Coughing whilst Pregnant

Introduction

Pregnancy presents itself with several uncomfortable symptoms, such as back pain, nausea, and fatigue. Fluctuating hormone levels during pregnancy may cause several uncomfortable side effects for the development and birth of a healthy baby.¹ One of the most pronounced symptoms is chronic coughing. Chronic cough is typically caused by changes in the immune system, blood volume, and swelling of the nasal tissue. 

During pregnancy, people assigned female at birth (PAFAB) may become more sensitive to allergens in the air that leads to chronic coughing fits.² However, like other common pregnancy symptoms, chronic cough is a normal sign of the physiological changes induced by pregnancy.² Despite its essential function in human health, coughing can cause several annoying and potentially serious side effects in pregnant PAFAB.

Types of Coughs During Pregnancy 

The most common types of coughing during pregnancy include dry coughs, wet coughs, and chronic coughs.³

1. Dry cough is a type of cough in which there is no production of phlegm or mucus. Dry cough can cause a tickling or irritating sensation in the throat and chest. Medical practitioners may refer to it as “non-productive coughs”.³
2. Wet cough occurs when phlegm and mucus is brought back up in the throat. Wet coughs are typically due to the viral infections, such as the flu, common cold, and chest infection. Medical practitioners may refer to it as “productive coughs”.³
3. Chronic Cough is a cough that lasts over eight weeks in adults. The most common causes of chronic coughs in pregnant people are allergies, asthma, acid reflux, and infection. This often occurs due to the increased sensitivity of the nerves involved in the coughing reflex.^{3, 4}
4. Whooping Cough, also known as ‘pertussis’, is a life-threatening disease that primarily affects babies and adults unvaccinated from the condition. Pregnant people are advised to receive the whooping cough vaccine to reduce the risk of  their baby being from the condition following birth.^{3, 5}

Causes of Coughs

Cold and Flu

Due to the hormonal changes that occur during pregnancy associated, pregnant people are typically more susceptible to catching a cold or the flu. These share several symptoms including sore throat, coughing, sneezing, and fatigue.

Post-nasal Drip 

Researchers have found a strong relationship between pregnancy and post-nasal drip occurrences.  Pregnancy causes excessive mucus production that is expelled through the nose and can also accumulate in the sinuses causing blockage, subsequently a build-up of phlegm in the throat. This build-up of mucus in the throat is also known as post-nasal drip and can cause irritation which then usually leads to dry coughing.³ Post-nasal drip is very common amongst pregnant people and the condition was formally classified as ‘pregnancy rhinitis’.^{6, 8}

Heightened Cough Reflex

According to Morice, PAFAB have an increased sensitivity to coughing, which may be a protective mechanism to prevent choking during pregnancy. This is referred to as the heightened cough reflex and it is believed to make pregnant people more susceptible to different types of coughs, to increase the survival of mother and child.⁷ The exact mechanism of this reflex is not fully understood yet but it is possibly mediated by both the immune system and brain.

Prolonged Stomach Acid Reflux

Prolonged stomach acid reflux is commonly referred to as heartburn.⁹ This is one of the most notorious pregnancy symptoms. According to the NHS, it is caused by hormonal changes and the pressure of the growing baby on the stomach and surrounding organs.⁹ Stomach acid reflux occurs following a meal, when the stomach acid flows back up the esophagus (i.e. food pipe) causing symptoms such as chest pain, heartburn, wheezing, and coughing. The backflow of stomach acid activates the body’s natural coughing reflex, thus, leading to coughing episodes.¹⁰  

Complications

Sleep Disturbances

​​Sleep disruptions in pregnant people suffering from a cough are quite common.¹¹ A survey conducted on chronic cough patients found that 17% of patients reported frequent sleep disturbances.¹² Since coughing is less common during the night and the cough reflex is less sensitive in the night, night-time coughing occurs typically prior to bedtime, which can prevent one from sleeping.⁷ The combination of coughing and other specific condition-related symptoms can cause sleep disturbances.

Urinary Incontinence

Urinary incontinence is when an individual urinates unintentionally.^{13, 14} Coughing during pregnancy can increase the risk of urinary incontinence. During pregnancy, bodily changes can cause an increase in pressure on the bladder.¹³ This increased pressure causes the bladder to flatten and decrease space for urine storage. Exercise, laughing, and coughing can increase the chance of urinary incontinence due to the increased stomach pressure that all three of  those actions cause.¹³

Can a cough affect the baby?

Generally, coughing during pregnancy will not affect or be felt by the baby. Coughing is generally only felt negatively by the pregnant mother due to changes in hormone levels and immune function.¹ However, there are potential risks that should be considered, for example a study by the Centres for Disease Control and Prevention concluded that pregnant people suffering from a cold or flu in the early stages of pregnancy are more likely to deliver a baby with birth defects.¹⁵ Although the risk lowers as the pregnancy progresses. However, wet coughing related to illnesses, such as asthma, bronchitis, and pneumonia, can harm the baby due to the impact of these conditions on the mother’s health, and thus the baby’s health as well.³

Treatments

​​When treating a cough, pregnant people should consult the advice of a medical practitioner before taking any treatment remedies to ensure that they are not harmful to the health of the baby. Some example treatments are described below.

At Home Remedies

Zinc: Research has found that 4 in 5 pregnant people are deficient in zinc. This is an essential contributor in strengthening the immune system. To counteract this, pregnant people are advised to eat food rich in zinc, such as avocados, blackberries, blueberries, beans, nuts, whole grains, and dairy products.¹⁶

Vitamin C: Vitamin C is an infection fighting nutrient that is able to aid in the killing and clearance of infection-causing organisms whilst also providing cough relief. Foods rich in vitamin C include oranges, bell peppers, kiwis, and grapefruit.¹⁶

Lemon and Black Pepper: To alleviate coughing in pregnancy, one could try dusting a lemon with black pepper powder. Research suggests that black pepper is able to relieve discomfort from cough while lemons are a source of vitamin C.¹⁶

Water and Lemon Mixture: Honey has several antibacterial properties that are useful for treating coughs at home. It soothes throat irritation from conditions like colds and flus, acid reflux, and postnasal drip, which then reduces cough occurrence.¹

Salt and Lukewarm Mixture: Research finds that gargling lukewarm water mixed with salt can provide some relief from cough symptoms.¹

Over the Counter¹

Most medical practitioners advise the avoidance of all medications during the first trimester of pregnancy because this is the most sensitive time of a baby’s development. Following the first trimester, it is safe to take the following for cold symptom relief:

• Menthol rubs on affected areas (chest, below the nose)
• Nasal strips
• Lozenges
• Over-the-counter cough syrup
• Acetaminophen- for achy sensation of the chest in dry and wet cough
• Antihistamines- for allergy related coughing 

Pregnant people should avoid medications that treat several symptoms under one condition as they can risk the baby’s health. These include:

• Aspirin
• Codeine
• Naproxen

When to seek medical advice 

If symptoms do not improve after two weeks and treatment with over-counter drugs and home remedies, one should seek medical help. You should alo immediately seek medical attention if you experience blood in the mucus of wet coughing, severe chest pain whilst coughing, loss of appetite, and insomnia.¹⁶ If one has distinct flu-like symptoms, it is recommended that medical treatment is sought urgently because complications from the flu have a high risk of causing premature birth and birth defects.¹⁶

Summary 

Coughing during pregnancy is very common and can be linked to changes in hormone levels and immune function during pregnancy.¹ Pregnant people are also more susceptible to coughing due to their increased sensitivity to allergens and viral infections. Additional causes include post-nasal drip, colds and flus, and prolonged acid reflux.⁶ Coughing can lead to sleep disturbances and urinary incontinence, however, it usually does not negatively impact an unborn baby’s health and development.¹ Coughing can often be treated with a wide range of home remedies and over-the-counter medications, but should be avoided in the first trimester of pregnancy due to physiological processes that take place in foetus development.¹⁶ If the coughing becomes unbearable and does not improve after two weeks, medical advice from a doctor should be sought out. This is to prevent any ill-effects on the mother and child’s health.^{16, 17}