Stuffy nose during pregnancy first trimester

Baby (and tissues!) on board: Tips for managing pregnancy rhinitis | Your Pregnancy Matters

What can we help you find?

Refine your search: Find a Doctor Search Conditions & Treatments Find a Location

Appointment New Patient Appointment
or Call214-645-8300

MedBlog

Your Pregnancy Matters

October 6, 2020

Your Pregnancy Matters

Robyn Horsager-Boehrer, M. D. Obstetrics and Gynecology

Pregnancy-related nasal symptoms are common, affecting up to 20% of women during pregnancy.

When you think of side effects or symptoms brought on by pregnancy, nasal congestion and runny nose are not typically among the first to come to mind.

But maybe they should. Having a stuffy nose, difficulty breathing or sleeping, and snoring when pregnant can be alarming, especially amid the COVID-19 pandemic and the start of flu season.

Pregnancy rhinitis, also called gestational rhinitis, is a common ailment in the second and third trimesters, affecting approximately 20% of women. Characterized by inflammation and swelling of the mucous membranes in the nose, pregnancy rhinitis symptoms include congestion (nasal obstruction), sneezing, postnasal drip, and runny nose. These symptoms can also lead to poor sleep when your growing belly might already be making it difficult to rest.

All these issues can dramatically affect your mood and quality of life. The good news is that, for most patients, pregnancy rhinitis is temporary and there are safe, effective treatments available.

I've invited my colleague, Ashleigh Halderman, M.D., an ear, nose, and throat specialist at UT Southwestern to explain in more detail the causes of pregnancy rhinitis and how patients can manage their symptoms.

What causes pregnancy rhinitis?

Dr. Ashleigh Halderman

The root cause of rhinitis can be allergic (affected by environmental irritants) or non-allergic (caused by infection). However, we are still learning how rhinitis is related to pregnancy.

We know that smoking, as well as having chronic rhinitis before pregnancy, predisposes patients to developing pregnancy rhinitis. Research suggests a few more potential causes:

Having extra fluid in the body: During pregnancy, the body makes more blood and fluids, which can cause swelling, even in unexpected places such as the nasal passages. Blood vessels in the nose can swell with this additional volume, causing stuffiness.
Higher levels of estrogen: Estrogen in older formulations of birth control pills has been associated with a side effect of nasal obstruction. However, in studies of the menstrual cycle, we don't see congestion with fluctuating estrogen levels. So, the connection remains unclear for now.
Creation of human growth hormone: The placenta creates a variant of the human growth hormone (HGH), which has been associated with nasal symptoms in other conditions. For example, tumors that grow on the pituitary glands secrete growth hormones, which can cause severe nasal congestion.

Gestational rhinitis is under-researched. Data to date suggest no known association of rhinitis with pre-existing asthma, maternal age, duration of pregnancy, or the number of times a patient has been pregnant. However, a recent study found that patients carrying female babies were diagnosed significantly more often than patients carrying male babies.

Related reading: How to manage allergies and asthma during pregnancy

How long do symptoms last?

The annoying, uncomfortable symptoms of pregnancy rhinitis typically last six weeks or longer. For most patients, symptoms typically resolve two weeks after delivery.

Approximately a third of patients who had chronic rhinitis before pregnancy will have the same level of symptoms during, and a third will experience worsening of rhinitis symptoms. However, the remaining third will have less severe or no symptoms during pregnancy. I've had many women tell me they've felt the best, sinus-wise, when they were pregnant. However, there's no specific reason why this occurs.

Related reading: 5 weird pregnancy symptoms you might not know about

What treatments are available?

The first step toward relief is a visit with your doctor to rule out infection, such as COVID-19, influenza, or sinusitis. We may also recommend testing for concerns such as sinusitis or pregnancy tumor (pyogenic granuloma) – a non-cancerous growth of blood vessels that may appear during pregnancy.

From there, your doctor and Ob/Gyn may suggest:

Getting regular exercise: Working out has been shown to significantly help relieve nasal congestion and regulate the sleep cycle. All the more reason to bust a move during pregnancy!
Elevating your mattress: Try positioning the mattress so your whole body is situated at a 45-degree angle. While not widely studied, patients have reported that this helps clear the nasal passages enough to sleep.
Using a humidifier: Adding a little moisture to the air can help alleviate nasal irritation. Many patients use them at night to wake up feeling less stuffy.
Trying a sinus wash: Nasal saline sprays or sinus irrigation systems such as a neti pot can help clear the sinuses. Make sure to use distilled or boiled (and cooled) water – using water straight from the tap is not recommended.

Topical decongestants such as Afrin can be incredibly and immediately effective, but there is a risk of dependency. If you use this type of treatment more than once or twice a week, your nose can become "addicted" to it, which can lead to rhinitis medicamentosa – the spray will stop working as well, and your symptoms may get worse. Also, unlike gestational rhinitis, rhinitis medicamentosa won’t resolve after you deliver. It will only resolve when you stop using topical decongestants.

In general, pregnant patients can take decongestants that include pseudoephedrine as directed. However, we always recommend talking with your Ob/Gyn first, especially if you have high blood pressure.

Your Ob/Gyn might also recommend a steroid nasal spray, such as Flonase or Rhinocort, for severe symptoms. If you were using a spray to manage chronic rhinitis prior to pregnancy, your Ob/Gyn might advise you to keep using it during pregnancy. It is generally considered safe to use these products while breastfeeding, under your Ob/Gyn's guidance.

Your body will change in interesting ways during pregnancy. If you have new or unusual symptoms, call your doctor. We'll help you sort out what's normal from what could be a sinus infection or respiratory illness.

To talk with a doctor about nasal symptoms during pregnancy, call 214-645-8300 or request an appointment online.

Relief for Ongoing Nasal Congestion Is Possible

If you're expecting a baby, you may be dealing with a stuffy nose that doesn’t seem to go away. This hassle is called pregnancy rhinitis. The cause of this condition isn’t really clear. However, it may be caused by hormonal changes.Having a history of allergies or asthma does not raise your risk of getting pregnancy rhinitis.

More than just a stuffy nose

Pregnancy rhinitis is an inflammation of the mucous membranes lining the nose. This causes nasal congestion. Increased blood flow to the nasal passages and enlargement of the nasal veins also play a role.

Symptoms occur during pregnancy. They can last for several weeks. On top of feeling uncomfortable, your sleep may be disrupted. This is because the congestion gets worse when you lie down. This may make you to feel more tired during the day. Long-lasting congestion also can lead to complications. These can include sinusitis and ear infections.

Be cautious when seeking treatment

Many women use non-prescription, over-the-counter (OTC) decongestant sprays to open up their nasal passages. Know that these medicines don’t work for pregnancy rhinitis. These medicines may give you temporary relief. However, they may actually make your symptoms worse and lead to a complete nasal blockage.

How can you get relief from pregnancy rhinitis? Experts say you can breathe easy with these measures:

Don’t use OTC nasal decongestants.
Drink plenty of fluids.
Increase the humidity levels in your home. Use a humidifier.
Don’t use nasal irritants, such as cigarette smoke.
Get moving. Regular, moderate-intensity exercise can reduce congestion. It can also help you sleep better. But first, check with your healthcare provider to see what exercises are safe for you.
When you go to sleep, raise the head of your bed. For instance, use an extra pillow or a wedge.
Ask your healthcare provider about using OTC nasal strips and saline sprays or drops.

The good news? Even if you don’t do anything, you can expect your stuffy nose to clear up soon after your baby is born. It often goes away within two weeks of childbirth.

Online Medical Reviewer: Bowers, Nancy, RN, BSN, MPH Foley, Maryann, RN, BSN

Date Last Reviewed: 4/12/2016

© 2000-2019 The StayWell Company, LLC. 800 Township Line Road, Yardley, PA 19067. All rights reserved. This information is not intended as a substitute for professional medical care. Always follow your healthcare professional's instructions.

Rhinitis in pregnant women

Otorhinolaryngologist, surgeon at GMS Clinic Oleg Abramov talks in his article about rhinitis of pregnancy (hereinafter referred to as RH).

It was no coincidence that I chose this topic after a series of publications on the social network about allergic rhinitis (hereinafter referred to as AR), as recent studies note that although the cause of RB is not completely clear, the combination of AR, which is especially poorly controlled together with RB, can lead to severe nasal congestion, to insufficient oxygen supply, and, as a result, to increased fatigue, irritability, frequent SARS, sleep disturbance, which can certainly affect the development of the fetus. Moreover, the presence of AR is associated with snoring in women during pregnancy, and together they can provoke the development of sleep apnea syndrome (stopping breathing during sleep), which leads to arterial hypertension, preeclampsia, slowed fetal growth and low Apgar scores. Therefore, the relevance of this problem is only growing. nine0003

Definition and concept

Rhinitis of pregnancy is a disease accompanied by nasal congestion and discharge, periodic sneezing without signs of inflammation, allergies, or other causes. This condition can occur in any trimester of pregnancy and usually resolves within two weeks after delivery.

Occurrence

Nasal congestion is a very common problem during pregnancy (occurs in about 65% of cases), which can occur due to various reasons. RB, according to various sources, occurs in 9-40% of cases, and in one of the last observations there is an increasing incidence, that is, most of all RB is observed in the 3rd trimester - 38.9%, including those who did not have problems in the 1st and 2nd trimesters.

Causes and mechanism of occurrence

The mechanism of occurrence is not fully understood, and it is believed that RB occurs due to hormonal changes, in particular, under the influence of progesterone, estrogen, hCG and other hormones, the concentration of which gradually increases during pregnancy. Some authors believe that the occurrence of RB is associated with the worsening of concomitant AR. Some studies show that hormonal action leads to relaxation of the smooth muscles that make up the vessel wall of the nasal mucosa, resulting in nasal congestion. Such findings are supported by other studies that show that oral contraceptives cause similar effects in the nasal cavity (but not in everyone). Other studies show that elevated body mass index, overweight, multiple pregnancies provoke or aggravate RB. nine0003

Progression and potential risks

RB, in the absence of adequate treatment, has an adverse effect on the course of pregnancy and can lead to the development of rhinosinusitis, which is especially difficult to tolerate in the 3rd trimester. On the other hand, pregnancy is a special period in a woman's life, during which a large number of drugs are prohibited, and ENT pathologies, these restrictions have not been spared either. Very often I hear at the reception: "Doctor, I'm pregnant and I've been suffering with my nose all this time, but the doctors tell me - there's nothing to be done, I need to endure it. " On the other hand, the opposite situation is often observed: “Doctor, I am pregnant and I cannot live without vasoconstrictor drops.” These situations, of course, are not correct, since on the one hand there is a way out and optimal treatment, and on the other hand, constant exposure to vasoconstrictor drugs is not a way out of the situation at all. nine0003

Diagnostics

At the moment, there is no specific test to confirm or exclude RB. The diagnosis is made on the basis of the patient's complaints and the exclusion of other pathologies of the nasal cavity.

Choice of therapeutic tactics

Saline solutions

Before considering more serious medications, we should start with our favorite saline solutions. It should be noted that we are not talking about ordinary saline solutions, but hypertonic saline solutions (with an increased salt content, approximately 19-23 g/l). Such sprays are sold in all pharmacies, but they will not be sold to you right away (you need to ask). Several studies have noted significant efficacy in reducing congestion when used in AR, chronic rhinosinusitis. Also, comparative studies show their greater effectiveness compared to conventional isotonic solutions. Examples: Physiomer - hypertonic solution (my favorite), Aqualor-congestion, or Aqualor-severe runny nose, Aquamaris Strong.

nine0008 Doctor, not helping...

As is known from past publications, intranasal glucocorticosteroids (iGCS) are the most effective in the treatment of AR today. They have proven efficacy in reducing nasal congestion, as well as nasal itching and watery eyes, and allow adequate control of symptoms. But, given their hormonal effect and possible harmful effects on the fetus, there are certain risks in their use. It should also be noted that at the moment there are no studies that provide reliable data confirming the danger of their use. Modern ICS — mometasone (nasonex, desrinit) and fluticasone (avamys, flixonase) has a very low systemic bioavailability, less than 1% and proven efficacy, thus can be considered as initial therapy for RB. The studies did not reveal a statistically significant relationship between the development of fetal defects and the use of these drugs. nine0003

Who are the US FDA and why is everyone listening to them?

Everything is very simple (it’s a pity that everything is not so simple with us). I copy the explanation from Wikipedia: “An agency of the US Department of Health and Human Services, one of the federal executive departments. The department is engaged in quality control of food products, medicines, cosmetics, tobacco products and some other categories of goods, and also monitors compliance with legislation and standards in this area. nine0003

Budesonide (Tafen Nasal) is classified as category B according to the FDA's classification for drug effects on the fetus, which means that there is evidence that the drug is safe to use during pregnancy. The bioavailability of budesonide is 33%. This drug has moved from group C to group B, thanks to several high-quality studies in Sweden since the beginning of the 21st century, proving its safety.

Also, according to the current recommendations of the American Academy of Allergology and Immunology (AAAAI), ICS are considered safe and effective in the treatment of rhinitis and rhinosinusitis during pregnancy. But at the same time, there is no indication of specific drugs. Other competent medical associations also do not give any recommendations in terms of choosing a drug. Therefore, summing up all of the above, and also according to the latest review, mometasone, fluticasone, budesonide can be considered as safe and effective agents in the treatment of RB. It should also be noted that an experienced ENT doctor should be involved in prescribing the drug and managing the patient, since these drugs are sold without a prescription in the Russian Federation; we strongly recommend not to self-medicate. nine0003

Yes, I will not take these hormones!

In some situations, acute respiratory viral infections during pregnancy may be accompanied (largely due to concomitant RB or AR, or their combination) with a prolonged runny nose, nasal congestion and heaviness in the face - classic symptoms of rhinosinusitis. This disease, if not adequately treated, can lead to serious complications, so the correct diagnosis of this disease is extremely important. Antibiotics of the penicillin series are classified as category B according to the FDA and can be used in the treatment (ORS). If you are allergic to penicillins, some cephalosporins or lincosamides (Clindamycin) may also be used. All of them belong to categories A and B. ICS are included in the treatment standards for acute rhinosinusitis (more details in the next publications) and can provide recovery in combination with saline solutions without antibiotics. nine0003

P.S. The decision on treatment is individual for each case and should be collective between the doctor and the patient. I hope this review has made it possible to clarify some aspects in the features of RB and make it clear that RB is not a sentence and can be adequately controlled.

Source: rumyantsevamd.ru

Prolonged nasal congestion (rhinitis) in pregnant women

nine0060 Article rating

3. 62 (Votes: 13)

Contents

Causes of prolonged nasal congestion and rhinitis in pregnant women
The frequency of occurrence of rhinitis of pregnant women
What are we afraid of in pregnancy rhinitis?
What to do if you are pregnant and you are suffering from a persistent runny nose and nasal congestion?

nine0002 One of the most common painful problems of pregnant women is rhinitis of pregnancy (swelling of the nasal mucosa, accompanied by difficulty in nasal breathing, in some cases with increased mucus production or without it).

Causes of prolonged nasal congestion and rhinitis in pregnant women

Increased hormonal levels of progesterone, estrogen.
Emotional stress (which is pregnancy itself)
An increase in the volume of circulating blood, which increases blood supply, including the lower turbinates. nine0068
Gastroesophageal reflux - reflux of acidic contents of the stomach into the esophagus and nasopharynx due to an increase in the volume of the uterus (change in acidity causes the development of swelling of the nasal mucosa.)

The incidence of rhinitis in pregnant women more or less pronounced symptoms of prolonged (more than 6 weeks) nasal congestion, which can develop at any period of pregnancy, but most often in the II-III trimesters of pregnancy (from 12 to 38 weeks), which is understandable, based on the listed reasons for its occurrence. nine0003

A feature of rhinitis of pregnancy is that its symptoms completely disappear 2 weeks after childbirth.

What are we afraid of in pregnancy rhinitis?

Despite the fact that prolonged nasal congestion and rhinitis in pregnant women accompanies a large number of women, unfortunately, if left unattended, these symptoms can lead to serious complications:

First, it is very easy to get naphthyzinum if a woman independently and uncontrollably uses vasoconstrictor drops, and this is highly undesirable during pregnancy, since the part of the drug that enters the bloodstream causes vasoconstriction and the entire vascular system and internal organs, including placental vessels, especially this it is dangerous if a pregnant woman has high blood pressure and a rapid heartbeat, these indicators may worsen while taking drops. nine0068
Secondly: against the background of a pronounced long-term edema and a block of fistulas of the paranasal sinuses, with hypothermia or contact with an infection, it is possible to develop inflammation in the sinuses: sinusitis, sinusitis, frontal sinusitis, which will entail serious treatment, antibiotic therapy and infectious intoxication of the mother and fetus.
Thirdly: prolonged obstruction of nasal breathing naturally entails the formation of moderate hypoxia (lack of oxygen in the blood) from which both the woman herself suffers (headaches, fatigue, mood depression) and the fetus. nine0068

What to do if you are pregnant and you suffer from persistent runny nose and nasal congestion?

Be sure to contact a specialized ENT clinic or ENT office, an otorhinolaryngologist, who, first of all, will conduct a safe and permitted diagnosis during pregnancy.

For example, in the ENT clinic plus 1, you will have an endoscopy of the ENT organs, including the deep sections of the nose and nasopharynx; to exclude inflammation of the paranasal sinuses, an ultrasound of the paranasal sinuses will be done; if necessary, laboratory diagnostic methods will be carried out.