Congestion and Other Nasal Symptoms During Pregnancy

Pregnancy congestion, also known as rhinitis of pregnancy, is inflammation of the mucous membranes in the nose causing congestion or a stuffy nose in pregnancy. Pregnancy rhinitis isn't linked to an infection or allergy and lasts for at least six weeks. This common condition is also called non-allergic rhinitis.

If you had underlying conditions such as asthma or allergies prior to becoming pregnant, you may find that their symptoms get worse during pregnancy, particularly during the third trimester, or week 28 and beyond. Nasal symptoms caused by pregnancy typically resolve within two weeks after you have your baby.

This article discusses the causes of congestion during pregnancy and what you can do about it. It also looks at the prescription medications that are available to treat severe congestion during pregnancy.

Rhinitis of Pregnancy

It is common to have congestion during pregnancy. Studies report varying rates of pregnancy rhinitis ranging from 22% to 32% of all pregnant women.

Rhinitis of pregnancy usually begins in the second or third trimester of pregnancy and lasts longer than 6 weeks. To be considered true rhinitis of pregnancy, no other known causes such as allergies or an upper respiratory infection can be causing your symptoms. Symptoms of rhinitis during pregnancy include:

• Congestion, which often causes difficulty breathing and sleeping at night
• Runny nose
• Postnasal drip
• Sneezing

Studies have shown that pregnancy-related nasal congestion can decrease the quality of life in people who are pregnant. In severe cases, it can be dangerous for the fetus (particularly if the pregnant person has underlying asthma).

The cause of pregnancy-induced nasal symptoms is not entirely understood but has long been thought to be caused by changing hormone levels, particularly estrogen and progesterone. It also may be in part due to the overall hyper-vascular and hyper-metabolic state associated with pregnancy.

This hormonal theory might be supported by the fact that some people report nasal symptoms that coincide with their menstrual cycles. Symptoms of non-allergic rhinitis have also been reported with the use of birth control pills.

Managing Pregnancy Congestion

Congestion can lead to other conditions such as sinus infections or ear infections, which need to be treated with antibiotics. Keeping congestion under control can prevent these infections.

Nasal irrigation with a neti pot is the first-line treatment. Be sure to use distilled or boiled (and cooled) water rather than water that is straight from the tap.

Some tips for managing congestion during pregnancy include:

• Drinking plenty of water
• Using a cool-mist humidifier by your bed when you sleep
• Participating in light exercise (but you should not engage in new types of exercise while pregnant without prior approval from your healthcare provider)
• Keeping the head of your bed elevated with an extra pillow or a wedge
• Using a saline nasal spray to keep secretions thin
• Avoiding known allergy triggers, polluted air, chemicals, or cigarette smoke

Medications for Severe Pregnancy Congestion

If the measures above are not sufficient to keep your symptoms under control, you can talk to your healthcare provider about using one or more of the following medications, which may help you manage more severe cases of pregnancy rhinitis.

Nasal (Inhaled) Corticosteroids

Inhaled nasal corticosteroids are often used to control asthma during pregnancy. They may be used in some cases to control pregnancy-induced nasal symptoms.

The first choice is Rhinocort (budesonide), as studies show it is generally safe to use during pregnancy. However, if budesonide is not effective other nasal corticosteroids may be used.

Nasal Decongestants

Most nasal decongestants are not considered safe during the first trimester of pregnancy. Do not use a nasal decongestant anytime during your pregnancy unless you have specifically checked with your obstetrician.

Nasal decongestants such as Afrin (oxymetazoline) are very effective at temporarily relieving congestion. However, they should be used sparingly if at all during pregnancy and not during the first trimester, as animal studies have shown potential risks to the fetus.

In some cases, using nasal decongestants to treat pregnancy rhinitis actually may make symptoms worse, especially if used for a prolonged period. Using nasal decongestants for more than three days in a row can lead to rebound congestion.

Prescription Medication

You may be able to treat a sinus infection while pregnant by using either cefprozil (Cefzil) or amoxicillin-clavulanate. To relieve pain and headaches caused by the infection, using Tylenol (acetaminophen) may be effective. However, these medications are not always safe for everyone. A healthcare provider can help find the treatment that works best for you.

Summary

Pregnancy congestion is common. It typically begins in the second or third trimester and resolves within the first two weeks after delivery.

Congestion during pregnancy can be uncomfortable and make it hard to sleep. If it bothers you, try home remedies like sleeping with a cool-mist humidifier or using a wedge pillow to keep your head elevated. Saline nose sprays can also help.

If you have severe congestion, you can also talk to your healthcare provider about prescription medications that are safe to use during pregnancy.

While the idea of using any medication can be frightening for many pregnant women, you must remember that leaving your symptoms untreated can lead to other more serious conditions that may pose a threat to your baby's health. Therefore, pregnancy rhinitis should always be reported to your healthcare provider so that symptoms can be properly managed.