Cough during pregnancy: causes, consequences, treatment and prevention

1. General information
2. Why is a cough dangerous during pregnancy?
3. Causes and symptoms
   Causes of cough typical for pregnant women
4. Treatment of cough in pregnant women
5. General recommendations
6. Prevention

Pregnant women, due to the stress on the body and a weakened immune system, are more often than others susceptible to acute respiratory viral infections and complications after an illness.
Cough, as a concomitant symptom of colds, is dangerous because it causes contraction of the abdominal, chest and back muscles. The air flow speed during bronchospasm is about 480 km/h. This dynamics leads to uterine tone and the threat of miscarriage. If a pregnant woman is diagnosed with a cough with sputum that is difficult to clear, only a doctor can prescribe a drug for treatment. Most often these are expectorants of plant origin.

Causes of cough in pregnant women

• Inflammation of the respiratory system of a bacterial, viral or fungal nature (tonsillitis, tracheitis, bronchitis, pneumonia, etc.). Infection can lead to complications and threats to the health of the mother and fetus.
• Irritation of the mucous membrane of the upper respiratory tract, exposure to cigarette smoke, dust, other particles and toxic substances in the air.
• Allergic reaction to food, wool, dust, plants and other agents.
• Compression of a certain part of the respiratory organs (for example, enlarged lymph nodes, foreign body, etc.).
• Inhalation of extremely hot or cold air.
• Reflux of acidic contents from the stomach into the esophagus (gastro-esophageal reflux).
• Diseases of the cardiovascular system. A cardiac cough is accompanied by shortness of breath and signs of lack of oxygen (pallor of the skin, blue tint of the mucous membranes and tips of the nails).
• Taking some medications can also cause coughing as a side effect.

Causes and symptoms

The nature of the cough helps the specialist to determine its cause and make a preliminary diagnosis.

• Influenza – a dry cough, mucous discharge sometimes of a purulent color appears after a few days. The cough is accompanied by severe headaches and muscle pain, high fever and general weakness.
• Bronchitis is a sharp spasmodic cough with contraction of the abdominal muscles. A strong cough can trigger the gag reflex. There is pain in the chest area. The cough gets worse in cold or dry air.
• Allergic cough is a problem that pregnant women face due to hormonal changes. Contact with an allergen provokes asthma attacks. The discharge is mucous in nature and practically absent.
• Rhinitis and pharyngitis are accompanied by a dry cough at night. In rare cases, headaches and the area under the eyes hurt.
• Pleurisy - acute chest pain, shortness of breath, high temperature that practically does not go down, frequent dry cough.
• Measles is a debilitating cough and rash on the skin.

Causes of cough typical for pregnant women

• Dryness in the room, which increases the sensitivity of mucous membranes. This leads to an increased urge to cough. This problem is more common during the winter months in heavily heated areas.
• Vasomotor rhinitis during pregnancy is a runny nose caused not by viruses, but by hormonal changes. With a stuffy nose, patients breathe more often through their mouth, which leads to dry mucous membranes, which, in turn, leads to throat irritation.
• Heartburn is a typical complaint. Coughing attacks occur in a lying position, when acid flows from the stomach back into the esophagus, irritating the sensitive mucous membrane of the throat, and then the urge to cough occurs.
• Cardiac cough occurs after excessive physical activity and as a consequence of heart failure. The blood stagnates, swelling forms in the lungs, which irritates the respiratory receptors and provokes a cough.

Dry cough during pregnancy

The dry type of cough is characterized by the absence of sputum. It is often paroxysmal, obsessive, and painful. With a prolonged course of the disease, coughing causes pain in the throat and behind the sternum, spasms and fatigue of the abdominal muscles and respiratory muscles. A strong dry cough interferes with normal breathing, can increase the tone of the uterus and intra-abdominal pressure, cause urinary incontinence with weakness of the pelvic floor muscles, and provoke severe fatigue.

Why is coughing dangerous?

In most cases, cough is a sign of a bacterial or viral respiratory disease. Therefore, in the absence of proper treatment, the disease can gradually become chronic, and complications are also likely to develop. In such conditions, the likelihood of miscarriage , premature birth, and intrauterine infection increases. The risk of developmental defects in the baby also increases.

In addition, immediately at the moment when the expectant mother coughs, the tone of her uterus increases. And this condition threatens miscarriage and hypoxia .

If the expectant mother has low placentation or placenta previa, then due to strong muscle tension during coughing, bleeding from the uterus may begin.

And with toxicosis, coughing attacks can significantly increase the severity of nausea and aggravate the condition.

Cough with phlegm during pregnancy

With a wet cough, sputum is released: it is distinguished by volume, consistency, thickness and color. Cough with sputum is more typical for diseases of the lower respiratory tract (bronchitis, pneumonia). With a productive cough, sputum is actively expectorated in large quantities. An unproductive cough is more often observed in the first days of infectious diseases in the form of a small amount of viscous discharge, or is of allergic origin.

General recommendations

• The air humidity in the room should be 65-70%. This level of humidity is comfortable for the body, prevents the mucous membrane from drying out, and reduces the rate of development of pathogens. Wet cleaning reduces the risk of contact with allergens (pollen, dust, pet hair).
• The room must be ventilated regularly, at least 2 times a day. Fresh air reduces the concentration of the virus in the air. It is recommended to maintain the room temperature at 22 degrees.
• It is necessary to drink enough fluid to liquefy the mucus naturally.
• Bed rest, especially in the first 3-4 days after the first symptoms appear.

How to treat cough during pregnancy

Recommendations for treating cough will depend on the cause of the symptom. If the cause is exposure to chemicals, cigarette smoke, or allergic agents, then the first step should be to reduce or completely stop their effect on the expectant mother’s body. If the disease is infectious, in addition to symptomatic treatment, antibacterial or antiviral drugs may be required.

It should be remembered that not all medications are approved for use during pregnancy, especially in the first trimester. Your doctor will choose the most effective and safe treatment.

In the first trimester

If you have a cough in early pregnancy, it is better to opt for gargling with a saline solution and drinking plenty of liquid. It is allowed to take Mucaltin and Libexin tablets if indicated. Among the physiotherapeutic procedures, inhalation with Borjomi mineral water or 0.5-2% sodium bicarbonate solution and drainage massage will have a positive effect.

is prohibited due to a lack of clinical studies and a possible negative effect on fetal development.

In the second and third trimester

To relieve dry cough and improve the removal of sputum when wet, it is recommended to take mucolytics and expectorants. All medicines and herbal preparations require caution if there is a tendency to allergic reactions of any severity. Semi-synthetic drugs are allowed in the 2nd and 3rd trimester, provided that their benefit significantly outweighs the possible harm - this is determined by the doctor. Ambroxol preparations can also be prescribed to stimulate fetal lung development.

Cough tablets that affect the respiratory center (Codeine, Solpadeine, etc.) are strictly prohibited

Prevention

• It is not recommended to visit crowded places, especially during seasonal flu epidemics.
• Contact with sick people should be limited.
• On a regular basis, it is necessary to use products to moisturize the nasal mucosa.
• After visiting public places, it is important to thoroughly clean your hands with antibacterial agents.
• It is necessary to wear a gauze bandage when visiting medical institutions and public institutions.
• You should only use personal household appliances and hygiene products to prevent the transmission of germs through household means.

Bromhexine during pregnancy

The effectiveness of bromhexine in bronchopulmonary diseases is determined by its mucolytic and secretomotor actions. It helps to liquefy sputum and can relieve a dry cough or improve the evacuation of thick and purulent discharge during a wet cough. Improving the mobility of the cilia of the epithelium lining the lower respiratory tract will speed up the removal of stagnant mucus, promoting rapid recovery.

Bromhexine: instructions for use

This medicine is approved for use from the 2nd and 3rd trimester only on medical advice. An important role is played by the release form (tablets, syrup, solution, etc.) and the manufacturer. The list of chemicals included in the drug, in addition to the main active component bromhexine hydrochloride, will depend on them. Less preferable for pregnant women are syrups that contain sweeteners, dyes, flavors and require a high daily dose.

Bromhexine is excreted in breast milk and is therefore not recommended for use by nursing women. Consultation with your physician is required before use.

Patients and methods

From September 2014 to January 2016, for a consultation with an ENT doctor in the department of early diagnosis of allergic diseases of women of childbearing age at the clinic with the CDC of PSPbSMU named after. acad. I.P. 613 pregnant women came to Pavlov with various complaints. The study included 92 (15.0%) women aged 20 to 44 years (average 30.5±0.5 years) who complained of a dry cough that occurred during pregnancy. Pregnant women who had a cough before pregnancy, as well as patients with polypous rhinosinusitis and signs of acute respiratory viral infection were excluded from the study.

Group 1 (23 people) included patients with complaints of cough and concomitant bronchial asthma diagnosed before pregnancy. Group 2 consisted of 69 pregnant women without previously diagnosed bronchopulmonary pathology. All patients were consulted by a pulmonologist; if necessary, he performed a study of external respiratory function. Bronchial asthma was differentiated by the severity of the course (mild episodic, mild persistent, moderate and severe) based on the frequency of occurrence and severity of asthma symptoms, taking into account the data of the external respiratory function [15], as well as by the level of control (controlled, uncontrolled) according to the criteria GINA 2007, and assessed in points: mild severity with episodic course - 1 point, mild persistent uncontrolled - 2 points, mild persistent controlled - 3 points, moderate persistent uncontrolled - 4 points, moderate persistent controlled - 5 points, severe severity - 6 points. All patients underwent a standard examination of ENT organs. Changes in the hypopharynx were assessed by the sum of points: the degree of hyperemia, pastosity and folding of the interarytenoid space (each sign - from 0 to 3 points), diffuse hyperemia of the hypopharynx - 1 point, with maceration of the mucous membrane - 2 points, thickening of the vocal folds - 1 point, hyperemia vocal folds - 1 point. It was considered that changes in the larynx were caused by GER if the degree of endoscopic changes in the interarytenoid space reached 2 points or more.

Based on an adapted questionnaire for diagnosing reflux syndrome [16], the main symptoms of GER were analyzed in points from 0 to 3 (heartburn, heartburn in the supine position, belching, bitterness in the mouth). We separately assessed diet and eating disorders that could contribute to the increase in GER (acute, marinades and citrus fruits) (0 - 1 point), whether the patient lies down during the day (0-1 point), how long before bedtime the last meal was taken (3 h - 0 points, 2 hours - 1 point, 1 hour - 2 points, 0 hours - 3 points). Statistical processing of data was carried out using the Mann-Whitney test and the Pearson correlation coefficient ®.

In case of debut or worsening of bronchial asthma, treatment was adjusted; in the presence of reflux-induced changes in the larynx, recommendations were given on nutritional rules, and antacid medications were prescribed for a period of 2 weeks; In case of severe nasal congestion, intranasal glucocorticosteroids were prescribed. In 8 cases, patients with severe cough without bronchial asthma were prescribed prenoxdiazine (300 mg per day) for 5-7 days. If a cough variant of bronchial asthma was suspected, the pulmonologist prescribed therapy according to the recommendations of GINA 2007 for 2 weeks; if it was ineffective, the patients were referred to an otolaryngologist.