Rhinitis of Pregnancy

Stuffy nose during pregnancy is very common, especially during the third trimester.  Circulating hormones cause the internal nasal tissues to swell, blocking breathing through the nose and creating a constant “drip”.
This does not usually indicate an infection, but sometimes an infection can overlap the symptoms.
The big question is “What do we do about it?”  Unfortunately, as any pregnant woman knows, there is no clear consensus on which medicines are safe and which may be unsafe during pregnancy.  There is simply no good safe way to test medicines on the human fetus, so we have very few medicines that get the FDA seal of approval for use during pregnancy.
Rhinitis is not sinusitis:
If you are experiencing headaches, neck aches, facial pain, fevers, pressure worse on one side than the other, or thick foul-smelling drainage then these are signs of a sinus infection and not just rhinitis.  Call your OB/GYN with these symptoms because you may need an antibiotic.
Rhinitis will cause a much more mild facial or nasal “congestion pressure”, will block nasal breathing, and will cause generally uncolored or whitish mucus.
The best simple treatments:
  1. Keep your head elevated, especially when sleeping.  If your head is level with your heart your nose will swell more. Simple as that.  Sleeping on several pillows or a wedge pillow will usually help.
  2. Use a humidifier when you sleep.  This will keep your throat and mouth from drying out if you become a mouth-breather at night due to the nose.  Be sure to keep the water and filter clean in the humidifier.
  3. Use saline nasal sprays, rinses, or nebulizers.  Saline is simple salt water that is balanced to your body.  It is inexpensive and very good at keeping the nose clear of mucus.  The salt will also help to draw out some of the swelling in the nose.
  4. Steam from a warm shower or wet warm cloth over the nose may help also, albeit temporary.
  1. Rhinocort nasal spray (prescription-only) is a slow acting nasal steroid that has a pregnancy class B rating (meaning it does not seem to cause harm to animal fetuses in studies).  It has the most safety data of the common nasal medications, but will take several days or a week to start working fully.
  2. Vick’s Vap-o-Rub is an over-the-counter ointment that is placed on the chest and neck.  It is not known to be harmful during pregnancy but has not been extensively studied, and has no pregnancy risk category.  It can act as a decongestant and mild cough suppressant.  Here in the South, women rub it into their feet and then put socks on top!
  3. Antihistamines like Benadryl, Claritin, Allegra, and Zyrtec are oral tablets that reduce inflammation.  These are all category B, so are among the safest studied.  The problem is they are not extremely effective for the swelling in the nose, though they do a good job with drying up excess mucus.
  4. Pseudoephedrine (Sudafed, or the “D” in a lot of over-the-counter meds) and phenylephrine (the “PE” in a lot of over-the-counter meds) are both oral tablets that can reduce nasal swelling.  They are both Category C (animal fetus studies have shown some harm, but use may be justified under care of a doctor)
  5. Mucinex is a tablet that “thins” the mucus out, trying to change the thick mucus into watery mucus that is easier for the body to clear.  It has a Category C rating as well.
  6. Oxymetazoline nasal spray (“Afrin”) has a category C rating also.  It is a fast-acting medication.  It is rapidly addictive, so not good to use for more than a couple days in a row.
Finally, the most effective and safest cure is delivery of your beautiful new baby!  Your hormones rapidly level out.  You should notice improvement in the nose within a couple days of delivery, and total resolution within 3-4 weeks.
Before using ANY medication the expectant mother should discuss the pro’s and con’s with her obstetrician.