Start with non-drug measures

• Rest, drink plenty of fluids, and use a humidifier or steam.
• Honey and warm tea can soothe the throat and thin mucus. MotherToBaby notes there is no pregnancy warning for honey in tea or food.
• Plain cough drops and lozenges (honey, menthol) carry no pregnancy warning on the same page. Avoid medicated or herbal ones unless your pharmacist confirms they are safe.
• A hot lemon and honey drink is suggested by NHS, though the evidence that it helps is limited.

Medicines generally considered acceptable

Use caution or avoid

• Decongestants (pseudoephedrine, phenylephrine): The sources disagree.
  • Textbook of Family Medicine lists them as acceptable, with pseudoephedrine preferred.
  • Rosen's Emergency Medicine says they are "not recommended during pregnancy" because they cause placental vasoconstriction. Limited first-trimester data link them to gastroschisis and intestinal atresia, though the risk appears low (Rosen's Emergency Medicine, Decongestants section).
  • The conservative approach is to avoid them in the first trimester and use saline spray instead.
• Codeine and other opioid cough suppressants: Early-pregnancy opioid exposure has been linked to about 2 to 3 times the expected rate of congenital heart defects and neural tube defects (Creasy & Resnik's Maternal-Fetal Medicine, Opioids section). Late use can also cause neonatal withdrawal and respiratory depression. Avoid them unless a doctor prescribes one.
• NSAIDs and aspirin (for the aches that come with a cough): Avoid them. NSAIDs can close the fetal ductus arteriosus early (Textbook of Family Medicine 9e, p. 484).
• Combination multi-symptom products: These expose you to drugs you don't need. Choose products that treat only your actual symptoms, and avoid ones containing alcohol (MotherToBaby).
• Herbal remedies: Many are poorly studied in pregnancy. Check with a pharmacist first.

When to see a doctor

• Cough lasting more than 2 to 3 weeks.
• Fever above 38°C (100.4°F), shortness of breath, wheezing, or chest pain.
• Coughing up blood, or green or bloody sputum.
• A cough that is worsening, or an existing condition such as asthma. Asthma, pneumonia, influenza, COVID-19 and whooping cough can all be more serious in pregnancy. The pertussis (Tdap) vaccine, given at 27 to 36 weeks, protects the baby.
• Persistent reflux or post-nasal drip as the cause, which needs targeted treatment.