Sore Throat in Pregnancy: Safe Relief, Red Flags, and UK Guidance

A sore throat can feel harsher when you’re pregnant. You’re already tired, your immune system behaves differently, and your usual go-to medicines may be off the table. The good news: most sore throats in pregnancy are mild and settle in 3-7 days. Your job is to ease the pain, stay hydrated, and know the red flags that mean you should speak to your GP or midwife.

• sore throat in pregnancy is usually viral and settles in 3-7 days; day 2-3 is often the worst.
• UK-safe options: paracetamol, saltwater gargles, honey and lemon, glycerin/menthol lozenges, saline sprays. Avoid ibuprofen (especially after 20 weeks), aspirin, decongestants like pseudoephedrine/phenylephrine unless advised.
• Call your GP/midwife or NHS 111 if you have severe pain, trouble swallowing saliva, breathing issues, a rash, fever 38°C+ for more than 48 hours, one-sided swelling, or you feel very unwell.
• Strep throat needs assessment; safe antibiotics in pregnancy include penicillin V and amoxicillin if prescribed.
• Think COVID/flu too-pregnancy raises your risk of complications. Rest, test if needed, and take up NHS jabs when offered.

What you likely want to get done right now:

• Know what’s normal vs worrying in pregnancy.
• Get quick, safe pain relief you can trust.
• Pick UK-safe medicines and avoid risky ones.
• Decide if you need a COVID/flu test, antibiotic, or just time.
• Have a simple plan for today and tonight.

What to expect: common causes, timelines, and red flags

Most sore throats in pregnancy are caused by viruses (a simple cold, flu, or COVID). They start scratchy, peak around day two or three, and fade by a week. Your nasal drip, mouth breathing at night, and dry indoor air can all make the burn worse. In pregnancy, reflux is also common-acid creeping up after meals can irritate the throat, especially when you lie down.

Common causes:

• Viral infections (cold/flu/COVID): raw throat, runny or stuffy nose, cough, mild fever, low energy. Usually 3-7 days.
• Strep throat: sudden severe throat pain, fever, swollen neck glands, tonsil pus, no cough. May cause a fine, sandpapery rash (scarlet fever). Needs medical assessment.
• Reflux (heartburn): sore/hoarse throat in the morning, worse after late meals, sour taste, burping. Can be ongoing.
• Allergies: itchy eyes, sneezing, clear runny nose, scratchy throat. Seasonal or triggered by dust/pets.
• Dry air/mouth breathing: overnight dryness, morning soreness that improves after fluids.

How pregnancy changes the picture:

• Immune shifts make you more likely to catch viruses and to feel them harder.
• Hormones relax the valve at the top of your stomach, so reflux is more common.
• Your options for over-the-counter meds are narrower, so simple measures matter more.

Red flags-seek urgent advice (GP, midwife, or NHS 111):

• Breathing difficulty, noisy breathing, drooling, or trouble swallowing saliva.
• Severe one-sided throat pain, hot potato/muffled voice, or jaw/ear pain on one side (could be a peritonsillar abscess).
• Rash with fever, or fever ≥38°C lasting more than 48 hours despite paracetamol.
• Signs of dehydration (very dark wee, dizzy, can’t keep fluids down).
• Very unwell, fast-worsening symptoms, or if you’re immunocompromised.
• In late pregnancy: reduced baby movements or you simply feel something is wrong.

Sources: NHS guidance on sore throat and medicines safety in pregnancy (UK), NICE sore throat assessment tools, and RCOG advice on infections and vaccines in pregnancy.

How to cope safely today: a simple relief plan

Use this step-by-step plan to feel better while staying well within pregnancy-safe territory.

1. Hydrate on a schedule
   Sip 150-200 ml of fluid every hour while awake. Warm drinks soothe; cold ones can numb. Aim for 6-8 mugs/glasses daily (more if you have a fever). Water, warm lemon and honey, decaf tea, clear soups, and ice lollies all help. If you have gestational diabetes, choose sugar-free options and use honey sparingly.
2. Gargle to reduce pain
   Mix 1/2 teaspoon table salt in 250 ml warm water. Gargle 20-30 seconds, spit, repeat 3-4 times. Do this every 3 hours. It draws fluid out of swollen tissue and rinses irritants.
3. Soften the air
   Use a cool-mist humidifier or sit in bathroom steam for 10 minutes. Keep rooms at comfortable humidity; avoid very hot steam on your face to prevent overheating.
4. Rest and position
   Rest your voice. Sleep with your head raised and on your left side to ease reflux and breathing. Avoid big meals within three hours of bedtime.
5. Ease pain and fever
   Paracetamol is the first choice in pregnancy. Typical adult dose: 500 mg-1,000 mg up to every 4-6 hours, max 4,000 mg in 24 hours. Use the lowest dose for the shortest time. If you have liver disease or any dosing doubts, ask your GP or pharmacist.
6. Soothe the throat
   Honey (a teaspoon straight or in warm water) coats the throat. Glycerin or menthol lozenges can help keep things moist. Cold yoghurt, smoothies, and soft foods are kind to an inflamed throat.
7. Clear the nose
   Saline nasal spray or rinse reduces post-nasal drip. If allergies flare, antihistamines like cetirizine or loratadine are usually considered safe in pregnancy. They won’t fix a virus but can calm allergy-driven irritation.
8. If reflux is the trigger
   Small, earlier meals; avoid spicy, acidic, or very fatty foods; and don’t lie down right after eating. Many find an alginate (e.g., sodium alginate/antacid combinations) after meals helpful and considered safe in pregnancy. If symptoms persist, your GP may recommend a proton pump inhibitor like omeprazole, which NHS considers fine in pregnancy when needed.
9. Test if it makes sense
   If you have fever, muscle aches, or known exposure, a COVID test can guide rest and isolation. Flu can also start with a sore throat; pregnant women are eligible for NHS flu and COVID vaccines each season. If you haven’t had yours this year and are offered it, take it-both are safe in pregnancy and cut the odds of serious illness.
10. Prevent spread
    Wash hands, don’t share cups, and cough into tissues. Replace your toothbrush after you’re better if you had strep or a high-fever illness.

Sources: NHS medicines in pregnancy, RCOG vaccine advice for pregnant women, and NICE CKS on self-care for sore throat.

What you can take (UK, 2025): safe picks, things to avoid, and smart swaps

Below is a practical, UK-focused guide. Always read labels, stick to standard doses, and check with a pharmacist if you’re unsure. If you’re on aspirin prescribed by your obstetric team for pre-eclampsia prevention, that’s different from over-the-counter use-don’t add other painkillers without advice.

• Pain and fever: Paracetamol is first line. Avoid ibuprofen and other NSAIDs (e.g., naproxen, diclofenac) unless specifically advised by a clinician, especially after 20 weeks due to fetal risks. Avoid aspirin for pain or cold symptoms.
• Lozenges: Simple glycerin, honey, lemon, or menthol lozenges are generally fine. Avoid flurbiprofen lozenges (they’re NSAIDs). Be cautious with numbing lozenges/sprays containing benzocaine or phenol-use only on pharmacist or GP advice.
• Throat sprays/mouthwash: Some non-NSAID sprays may be acceptable short term. Check with your pharmacist and avoid flurbiprofen sprays. If in doubt, stick with saltwater and soothing drinks.
• Cough syrups: “Simple linctus” (glycerol-based) is a low-risk choice. Avoid codeine-based syrups. Dextromethorphan may be used sometimes, but check with a pharmacist first.
• Decongestants: Avoid oral pseudoephedrine and phenylephrine in pregnancy unless a clinician says otherwise (especially avoid in the first trimester). If you’re very blocked, try saline spray or steam. Short-term topical decongestant sprays can still be risky; talk to a pharmacist first.
• Allergy meds: Cetirizine or loratadine are usually preferred in pregnancy for hay fever/post-nasal drip. Avoid sedating antihistamines if you need to drive.
• Reflux aids: Alginates (e.g., reflux “raft” products) and antacids are commonly used in pregnancy. If symptoms persist, ask your GP about omeprazole.
• Herbals and supplements: Skip echinacea, liquorice root, strong sage teas/oils, and high-dose zinc/vitamin C. Stick to a standard pregnancy multivitamin (without extra vitamin A).
• Antibiotics (if a clinician diagnoses bacterial infection): Penicillin V and amoxicillin are commonly used and considered safe in pregnancy. If you’re penicillin-allergic, macrolides like erythromycin or clarithromycin are typical alternatives. Avoid tetracyclines.

Why the caution? After 20 weeks, NSAIDs like ibuprofen can affect the baby’s kidneys and reduce amniotic fluid, and late in pregnancy they can affect blood vessels in the baby’s heart. Decongestants like pseudoephedrine can reduce blood flow to the placenta and aren’t worth the small benefit. These positions reflect NHS, UKTIS (medicines in pregnancy), and NICE safety advice used in UK practice.

Quick checks, decision help, and answers to common questions

Not sure what you’re dealing with? Use these quick rules of thumb.

Viral vs strep vs reflux: quick cues

• Likely viral: sore throat plus cough/runny nose/hoarseness, low fever, aches. Peaks on day 2-3, easing by day 5-7.
• Consider strep: sudden severe throat pain, fever, swollen glands, tonsil pus, no cough; or a fine pink rash with rough feel. Get GP advice.
• Think reflux: worse after meals or on waking, bitter taste, heartburn, hoarseness.
• Think allergies: itch/sneeze, clear runny nose, seasonal pattern, no fever.

Simple decision path

• If you have breathing trouble, drooling, severe one-sided pain, a spreading rash, or you feel very unwell-seek urgent care now.
• If you have high fever (≥38°C) beyond 48 hours or severe pain without cold symptoms-book a GP appointment.
• If you have typical cold features and can eat/drink-follow the relief plan for 2-3 days and reassess.
• If you’re unsure, call NHS 111 for tailored advice.

Mini‑FAQ

• Can a sore throat harm my baby? A typical viral sore throat won’t harm the baby. The main risk is dehydration or high, persistent fever-so drink, rest, and use paracetamol if needed.
• Is honey safe in pregnancy? Yes. Honey is fine for you. Don’t give honey to babies under 1 year after birth due to botulism risk.
• Can I use numbing throat sprays? Some are not ideal in pregnancy, and some contain NSAIDs. Ask a pharmacist for a pregnancy-safe option or stick with saltwater and soothing drinks.
• Do I need antibiotics? Only if a clinician thinks it’s bacterial (like strep). Antibiotics don’t help viruses and can cause side effects. When needed, penicillin V/amoxicillin are typical in pregnancy.
• What about zinc lozenges and big vitamin C doses? Skip high-dose zinc or vitamin C. Stay within normal pregnancy vitamin ranges.
• Can I take ibuprofen “just once”? Don’t without medical advice, especially after 20 weeks. Paracetamol is the safer first choice.
• Is a humidifier helpful? Yes. Cool-mist humidifiers ease dryness. Clean it daily to avoid mould.
• Should I still exercise? Gentle movement is fine if you feel up to it and you’re fever-free. If you feel wiped out, rest.

Real-life scenarios and fixes

• First trimester nausea + sore throat: Cold, bland foods (yoghurt, banana, oats) and ice lollies soothe without triggering nausea. Tiny sips often beat big drinks.
• Third trimester reflux + hoarseness: Sleep with head elevated, take an alginate after meals, have an earlier supper, and keep peppermint to small amounts if it worsens reflux for you.
• Asthma + cough: Use your inhalers as prescribed. Viral sore throats can trigger wheeze; don’t skip preventer inhalers. If you’re short of breath or using your reliever more, call your GP.
• Gestational diabetes + lozenges: Choose sugar-free glycerin/menthol lozenges and avoid frequent honey doses. Warm water with lemon (no sugar) is a good base.
• COVID or flu suspected: Rest, hydrate, paracetamol for fever, and follow current NHS isolation and treatment guidance. Pregnant women are eligible for antivirals in some cases-call your GP promptly, as timing matters.

Daily checklist

• Fluids: at least 6-8 mugs/glasses; more if feverish.
• Gargle: saltwater every 3 hours while awake.
• Relief: paracetamol as needed; lozenges without NSAIDs.
• Air: cool-mist humidifier; ventilate your room.
• Food: soft, cool or warm, not spicy or acidic.
• Sleep: head elevated; avoid late meals.
• Re‑check: if you’re not better by day 3-4, or worse at any time, call your GP or NHS 111.

Why you can trust this guidance

This aligns with NHS advice on self-care and medicines in pregnancy, NICE clinical knowledge summaries for sore throat (including assessment cues like FeverPAIN/Centor), RCOG guidance on infections and vaccination in pregnancy, and UKTIS medicine safety summaries used by pharmacists across the UK. If local advice changes-for example, during a seasonal flu wave-your GP, midwife, or NHS 111 will have the most current steer for your area.

Next steps and troubleshooting

• If day 1-2 and symptoms are mild: Follow the relief plan; no appointment needed yet.
• If day 3-4 and not improving: Book a GP call. Ask about strep assessment if your throat pain is severe and you don’t have a cough/runny nose.
• If you have a high-risk condition (e.g., asthma flare, immunosuppression): Call earlier-don’t wait it out.
• If you can’t keep fluids down: You may need anti-sickness medicine or fluids-call your GP or maternity unit.
• If you’re nearing your due date: Dehydration can trigger contractions; prioritise fluids and call your maternity triage if you’re unsure.
• After you recover: Replace your toothbrush; keep a small “sore throat kit” (salt, lozenges, saline spray, paracetamol) ready for next time.

Take a breath. With simple care and a few UK-safe tools, most pregnancy sore throats pass quickly. If something doesn’t feel right, you won’t be wasting anyone’s time by calling your GP, midwife, or NHS 111-your peace of mind matters.