Pregnancy is not always the preserve of the healthy glow. Despite attempting to stay healthy by eating the right foods and exercising, many women find they spend much of the nine months warding off niggling ailments. Compromised natural defences - the immune system undergoes significant changes to allow a woman's body to tolerate the foetus that would otherwise be considered a foreign object - means that succumbing to colds, coughs and other complaints is commonplace. But with many medications considered unsafe, working out what you can and cannot take to aid recovery is problematic.
Last week, a US study led to renewed calls for pregnant women to be vaccinated against the influenza virus and a separate report warned that women at risk of giving birth prematurely should not be given antibiotics as it increases the risk of the child having cerebral palsy. So what should you take? Here we look at the best routes to avoiding and treating illness:
Because of their compromised immune systems, pregnant women are more likely to catch the influenza virus than other women. Following new evidence in the New England Journal of Medicine last week, the joint committee on vaccination and immunisation (JCVI), a government advisory panel, are calling for all pregnant women to be offered the flu jab. Professor Mark Steinhoff, from the Johns Hopkins University Bloomberg School of Public Health in Baltimore randomly assigned 340 women to have the flu vaccine while pregnant. He found approximately one-third fewer cases of flu in mothers who had had the jab, as well as in their newborn babies. The study also found that the babies whose mothers had been vaccinated were 63% less likely to catch the virus during the first six months of their lives - a significant figure as the risks of complications including bronchitis and pneumonia are greater in infants under six months, who are too young be vaccinated. The flu vaccination is considered safe to take during pregnancy and is already routinely given to pregnant women in the US and Canada.
What to do: The Department of Health advises women not to panic. At present, the vaccination programme recommends flu jabs for only at-risk groups such as those with diabetes, chronic respiratory diseases such as asthma and chronic heart disease, although the department says it is keeping this under review. If you do get flu while pregnant, the advice from NHS Direct is to drink plenty of water, take paracetamol to treat a high temperature, headache and muscle pain but only to take over-the-counter medications after consulting a pharmacist or doctor. Generally, aspirin and non-steroidal anti-inflammatories (such as ibuprofen) should be avoided, particularly in the third trimester.
Tonsilitis and bacterial infections
Although bacterial infections, such as tonsilitis, are generally treatable with antibiotics, doctors are now being warned not to prescribe the medication to women at risk of premature labour as it may increase the chance of their babies getting cerebral palsy. Last week it was announced that the Department of Health had written to doctors about the risks following a study designed to look into the effect of antibiotics on premature births. Dr Sara Kenyon of Leicester University, who led the study, found that erythromycin and another antibiotic called co-amoxiclav appeared to have harmful effects for some children born to mothers in premature labour whose waters had not broken. When the children were re-assessed at seven, those born to mothers who had taken antibiotics were likely to have cerebral palsy.
What to do: Despite this latest study, the Royal College of Obstetricians and Gynaecologists insists most pregnant women showing signs of infection can be treated promptly and safely with antibiotics. Kenyon says, "Where there is an obvious infection, antibiotics should be prescribed because they could be life-saving for mother and baby." With tonsilitis, paracetamol can also be taken to bring down temperature and taking warm drinks, soft food and throat lozenges or boiled sweets can help to ease swallowing.
Coughs and colds
During pregnancy, many women find they suffer a constant stream of niggling coughs and colds. Remedies often contain several active ingredients, including painkillers, antihistamines and decongestants, which pregnant women are urged to avoid. Cough medicines containing iodine as an expectorant should not be taken, as this might impair the functioning of a baby's thyroid gland.
What to do: Drinking plenty of water or warm drinks can help to relieve a chesty cough and inhaling steam can help to loosen mucus. 'Although there is no confirmed evidence that vitamin C reduces the duration or intensity of a cold, there is no harm in taking the recommended daily allowance of 40mg if you think it helps," says Louise Sutton, a dietician at Leeds Metropolitan University. "However, taking more than this is inadvisable as it can cause diarrhoea and tummy ache." Some soothing cough mixtures such as linctus are safe, but check with your pharmacist.
About 40% of women experience constipation during pregnancy. It is thought raised levels of the female hormone progesterone act as a relaxant to the intestinal muscles - causing food and waste to move slower through the system - combined with the pressure from the expanding uterus. Iron tablets prescribed for anaemia may also contribute.
What to do: "Try drinking more fluids and eating more high-fibre foods, including dried and fresh fruit and wholegrain cereals, before resorting to other measures," says Sutton. "If that doesn't work, lots of laxatives are safe for pregnant women - including the bulking agents like lactulose and macrogols. Always ask your pharmacist before taking them as some are not suitable."
Headaches and migraines
During pregnancy, these have been shown to decrease in people who usually suffer from them regularly, but not everyone will escape them.
What to do: Aspirin and non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen are not recommended during pregnancy as they have been linked to complications in labour. Aspirin can also increase the risk of bleeding in the mother and baby, particularly if taken in the third trimester. Only paracetamol is safe for mild to moderate pain. For migraine sufferers, the advice from The Migraine Trust is "to take as few drugs as you can and at the lowest effective dose". Some migraine tablets contain ergotamine which has been shown in trials to stimulate the muscles of the uterus, raising the risk of a miscarriage and the trust says that the use of triptan drugs should be avoided. While paracetamol is safest, it says, your doctor will be able to prescribe a migraine medication suitable for use in the second and third trimesters.