pregnancy and breastfeeding. It is poorly absorbed through the skin, and no particular risks have been reported.

Sulphur ointment can also be used during pregnancy and breastfeeding. Sulphur ointment must not come into contact with the infant’s mouth so do not treat the breasts with the sulphur ointment unless they show symptoms of scabies. It is recommended to pump the milk and bottle feed the infant during sulphur ointment treatment. 

If scabies treatment has failed with permethrin and sulphur ointment, the use of benzyl benzoate can be considered during pregnancy and breastfeeding. Benzyl benzoate must not come into contact with the infant's mouth so wash the tips of the breasts with water and soap before breastfeeding. 

All topical care products available prescription-free at pharmacies, such as vaginal suppositories and creams, are safe to use during pregnancy and breastfeeding. Topical care products are recommended as primary options, because they only excrete very low levels of drugs into the bloodstream. Please be careful when using the applicator towards the end of the pregnancy.

We do not recommend one-off doses administered orally (fluconazol) during pregnancy, unless there are particular reasons for it. Using this medication has been associated with an elevated risk of miscarriage. A vaginal yeast infection (candidiasis) is to be treated along the same principles during both pregnancy and breastfeeding. 

Nystatin, which is used to treat oral candidiasis, is safe to use during pregnancy and breastfeeding. The product excretes very little of the drug into the system through the mucous membranes of the mouth or through the digestive tract.

Untreated bacterial vaginosis may elevate the risk of your water breaking early and of premature birth. The symptoms of bacterial vaginosis include a greyish discharge that smells offensive, and often also slight itching and irritation. 

Bacterial vaginosis is treated with antibiotics. During pregnancy, the primary treatment option is a topical care product (vaginal cream or suppository), but an orally administered course of antibiotics may be considered if necessary. Bacterial vaginosis is to be treated according to the same principles during both pregnancy and breastfeeding.

Nausea and occasional vomiting occur in 70 to 80% of pregnancies during early pregnancy. The symptoms commonly start a few weeks after menstruation stops and are at their worst 2 to 3 weeks later. Generally, nausea and vomiting ends by gestational weeks 12–16, but about one in a thousand pregnant women suffer symptoms throughout pregnancy. Comfortingly, studies have not shown any increased risk of pregnancy complications from pregnancy nausea; on the contrary—the risk of miscarriage seems to be lower.

You can ease nausea in pregnancy in the following ways:

• Eat and drink often, small amounts at a time (an empty stomach or a very full, stretched stomach can cause vomiting)
• Avoid food items that you notice causing nausea
• Liquid and cold food is generally easier to keep in
• You can use the over-the-counter anti-nausea medicines meclizine and cyclizine to treat nausea in early pregnancy if drug-free remedies do not help. However, you should always discuss taking medication at the maternity health clinic beforehand
• If the drug-free remedies and over-the-counter medications do not help, your doctor can prescribe a combination product that contains doxylamine and pyridoxine (vitamin B6).
• Repeated vomiting is often accompanied by heartburn, which can be treated with medication (see below). Treating heartburn can also ease the nausea symptoms.

Hyperemesis gravidarum means severe vomiting in pregnancy that can lead to dehydration and significant weight loss. This type of condition would require hospitalization (hydration and medication).

Heartburn is a common issue during pregnancy. You can try to relieve it with the following ways:

• Eat small meals and avoid lying down immediately after a meal.
• Avoid greasy foods and very spicy foods.
• You can take antacids, sucralfate, or sodium alginate available in pharmacies. It is important to comply with the dosage instructions on the package.
• If the antacids or mucosal protective agents are not effective, heartburn can be treated with omeprazole or esomeprazole, for example, if necessary. However, you should always discuss any medication with your maternity clinic doctor.

Breastfeeding and heartburn

Antacids and mucosal protective agents are not really absorbed by the body and can be used during breastfeeding. If the antacids or mucosal protective agents are not effective, heartburn can be treated short-term with famotidine or omeprazole, for example, if necessary. Always discuss long-term use and other medication options with your maternity clinic doctor.