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Fever and Chills During Pregnancy

What is Fever and Chills in Pregnancy?

Fever is a body‑temperature reading higher than the normal range (generally >100.4 °F / 38 °C). Chills are the feeling of cold accompanied by shivering, often occurring when the body tries to raise its temperature. In pregnancy, fever and chills are especially important because a higher maternal temperature can affect fetal development, especially in the first trimester.

While a mild fever is common when the body fights an infection, persistent or high‑grade fevers may indicate a more serious condition that needs prompt medical evaluation.

Common Causes

Many different conditions can produce fever and chills during pregnancy. Below are the most frequently encountered causes:

• Viral infections – influenza, COVID‑19, respiratory syncytial virus (RSV), and other common colds.
• Bacterial infections – urinary tract infection (UTI), bacterial pneumonia, cellulitis, and group B Streptococcus.
• Sexually transmitted infections (STIs) – chlamydia, gonorrhea, and syphilis.
• Gastrointestinal infections – food‑borne illnesses (Salmonella, Listeria), gastroenteritis.
• Inflammatory conditions – appendicitis, cholecystitis, or pelvic inflammatory disease (PID).
• Autoimmune flare‑ups – systemic lupus erythematosus (SLE) or rheumatic fever.
• Maternal hyperthyroidism – overactive thyroid can cause low‑grade fever and chills.
• Heat‑related illnesses – heat exhaustion or heat stroke during hot weather or excessive sauna use.
• Vaccination reactions – mild fever and chills are normal after certain immunizations (e.g., Tdap or flu shot).
• Non‑infectious causes – anemia, dehydration, or medication side effects.

Associated Symptoms

Fever and chills rarely occur in isolation. Other symptoms that often appear alongside include:

• Headache or neck stiffness
• Fatigue or malaise
• Muscle aches (myalgia) or joint pain
• Abdominal pain or uterine tenderness
• Frequent urination, burning on urination, or cloudy urine (suggesting UTI)
• Cough, shortness of breath, or chest discomfort (possible respiratory infection)
• Nausea, vomiting, or diarrhea (gastroenteritis or food‑borne illness)
• Rash or skin lesions (possible viral exanthem or cellulitis)
• Bleeding or spotting

When to See a Doctor

Because a fever can affect fetal growth, pregnant people should err on the side of caution. Contact your obstetrician or seek urgent care if you experience any of the following:

• Temperature ≥100.4 °F (38 °C) lasting more than 24 hours.
• Fever accompanied by severe headache, stiff neck, or visual changes.
• Persistent vomiting or inability to keep fluids down.
• Foul‑smelling urine, burning on urination, or lower‑back pain – signs of a UTI.
• Abdominal pain, cramping, or uterine contractions.
• Reduced fetal movements after 24 weeks gestation.
• Rash with fever, especially if painful or spreading quickly.
• Any signs of preterm labor (regular contractions, pelvic pressure).

Diagnosis

Evaluation typically involves a combination of history, physical exam, and targeted testing:

• Temperature measurement – oral, tympanic, or temporal artery readings.
• Physical examination – assessment of throat, lungs, abdomen, skin, and neurological status.
• Urinalysis and urine culture – to rule out UTI, a common cause of fever in pregnancy.
• Blood tests – complete blood count (CBC) for infection, C‑reactive protein (CRP) or erythrocyte sedimentation rate (ESR) for inflammation.
• Pathogen testing – rapid influenza test, COVID‑19 PCR, or throat swab for streptococcal pharyngitis, depending on symptoms.
• Imaging when indicated – ultrasound for abdominal pain, chest X‑ray (with abdominal shielding) for suspected pneumonia, or MRI if appendicitis is suspected.
• Fetal assessment – non‑stress test (NST) or ultrasound to ensure appropriate fetal heart rate and growth if fever is prolonged.

All diagnostic steps are chosen to minimize fetal radiation exposure while obtaining accurate information.

Treatment Options

Medical Management

• Antibiotics – prescribed for bacterial infections. Penicillins, cephalosporins, and erythromycin are generally safe in pregnancy. Always follow the obstetrician’s choice.
• Antivirals – oseltamivir for influenza or specific agents for COVID‑19, if indicated.
• Antipyretics – acetaminophen (Tylenol) is first‑line for reducing fever. Ibuprofen is avoided after 20 weeks gestation because of fetal kidney effects.
• Intravenous fluids – for dehydration, especially with vomiting or high fever.
• Hospitalization – required for severe infections (e.g., pyelonephritis, sepsis), uncontrolled high fever (>102 °F / 38.9 °C), or when fetal monitoring is needed.

Home Care (Adjunctive)

• Rest in a cool, well‑ventilated room.
• Apply a cool, damp cloth to the forehead or take a lukewarm sponge bath.
• Stay hydrated with water, oral rehydration solutions, or clear broths.
• Wear loose, breathable clothing and avoid heavy blankets.
• Consume nutrient‑dense foods (soups, fruits, vegetables) as tolerated.
• Track temperature every 4–6 hours and keep a symptom diary for your provider.

Prevention Tips

While not all fevers can be prevented, many strategies reduce risk:

• Vaccination – receive the inactivated flu vaccine and Tdap vaccine during each pregnancy (CDC recommendation).
• Hand hygiene – wash hands with soap for at least 20 seconds, especially after using the restroom or handling raw foods.
• Avoid cross‑contamination – separate raw meat, poultry, and eggs from ready‑to‑eat foods; cook meats to safe internal temperatures.
• Stay up‑to‑date on prenatal visits – early detection of asymptomatic infections (e.g., asymptomatic bacteriuria) can prevent complications.
• Limit exposure – avoid close contact with people who are ill, especially during flu season.
• Proper food handling – refrigerate leftovers promptly, avoid unpasteurized dairy, and wash fruits/vegetables thoroughly.
• Manage chronic conditions – keep thyroid disease, diabetes, or autoimmune disorders well‑controlled under your provider’s guidance.
• Stay cool in hot environments – use fans, air‑conditioning, and adequate fluid intake during heat waves.

Emergency Warning Signs

Key Takeaways

Fever and chills during pregnancy are a signal that the body is fighting something—usually an infection. While many causes are mild and treatable, certain fevers can pose risks to both mother and baby. Prompt evaluation, appropriate treatment, and preventive measures (vaccination, hygiene, and prenatal care) are essential for protecting maternal and fetal health.

References

• American College of Obstetricians and Gynecologists. Management of Fever in Pregnancy. 2023.
• Mayo Clinic. Fever in pregnancy. https://www.mayoclinic.org
• Centers for Disease Control and Prevention. Pregnancy and Vaccines. 2024.
• National Institutes of Health. Urinary Tract Infections in Pregnancy. https://www.nih.gov
• Cleveland Clinic. Pregnancy: Common Infections and Their Treatment. 2022.
• World Health Organization. Guidelines on the Prevention and Management of COVID‑19 in Pregnancy. 2023.

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