When does pregnancy rhinitis occur and how long does it last?

Most often, pathology occurs:

• up to and including the 20th week of pregnancy - in this case, rhinitis usually resolves on its own (after about a month or two) and does not manifest itself in the later stages;
• after the 20th week of pregnancy - this condition can continue until childbirth and after them (after 2-3 weeks).

If the symptoms last longer than two months and are not relieved by any independent action (vasoconstrictor sprays are prohibited!), then the cause may be hiding in a chronic disease.

Symptoms of pregnancy rhinitis

• Difficult nasal breathing, nasal congestion;
• Nasal discomfort, sneezing;
• Presence of clear mucous discharge;
• Feeling of constriction in the region of the nose and sinuses;
• Mild headaches.

Difficulty in nasal breathing in the mother leads to sleep disturbance and hypoxia, which is also felt by the fetus.

Causes of pregnancy rhinitis

The pathogenesis of the disease is still a controversial issue. Most doctors are inclined to believe that it is of a hormonal nature and is associated with an increased level of estrogen and acetylcholine in the blood serum (as a result), which leads to hyperemia of the nasal mucosa and swelling. The concentration of estradiol, estrone, estriol in the bloodstream of pregnant women increases, in some future mothers, for this reason, the shape of the nose may change, it may increase in size.

There is evidence that pregnant women with symptoms of vasomotor rhinitis have elevated serum placental hormone levels. Another reason that can cause long-term nasal obstruction is the tone of smooth muscle cells under the influence of the inhibitory action of the steroid hormone progesterone. It causes fluid retention in the body and has such a side effect on the nasal mucosa.

Histochemical studies have shown that nasal congestion may occur due to plethora due to hyperactivity of the parasympathetic nervous system in pregnant women.

How to distinguish the symptoms of pregnancy rhinitis from other pathologies?

Symptoms of rhinitis during pregnancy are really similar to manifestations of other diseases, for example, viral infections, sinusitis. It is difficult for a future mother to distinguish a pathology by external signs, therefore a doctor's consultation is necessary. Our clinic employs specialists with extensive experience who will quickly diagnose and prescribe treatment.

If the symptoms are accompanied by a sore throat, fever, then this indicates the presence of a bacterial and/or viral infection or other inflammatory process.

With sinusitis, mucous discharge may have a yellowish or greenish tint. When pressing in the area of ​​the maxillary and frontal sinuses, there are painful sensations, when the head is tilted, the pain may intensify. Also, sinusitis often causes an increase in temperature, while with nasal obstruction, such symptoms are not observed.

Sometimes rhinitis of pregnancy is confused with allergic rhinitis, which may worsen, there may be sensitization to allergens to which patients have not previously reported sensitivity.

Treatment of pregnancy rhinitis

In our clinic, a thorough diagnosis is carried out in order to exclude diseases similar to rhinitis in terms of symptoms. After the examination, individual treatment is prescribed depending on the severity, severity and indications.

Treatment is complicated by the fact that many drugs can cause contraction of the myometrium and fetal circulation or vasoconstriction with impaired placental function. Therefore, a doctor should prescribe drug therapy; you cannot use drugs on your own - they can cause a violation of the development of the fetus.

General advice for pregnant women with symptoms of rhinitis

1. Washing the nose with mild saline solution (2 teaspoons of sea salt per glass of water). Salt solution improves the discharge of nasal mucus and reduces the feeling of congestion.
2. Nasal douches (nose washers) are very helpful. You can use regular saline for them.
3. Ventilate the room before going to bed, use humidifiers. Dry air can exacerbate unpleasant symptoms.
4. Use a high pillow (or multiple pillows) to sleep with your head well above your torso.
5. Walking in the fresh air before going to bed is useful.
6. Do morning exercises and breathing exercises several times a day to reduce the symptoms of hypoxia.
7. Do not wear perfume and stay away from smokers.

Do not use vasoconstrictor nasal drops during pregnancy as they may cause vasomotor rhinitis.

Preparations for the treatment of rhinitis

Preparations for use during pregnancy are selected with great care and individually. Pregnant women are not given oral systemic corticosteroids, although their effect on the fetus is not fully understood. In some cases, the doctor prescribes corticosteroids in the form of aerosols. Oral antihistamines are also not prescribed due to the increased risk of embryopathies. The choice of physiotherapy is also limited, because most methods negatively affect the development of the fetus.

If you suffer from rhinitis, headaches or other unpleasant symptoms, we advise you to see a doctor immediately. Timely treatment is the key to the quality of life of the mother, which is very important for bearing the fetus. And also allows you not to miss other more serious diseases that can adversely affect the health of the mother and child.

Important! Do not use drugs that were prescribed to you by a doctor before pregnancy, or drugs prescribed to someone else.

Rhinitis during pregnancy usually does not pose a threat to either the fetus or the mother, but improper treatment can lead to unpredictable consequences.

Seeing a doctor early can help keep you healthy.
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Rhinitis in pregnancy

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.

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.

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.

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.

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.

Who are the FDA in the US 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.

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.

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.

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