Bronchitis During Pregnancy: Prevention and Treatment

Developing bronchitis while pregnant is unlikely to harm your fetus, but serious complications are possible. If you’re pregnant and you have symptoms of bronchitis, it’s important to contact your healthcare provider.

While people who are pregnant are not truly immunosuppressed, the delicate balance of the immune system during pregnancy can be upset by viral infections, including bronchitis.

This article goes over the symptoms, causes, and potential complications of bronchitis while pregnant.

Symptoms of Bronchitis During Pregnancy

Bronchitis often develops along with a viral infection. Symptoms may include:

• Coughing
• Mucus that may be clear, yellow, or green
• Sore throat
• Chest congestion
• Fever and chills
• Body aches

See your healthcare provider if you experience any of the following:

Causes of Bronchitis During Pregnancy

Around 90% of bronchitis cases begin with a viral infection, but bacterial bronchitis is also possible.  

Viruses that may be responsible for bronchitis during pregnancy include:

• Human rhinoviruses
• Influenza virus
• Respiratory syncytial virus
• SARS-CoV-2, the virus that causes COVID-19

You can also get bronchitis from exposure to environmental irritants, such as cigarette smoke and chemical fumes. Conditions such as gastroesophageal reflux disease (GERD) and asthma can also make you more prone to developing bronchitis.

Related Complications

While bronchitis often runs its course in the general population as well as among women who are pregnant, you could be at risk for complications ore more severe illness. These complications, though uncommon, can range from pneumonia to problems that affect pregnancy directly such as miscarriage or premature labor.

Pneumonia

During pregnancy, the immune system operates on a fine balance between tolerating a “foreign” entity (the fetus) and remaining competent to fight off infectious organisms such as viruses and bacteria. Viral infections can disrupt this balance by causing changes in inflammation, immune cells, and more.

Secondary bacterial pneumonia is a common complication of bronchitis. It occurs in roughly .5 to 1 out of every one thousand pregnancies.

Not all women are at the same risk. Pneumonia is more likely to occur:

• When people become ill with viral infections during the fall and winter months
• When they have underlying conditions (such as asthma)

That said, anyone could potentially develop pneumonia as a complication of bronchitis, thus it’s important to be aware (but not unduly worried) about this complication. When diagnosed early, pneumonia during pregnancy is generally treatable.

Acute Respiratory Distress Syndrome (ARDS)

Influenza and COVID-19 are important causes of bronchitis and, in pregnant people, can be a risk factor for acute respiratory distress syndrome (ARDS).

While very uncommon, ARDS in pregnant women can be very serious or lead to death. It is more common toward the end of pregnancy.

During years in which influenza seasons are particularly bad, the risk of ARDS was found to be twice as high in pregnant women as in women who were not pregnant. This may sound alarming, but studies have looked primarily at years when the influenza rate was very high, and complications were much more likely to occur in those who had underlying risk factors.

Premature Labor or Pregnancy Loss

In addition to pneumonia and other lung issues, viral infections may also increase the risk of premature labor and delivery (often due to the secondary infections that follow the viral infection).

There are a number of reasons why a viral infection (or subsequent bacterial secondary infections) could be a problem. These include:

• The oxygen level in the mother falls (hypoxia), resulting in less oxygen to the fetus
• Some bacterial infections (that can follow a viral infection) can directly increase the risk of premature labor

While not looked at separately in many studies, the same principles (hypoxia or direct bacterial effect) could also increase the risk of miscarriage.

Congenital Infections

Though the viral infections that lead to bronchitis are uncommon as far as causes of congenital infections (infections that affect babies and can lead to problems such as birth defects), it’s important to note that some viruses—such as herpes simplex, cytomegalovirus, and others—can be associated with these problems.

When to Call Your Healthcare Provider

It’s important to call your healthcare provider if you have any concerns at all about your health, but there are some symptoms that should prompt you to call your practitioner right away. These include:

• Symptoms that are persistent: If you continue to have symptoms for more than two weeks, and especially after three weeks, it’s important to contact your healthcare provider.
• Symptoms that improve and worsen again: If you feel you are getting better and then your symptoms worsen again, you could have a secondary bacterial infection.
• High temperature: A low-grade fever is common with bronchitis, but a fever greater than 101 degrees F may be a sign of a secondary infection.
• Wheezing: Slight wheezing is common with bronchitis, but loud or persistent wheezing suggests airway obstruction (reactive airway disease).
• Shortness of breath: Many women feel mild shortness of breath due to pregnancy, but if you notice the sudden onset or worsening of symptoms, you should contact your healthcare provider.
• Rapid respiratory rate: While some shortness of breath can be normal in pregnancy, the rate of your breathing (respiratory rate) should remain the same (respiratory rate does not change in pregnancy, but volume of air taken with each breath is mildly increased). If you notice you are breathing faster than usual (tachypnea) or if your breathing is shallow, talk to your healthcare provider right away.
• Coughing up blood: Coughing up blood, even a trace, is a reason to contact your practitioner right away.
• Chest pain/tightness: A feeling of chest tightness is common with pneumonia. While coughing can cause some discomfort, it’s best to talk to your healthcare provider.
• Lightheadedness: If you feel lightheaded or faint, it could be a sign that you aren’t getting enough oxygen.
• Decreased fetal movement: If your baby seems to be moving less often than usual, call your practitioner.

How to Treat Bronchitis During Pregnancy

Generally, bronchitis will clear up on its own in time, though if it is due to a bacterial infection (or if you develop a secondary infection), antibiotics may be needed.

The mainstay of “treatment” most of the time will be home remedies to control your symptoms while the illness runs its course.

Prescription Medication

If you feel you need a cough or cold preparation, call your obstetrician to learn about their recommendations. It’s important to remember that many medications are not safe to use during pregnancy.

If your healthcare provider determines that you have a bacterial infection, they may prescribe antibiotics. Antibiotics that are considered safe during pregnancy include:

• Amoxil (amoxicillin)
• Ampicillin
• Zithromax (azithromycin)
• Cleocin (clindamycin)
• Macrobid (nitrofurantoin)
• Penicillin
• Firvanq (vancomycin)

Natural Remedies

Some natural remedies and comfort care you can try if you have bronchitis include:

• Rest: Getting plenty of rest will give your body a chance to recover. Don’t be afraid to ask for help if you need it.
• Drink enough fluids: Fluid requirements increase during pregnancy. Having an infection can further increase your water needs, and being dehydrated may increase your risk for kidney infections. Try to drink between 64 and 96 ounces or 8 to 12 cups of water daily.
• A cold air humidifier: A humidifier can help with congestion, but make sure it is cleaned properly before use. You should also avoid adding anything (such as Vicks) to the water.
• Honey: A 2021 review of studies found that honey actually worked better than over-the-counter cough suppressants and other remedies to control the frequency and severity of coughing.
• Warm tea: Warm liquids can be soothing if your throat is sore from coughing. Adding a little honey and lemon may actually help reduce your cough.
• Use medications sparingly: Tylenol (acetaminophen) and some cough and cold medications can be taken safely during pregnancy, but use them only as needed. A low-grade fever, as long as you’re not uncomfortable, actually helps fight infections.
• Saline nasal flush: Some people find a saline flush can help with nasal congestion, and Neti Pots are now available at most pharmacies. A caveat is that it’s important to only use sterile saline to avoid the rare risk of serious infection.

Prevention Tips

Although you may not be able to prevent bronchitis entirely, there are a number of ways that you can reduce your risk. These include:

• Avoiding friends or family members who are ill
• Avoiding crowded events, especially during cold and flu season
• Frequent handwashing, or using hand sanitizer when needed
• Avoiding cigarette smoke
• Wearing a mask if you will be exposed to dust/fumes (such as wood dust) or if you may be around people who have cold and flu symptoms
• Minimizing outdoor activity if the air pollution level in your area is high (traffic-related air pollution is an important risk factor for bronchitis during cold season)

Vaccination

Getting your annual flu shot and making sure you’re fully vaccinated against COVID-19 are also important. In addition, women who develop symptoms of influenza or COVID-19 should contact their healthcare provider.

Getting vaccinated not only helps you, but can help your developing baby. Antibodies are passed from a mother to infant both through the placenta and via breast milk (in those who are nursing), and can protect babies until 6 months of age when they become eligible for vaccination.

For people ages 19 to 64 who smoke or have certain medical conditions, the pneumonia vaccine (in this case, PPSV 23) may be recommended. Make sure your obstetrician is aware of your past medical history. Even though women who are pregnant may be hesitant to tell their healthcare provider that they smoke, this is one reason why speaking up honestly is important, as the pneumonia vaccine is recommended for anyone who smokes.

Control of Coexisting Conditions

If you have other medical conditions—such as asthma—that can lead to complications of viral infections, it’s important to make sure these conditions are controlled as well as possible during pregnancy as they can increase the risk of complications from viral infections.

Summary

In most pregnant people with bronchitis, the infection resolves without complications. It is possible, however, to develop bronchitis-related problems such as pneumonia or acute respiratory distress syndrome. Premature labor or pregnancy loss are also possible. This is why it is important to see your healthcare provider if you develop symptoms of bronchitis so your condition can be monitored and treated.

You can prevent bronchitis by avoiding crowded places, washing your hands frequently, and staying away from environmental irritants like cigarette smoke. It’s also important to make sure you’ve been vaccinated for influenza and COVID-19, and that existing conditions such as asthma are well managed.