If you are in a hurry
- If you get a fever during pregnancy, first call the obstetrics clinic where you are being seen
- If you have abdominal tightening or pain, bleeding, a feeling that your water has broken, or fewer baby movements, call the obstetrics clinic and go right away, even at night or on a holiday. If you have severe trouble breathing, are slow to respond, or have a seizure, call 119 (Japan’s emergency number)
- Acetaminophen is the basic fever reducer; use it as a doctor or pharmacist directs, and do not take loxoprofen, ibuprofen, or similar medicines on your own judgment
Hello. I am Shunichi Gamo, MD, PhD, a board-certified pulmonologist and the director of Sendai Airport North Clinic.
When the season for influenza and COVID-19 arrives, we get many questions from pregnant women and their families:
“I have a fever, but where should I go? Can I take medicine?”
Thinking of the baby in your belly, I’m sure you feel even more unsure than usual.
Let me start with the conclusion: if you get a fever during pregnancy, the basic step is to first call the obstetrics and gynecology clinic where you are being seen. Also, if you have abdominal tightening or pain, bleeding, a feeling that your water has broken, or fewer baby movements, go to an obstetrics clinic right away, even at night or on a holiday. In this article, drawing on data from research papers, I explain how to choose an obstetrics clinic or a fever clinic, which fever reducers can be used in pregnancy and which medicines to avoid, and what to watch for with influenza and COVID-19.
First, a note about our Sunday and public holiday fever clinic. For influenza and COVID-19, you get the PCR test result (a test that copies the virus’s genetic material to detect it) on the same day.
Since October 4, 2026, our fever clinic is also open on Sundays and public holidays
10:00 to 15:00 (no lunch break). No appointment is needed; you are seen by checking in on the day. We give you the PCR test result on the same day. On Sundays and public holidays we run the fever clinic only, with no general outpatient care or IV drips. We are closed on Sunday, October 25, and from November we are in principle open every Sunday and public holiday. Announcement about the Sunday and public holiday fever clinic
Shunichi Gamo, MD, PhD
Director, Sendai International Airport North Clinic
Born and raised locally, he attended Yuriage Elementary School and Yuriage Junior High School in Natori City. After graduating from Tohoku University School of Medicine, he worked at Sendai Open Hospital and Kesennuma City Hospital, and then at Tohoku University Hospital. In April 2021, in the middle of the COVID-19 pandemic, he opened Sendai International Airport North Clinic. Holding to a fever clinic that never turns patients away, he cared for well over 20,000 patients with fever in the two years before COVID-19 was moved to Class 5 under Japan’s infectious disease law.
Society memberships and board certifications
Certified Member and Board Certified Fellow, Japanese Society of Internal Medicine
Board Certified Pulmonologist, Japanese Respiratory Society
Board Certified Allergist, Japanese Society of Allergology
Board Certified Specialist, Japanese Society of Anti-Aging Medicine
PhD in Medicine (Tohoku University)
Conclusion: who should you consult about a fever in pregnancy? First, “call your obstetrics clinic”
When you have a fever during pregnancy, it is fine to act in roughly this order.
- [Call first]
Call the obstetrics and gynecology clinic where you are being seen (or where you plan to give birth) and tell them you have a fever - [Follow their instructions]
If they tell you to come to the obstetrics clinic, go there; if they recommend a fever clinic, visit a fever clinic - [Say you are pregnant]
At a fever clinic, always tell them that you are pregnant, how many weeks, and which obstetrics clinic you attend
The cause of a fever may be a cold, influenza, or COVID-19, or it may be something like pyelonephritis (a kidney infection in which bacteria reach the kidney). The obstetrics clinic, which knows how your pregnancy has gone, is the one that can judge the situation including the baby’s condition. There is no need to hold back, thinking, “Is it okay to call the obstetrics clinic just for a fever?”
Dr. GamoA fever during pregnancy must be very worrying for you and your family. Please do not carry it alone; call and talk to them first.
Go right away or call 119: signs in a fever during pregnancy that you must not wait on
In the following cases, go right away, even at night or on a holiday, however high the fever is. If you phone your obstetrics clinic first and say, “I am coming now,” they can prepare to receive you.
- Abdominal tightening or pain that continues or gets gradually stronger
- Bleeding from the vagina
- Your water may have broken (watery fluid is leaking and will not stop)
- You are at the stage when you feel the baby move, but the movements are clearly fewer than usual or absent
Also, if you have severe trouble breathing, your lips look purplish, you are slow to respond when called, or you have a seizure, call 119 without hesitation. Tell the ambulance crew that you are pregnant and how many weeks.
Symptoms in the belly are for the obstetrics clinic, not the fever clinic. Please do not wait your turn at a fever clinic when you have abdominal tightening or bleeding.
What if you have only a fever, with no symptoms in the belly?
Even when you have no abdominal tightening or bleeding and only a fever, cough, or sore throat, it is fine to call the obstetrics clinic first. Some obstetrics clinics will tell you to “get tested at a fever clinic first,” and others will say “please come here.” Infection control procedures differ from one facility to another, so follow your obstetrics clinic’s instructions.
What to say on the phone
To get the information across accurately in a short call, it helps to jot down the following.
- How many weeks pregnant you are (or your due date)
- Since when you have had a fever, and your highest temperature
- Symptoms besides fever, such as cough, sore throat, trouble breathing, lower back or back pain, or pain when urinating
- Whether you have abdominal tightening or pain, bleeding, a feeling that your water has broken, or a change in baby movements
- Whether anyone in your family or at work has influenza or COVID-19
- Any medicines you took (including over-the-counter ones) and when you took them
Which fever reducers can be used in pregnancy? Which medicines should be avoided?
Acetaminophen is a fever reducer that is used in pregnancy
For fever and pain in pregnancy, acetaminophen (for example, Calonal) is used. The Japan Pregnancy and Medication Information Center at the National Center for Child Health and Development also says it is used as the first-line treatment (the medicine chosen first) for pain and fever in pregnancy[1]. When a fever makes you miserable, you can ask a doctor or pharmacist and use it without enduring it.
In fact, acetaminophen is also not a medicine you can take in any amount. Its package insert (the official drug information sheet) warns that using it in late pregnancy may narrow the baby’s ductus arteriosus[2]. The ductus arteriosus is an important blood vessel found only in babies in the womb, which carries blood without passing it through the lungs. For that reason, for pregnant women it is “used when the benefit of treatment outweighs the risk”[2]. The Japan Pregnancy and Medication Information Center also explains that this handling has not changed and that it can be taken after careful judgment[1].
In other words, the basic approach is to use it when needed, in the amount and number of doses a doctor or pharmacist tells you. Please do not increase the amount or keep taking it for a long time on your own judgment.
Some of you may have been worried by the reports that made news suggesting that acetaminophen in pregnancy might affect a child’s development. The Japan Pregnancy and Medication Information Center explains that later large studies in Japan and abroad found that “acetaminophen itself cannot be said to be the cause”[1]. It adds that taking it in pregnancy remains possible as before, and that you should talk with your doctor or pharmacist about any concerns[1]. It is also treated as a medicine that can be used in pregnancy in many countries, including Europe, the UK, and Australia (as of October 2025)[1].
Do not use loxoprofen, ibuprofen, and similar medicines on your own judgment
On the other hand, caution is needed with fever and pain relievers called NSAIDs (non-steroidal anti-inflammatory drugs), such as loxoprofen (for example, Loxonin) and ibuprofen. The package insert for oral loxoprofen (Loxonin) lists women in late pregnancy as “contraindicated” (must not use)[3]. Other NSAIDs such as ibuprofen are also known to possibly affect the baby when used in the second half of pregnancy[1].
In October 2024, on the instruction of the Ministry of Health, Labour and Welfare, the warning text was revised to add that there have been reports of the baby’s ductus arteriosus narrowing even with use in mid-pregnancy[4]. There are also reports of oligohydramnios (too little amniotic fluid)[4]. For this reason, even outside late pregnancy, use is limited to when a doctor judges it necessary[3].
- Over-the-counter cold medicines and pain relievers may also contain NSAIDs. Before you buy, tell the pharmacist that you are pregnant
- There are reports of the baby’s ductus arteriosus narrowing even with pain-relief patches and ointments used in late pregnancy[4]. Do not let your guard down thinking, “It’s only a patch”
- Do not use leftover medicine at home or a family member’s prescription
What you can do without medicine
While you are shivering with chills, keep warm; once the fever has peaked and you feel hot, dress lightly and cool your neck and armpits gently, which is enough. For fluids, take barley tea or oral rehydration solution in small, frequent sips. If you cannot drink, or you are passing extremely little urine, contact your obstetrics clinic early.
Does the fever itself affect the baby?
Many people worry, “I got a fever; is the baby all right?”
There is a systematic review (a method that gathers studies from around the world by a set procedure and organizes them) of studies on how fever in pregnancy relates to the health of the children born[5]. Within it, a meta-analysis (a method that combines the numbers from several studies) was also carried out.
In this meta-analysis, fever in early pregnancy (up to about week 13) was linked to roughly 1.5 to nearly 3 times the likelihood of the following conditions[5]. They are neural tube defects (abnormalities in the part that becomes the brain and spinal cord), congenital heart disease, and oral clefts (cleft lip and palate)[5]. There was also data suggesting that using a fever reducer when the fever appeared might be protective[5].
Even so, these are originally very rare conditions. It certainly does not mean that “a fever means something will happen to the baby.” What matters is not to endure a fever but to talk with someone, find the cause, and treat it.
Influenza and COVID-19 can become more severe in pregnancy
During pregnancy, the body’s immunity and the work of the heart and lungs change, so influenza and COVID-19 are known to become severe more easily.
Influenza
There is a meta-analysis that pooled 142 studies comparing the severity of influenza in pregnant and non-pregnant women[6]. Pregnant women were more likely to be hospitalized, with an odds ratio (a ratio of how likely something is) of 2.44[6]. The 95% confidence interval (the range the true value is thought to fall within) was 1.22 to 4.87[6]. On the other hand, no clear difference was seen in the share who died[6]. Note that most of the studies were from the 2009 influenza pandemic.
COVID-19
There is a study (published in 2022) that used Japan’s national COVID-19 registry and, matching age and chronic illnesses and similar factors, compared 187 pregnant women with 935 women who were not pregnant[7]. The share who reached moderate illness (a state more severe than mild, such as having pneumonia symptoms) or worse was 9.6% in pregnant women and 4.9% in non-pregnant women[7]. Among pregnant women, having a chronic illness and being in mid to late pregnancy were linked to becoming severe more easily (odds ratio 3.87 for mid to late pregnancy)[7].
Antiviral medicines for influenza are used in pregnancy
Antiviral medicines for influenza are used in pregnancy. The Japan Pregnancy and Medication Information Center explains that there are several reports that the oral medicine Tamiflu, used in early pregnancy, did not increase birth defects in babies[1]. Relenza and Inavir are inhaled medicines, and very little enters the mother’s blood, so it says their use in pregnancy is not a problem[1]. As a guide, antiviral medicines for influenza should be started within 48 hours of onset. For details, see the article on antiviral medicines for influenza at the end of this article.
Some oral COVID-19 medicines cannot be used in pregnancy
On the other hand, among oral COVID-19 medicines, Xocova (ensitrelvir) and Lagevrio (molnupiravir) cannot be used by pregnant women or women who may be pregnant[8]. This is because animal studies have shown teratogenicity (the property of causing birth defects)[8]. Please always tell us at every visit if you are pregnant or may be pregnant.
About vaccines
The influenza vaccine is an “inactivated vaccine” in which the virus has been made unable to infect, and vaccination in pregnancy is considered safe[1]. In a study of pregnant women vaccinated in early pregnancy, too, no increase in birth defects was seen[1]. The Japan Pregnancy and Medication Information Center says that preventing infection is especially important in pregnancy and that vaccination is recommended[1]. If you are thinking of getting vaccinated, please talk with your obstetrics clinic.
On the COVID-19 vaccine, the Japan Society of Obstetrics and Gynecology and other bodies issued a statement in July 2025 that they do not recommend vaccination for all pregnant women uniformly[9]. However, vaccination continues to be recommended for pregnant women with chronic illnesses that make severe disease more likely (severe disease here means becoming ill enough to need hospital care, as with pneumonia)[9]. Pregnant women who wish to be vaccinated, for example hoping to pass antibodies to the baby, can receive the vaccine[9]. In the society’s analysis, risk factors for severe disease during the Delta variant wave included age 31 or older, a pre-pregnancy BMI (body mass index, a measure of body weight relative to height) of 25 or higher, infection at or after 21 weeks of pregnancy, and chronic illnesses such as respiratory disease[9].
When you visit our fever clinic
If your obstetrics clinic tells you to “visit a fever clinic,” you are welcome at ours. Our policy is not to turn anyone away from the fever clinic (depending on the symptoms, we may direct you to a more suitable medical institution).
Please always tell us that you are pregnant
In the pre-visit questionnaire, at check-in, and at the examination, please tell us that you are pregnant, how many weeks, and which obstetrics clinic you attend. This is very important information because it changes which medicines and tests can be used. Please also bring your Maternal and Child Health Handbook and your medicine notebook.
| Day | Hours |
|---|---|
| Mon, Tue, Wed, Fri, Sat | 9:00-12:00 / 14:00-18:00 |
| Sundays and public holidays (from October 4, 2026) | 10:00-15:00 (no lunch break, fever clinic only) |
| Thursday | Closed |
On Sundays and public holidays we are open from 10:00 to 15:00. We are closed on Sunday, October 25, and from November we are in principle open every Sunday and public holiday. On Sundays and public holidays we run only the fever clinic, with no general outpatient care or IV drips. For details, see the announcement about the Sunday and public holiday fever clinic.
How a visit works (no appointment needed)
You register by checking in on the day with the QR code (a square pattern read with a smartphone camera) at the fever clinic entrance. When your turn is near, we call you by SMS (a text message sent to a mobile phone number) or by phone.
- Before you come, fill in the pre-visit questionnaire (optional; you may also fill it in when you check in at the entrance)
- Scan the QR code at the fever clinic entrance and check in by choosing “I have arrived, so I will check in” (required)
- On weekdays, once you have checked in, please wait in your car
- On Sundays and public holidays, after check-in your insurance card (My Number insurance card, certificate of eligibility, and so on) is checked at the general outpatient entrance. We do not run general outpatient care on those days, so please come in without hesitation. When the check is done, please wait in your car or similar
- When your turn is near, we call you by SMS or by phone. Press the intercom at the fever clinic entrance and give your name
In principle we see people in the order they checked in, but the order can change depending on how severe the symptoms are. For details, see About the fever clinic pre-visit questionnaire and same-day check-in.
*If you have abdominal tightening or pain, bleeding, a feeling that your water has broken, or fewer baby movements, go to the obstetrics clinic where you are being seen, not to the fever clinic.
Dr. GamoPlease do not hold back, thinking, “I’m pregnant, so I might be a bother.” Just be sure to tell us you are pregnant, and come to see us with peace of mind.
Frequently asked questions
- I have a fever in pregnancy. Is the obstetrics clinic or a fever clinic the right place?
-
First, call the obstetrics and gynecology clinic where you are being seen. Some obstetrics clinics will tell you to come to them, and others will recommend a fever clinic first. If you have abdominal tightening or pain, bleeding, a feeling that your water has broken, or fewer baby movements, call the obstetrics clinic and go right away, even at night or on a holiday.
- Is there a fever reducer I can take in pregnancy?
-
Acetaminophen (for example, Calonal) is used for fever in pregnancy. When you feel miserable, do not endure it; ask a doctor or pharmacist and use it in the amount they direct. Loxoprofen, ibuprofen, and similar medicines may affect the baby in the second half of pregnancy, so do not take them on your own judgment.
- I took one Loxonin that I had at home. Is that okay?
-
Do not take any more, and tell the obstetrics clinic where you are being seen the name of the medicine, the amount, the time you took it, and how many weeks pregnant you are, and ask their advice. Whether a check is needed depends on the stage of pregnancy and the amount you took.
- Is it safe to take influenza medicine in pregnancy?
-
Antiviral medicines for influenza are also prescribed in pregnancy. There are several reports that Tamiflu used in early pregnancy did not increase birth defects in babies. Influenza can become severe more easily in pregnancy, so if you are diagnosed, please get treatment after talking with your doctor.
- Can I visit your fever clinic while pregnant?
-
Yes, you can. In the pre-visit questionnaire and at check-in, please be sure to tell us that you are pregnant, how many weeks, and which obstetrics clinic you attend. If you have abdominal tightening or pain, bleeding, a feeling that your water has broken, or fewer baby movements, go to your obstetrics clinic, not the fever clinic.
Summary: for a fever in pregnancy, first call your obstetrics clinic
- If you get a fever during pregnancy, first call the obstetrics clinic where you are being seen
- If you have abdominal tightening or pain, bleeding, a feeling that your water has broken, or fewer baby movements, call the obstetrics clinic and go right away, even at night or on a holiday. If you have severe trouble breathing, are slow to respond, or have a seizure, call 119
- Acetaminophen is the basic fever reducer; use it as a doctor or pharmacist directs, and do not take loxoprofen, ibuprofen, or similar medicines on your own judgment
- Influenza and COVID-19 can become severe more easily in pregnancy, but antiviral medicines for influenza are used in pregnancy
- At a fever clinic, always say that you are pregnant, how many weeks, and which obstetrics clinic you attend
With a fever in pregnancy, it is easy for worry to grow, thinking, “What if something happens to the baby?” If you remember just this much, you will be fine: call your obstetrics clinic first, and do not endure it when you feel miserable. Leave the medical care to us.
That’s all.
Disclaimer
This article is intended to provide general medical information and does not replace an examination, diagnosis, or treatment by a doctor. The content is based on medical knowledge at the time of publication, but the right response differs from person to person. If you are worried about your symptoms, please consult a medical institution.
References
- National Center for Child Health and Development, Japan Pregnancy and Medication Information Center. Q&A on medicines in pregnancy (in Japanese). National Center for Child Health and Development website. Accessed October 2026. https://www.ncchd.go.jp/kusuri/process/qa_ninshin.html
- Ayumi Pharmaceutical Corporation. Package insert for Calonal tablets 200/300/500 (revised August 2026, 5th edition) (in Japanese). Pharmaceuticals and Medical Devices Agency, search for prescription drug information. 2026. https://www.pmda.go.jp/PmdaSearch/iyakuDetail/ResultDataSetPDF/172190_1141007F1063_5_07
- Daiichi Sankyo Company, Limited. Package insert for Loxonin tablets 60 mg / Loxonin fine granules 10% (revised March 2025, 4th edition) (in Japanese). Pharmaceuticals and Medical Devices Agency, search for prescription drug information. 2025. https://www.pmda.go.jp/PmdaSearch/iyakuDetail/ResultDataSetPDF/430574_1149019C1149_1_13
- Director, Pharmaceutical Safety Division, Pharmaceutical Bureau, Ministry of Health, Labour and Welfare. On revision of the “Precautions for Use” (Notification Iyaku-anhatsu 1008 No. 1, October 8, 2024) (in Japanese). Pharmaceuticals and Medical Devices Agency website. 2024. https://www.pmda.go.jp/files/000271157.pdf
- Dreier JW, Andersen AM, Berg-Beckhoff G. Systematic review and meta-analyses: fever in pregnancy and health impacts in the offspring. Pediatrics. 2014 Mar;133(3):e674-88. doi:10.1542/peds.2013-3205 PMID: 24567014
- Mertz D, Geraci J, Winkup J, Gessner BD, Ortiz JR, Loeb M. Pregnancy as a risk factor for severe outcomes from influenza virus infection: A systematic review and meta-analysis of observational studies. Vaccine. 2017 Jan;35(4):521-528. doi:10.1016/j.vaccine.2016.12.012 PMID: 28024955
- Shoji K, Tsuzuki S, Akiyama T, Matsunaga N, Asai Y, Suzuki S, et al. Clinical Characteristics and Outcomes of Coronavirus Disease 2019 (COVID-19) in Pregnant Women: A Propensity Score-Matched Analysis of Data From the COVID-19 Registry Japan. Clin Infect Dis. 2022 Aug;75(1):e397-e402. doi:10.1093/cid/ciac028 PMID: 35037051
- Ministry of Health, Labour and Welfare. Q&A on the comprehensive measures against acute respiratory infections (ARI), winter 2026 (Reiwa 8) season (in Japanese). Ministry of Health, Labour and Welfare website. 2026. https://www.mhlw.go.jp/stf/seisakunitsuite/bunya/kenkou_iryou/kenkou/kekkaku-kansenshou/infulenza/QA2026.html
- Japan Society of Obstetrics and Gynecology; Japan Society for Infectious Diseases in Obstetrics and Gynecology. On COVID-19 vaccination for pregnant women (July 31, 2025) (in Japanese). Japan Society of Obstetrics and Gynecology website. 2025. https://www.jsog.or.jp/news/pdf/20250731_COVID19_ippan.pdf
More articles to read about fever
For the Sunday and public holiday fever clinic, see the announcement about the Sunday and public holiday fever clinic; for how to come in, see About the fever clinic pre-visit questionnaire and same-day check-in.
