Pregnancy Rhinitis

Have you suddenly developed a stuffy and runny nose that is not caused by a cold or allergies? You might be experiencing pregnancy rhinitis, also known as nasal congestion.

It is a common condition that affects 39% of women during pregnancy. It starts anytime from the time of conception throughout the various stages of pregnancy up until childbirth and is usually caused by changes in your hormones. ⁽⁴⁾

The constant stuffy feeling and sneezing are so frustrating. They mess with your sleep and get worse if you have been diagnosed with sinusitis, but fortunately, there are ways to manage them safely.

What Is Pregnancy Rhinitis?

Pregnancy rhinitis is an inflammation of the mucus membrane, which is characterized by nasal congestion, sneezing, and a runny or stuffy nose that develops during pregnancy without any signs of a cold, flu, or allergy. 

It happens due to changes in your body, especially the rise in pregnancy hormones like estrogen and progesterone. These hormones cause more blood to flow to the lining of your nose, resulting in swelling and increased mucus. 

Pregnancy rhinitis is not caused by cold, flu, or allergies. Although the symptoms are similar, pregnancy rhinitis does not typically come with fever, fatigue, or body aches. Colds and flu are caused by viruses, while pregnancy rhinitis occurs due to hormonal changes, mainly the rise in estrogen and blood volume, which affect the nasal passages.

If your congestion is accompanied by sneezing fits, itchy eyes, or a scratchy throat, it could be due to allergies. Allergic rhinitis is triggered by things like pollen or dust. Unlike pregnancy rhinitis, which often appears without exposure to allergens, allergies usually follow a clear pattern and may be preexisting or develop during pregnancy.

It’s also sometimes mistaken for a sinus infection (sinusitis), especially when the congestion lingers. However, sinusitis often includes thick yellow or green mucus, facial pain, pressure around the eyes, and even fever.

If you have been diagnosed with allergies, sinusitis, or any other nasal conditions, symptoms tend to worsen our during pregnancy. Approximately 20%–40% of women report rhinitis symptoms during childhood or adolescence, and 10%–30% of these women report symptom worsening during pregnancy. ⁽⁶⁾

A study shows 11.65% of pregnant women experience pregnancy rhinitis in their first trimester. Studies also show that it is most commonly seen during the second and third trimesters⁽¹⁰⁾. However, pregnancy rhinitis develops during pregnancy and can be seen from your first trimester up until 2 weeks after childbirth. ⁽⁷⁾

What Causes Congestion during Pregnancy?

Dr G.V.K. Chaitanya Roa, a sinus doctor, explains that hormonal changes, especially the increase in estrogen and progesterone, are among the causes of pregnancy rhinitis.⁽¹¹⁾

These hormonal changes lead to swelling of the tissue inside your nose and sinuses, and this causes nasal congestion. 

Some other causes and contributing factors are:

• Vascular changes. Hormones also increase blood vessel activity, which can cause nasal swelling and congestion.

• Immune sensitivity. During pregnancy, your immune system shifts to protect your baby, which can make you more sensitive to allergens like pollen or dust and worsen your symptoms.

• Allergies. If you have pre-existing allergies, they can be worsened by hormonal changes.

• Environmental triggers. Dust, pollen, and pollutants can irritate your sensitive nasal passages even more.

The full reason why pregnancy rhinitis happens is not fully known, but it has been linked to hormonal changes. 

What are the symptoms of Pregnancy Congestion?

According to the National Institute of Health, the main symptoms of pregnancy congestion, also known as pregnancy-induced rhinitis, are sneezing, nasal congestion, or a runny nose. ⁽⁴⁾

Also, Dr Anusha Rao, an Obstetrics and Gynecologist at Yashoda Hospital, explains that the primary symptoms of pregnancy rhinitis are persistent nasal congestion, which can cause a stuffy or runny nose. ⁽⁹⁾

These symptoms can be troubling because they disrupt sleep, resulting in fatigue and a decreased quality of life. Here are some other symptoms you may experience. 

• Nasal swelling 

• Sneezing 

• Post-Nasal Drip

• Reduced sense of smell

• Mild headaches due to nasal congestion 

• Sore throat from post-nasal drip and mouth breathing.

While pregnancy rhinitis can occur at any time during your pregnancy, it is most common during the second and third trimesters.

Your symptoms may last for at least 6 weeks or the entire duration of your pregnancy. It is also common to first notice these symptoms during your first trimester because it is at this stage that your hormones and progesterone levels are increasing rapidly. ⁽³⁾

20% of women also report experiencing these symptoms throughout all trimesters of their pregnancy⁽⁷⁾. The good news is they usually disappear within 2 weeks of your baby's birth.

How doctors diagnose pregnancy rhinitis.

For a diagnosis of pregnancy rhinitis to be made, several assessments would be carried out, including a detailed medical history, allergy tests, and nasal endoscopy to rule out other causes. It usually involves a few processes explained by Dr G.V.K. Chaitanya Roa. ⁽¹¹⁾

This diagnosis is made if you have been experiencing a stuffy or runny nose for several weeks without any signs of a cold, flu, or allergies.

How congestion during pregnancy is diagnosed

• First, your doctors will begin by asking you questions about the onset, duration, and severity of your symptoms. They will also ask if you have a history of allergies, respiratory infections, or any other medical conditions. 

• The next thing your doctors would do is to examine your nasal passage for signs of congestion, inflammation, and irritation. 

• Also, your doctors would do a differential diagnosis. This is to rule out any other causes. For example, if you have a history of allergies, tests like a skin prick or blood test will be done to identify the specific allergens. ⁽⁸⁾

• If your symptoms are accompanied by fever or body pain, it is most likely a cold or flu. Also, if it is accompanied by facial pain, headaches, or a thick foul-smelling nasal discharge, you might have sinusitis. ⁽¹⁾

• In some cases, your doctor may perform a nasal endoscopy by inserting a small camera into your nose to visualize your nasal passages and check for inflammation or other abnormalities.

Pregnancy rhinitis is not a life-threatening or harmful condition, but if you experience facial pain, snoring while you sleep, or waking up at intervals during the night, consult your doctor immediately. 

This is because a study showed that snoring and sleep apnea in pregnancy rhinitis potentially led to serious complications such as maternal hypertension and preeclampsia. ⁽⁶⁾

Home Remedies For Pregnancy Congestion

According to sinus specialist Dr. GVK Chaitanya Rao, one of the easiest things you can do is to sleep in a head-up position. Using an extra pillow under the head helps decongest the nasal passages, he explains. This tip is just one of many simple home remedies that can bring you some much-needed relief. 

Other home remedies you can do include:

• Using saline nasal sprays. These sprays moisturize your nasal passages and clear congestion without the need for medication or side effects.

• Humidifiers can add moisture to the air, especially in bedrooms. They can soothe dry nasal passages and make breathing easier.

• Drink plenty of water to help thin out mucus, so your nose doesn't feel so stuffed. When you consume plenty of water, the mucosal secretions that form inside your nose and sinuses thin out and can be easily cleared by your nose. 

• Exercises like walking or yoga can improve circulation and temporarily relieve congestion. Just make sure to check with your doctor first.

• Do a Steam Inhalation. Don't do it for more than a minute, as it can be counterproductive. Once in the morning and once in the night, for up to a minute, makes a huge difference and definitely helps decongest the nose. 

• Eat a little bit of warm, spicy food, such as soups or dishes made with chili, garlic, or ginger, to help open up your nasal passages. 

• Limit Your Exposure to Triggers. Avoid known irritants like smoke, strong perfumes, and allergens; it will help prevent your congestion symptoms from worsening.

• For a sore throat, try gargling with salt water. Mix half a teaspoon of salt in a glass of warm water and gargle several times a day. This can help reduce inflammation and soothe throat discomfort. Also drink a warm liquid or suck on ice. Honey and lemon may also soothe a sore throat.

If after you have tried all these conservative measures and it does little or nothing to help your congestion, your doctor would prescribe antihistamine medication such as:

• Chlorpheniramine (Chlor-Trimeton), which is recommended for treating runny nose and sneezing in all trimesters. 

• Doxylamine (Unisom) and diphenhydramine (Benadryl) are also considered safe but may cause drowsiness. 

• Cetirizine (Zyrtec) and loratadine (Claritin) are alternatives that cause less drowsiness.

Once your first trimester is complete, your doctor would recommend medications like levocetirizine, loratadine, and systemic decongestants such as adrenergic. ^(6)(11)

There are certain medications that you are allowed to take during pregnancy to relieve nasal congestion,but medications like nasal steroid sprays such as triamcinolone (Nasacort), nasal decongestants like oxymetazoline (Afrin), and oral decongestants like pseudoephedrine (Sudafed) and phenylephrine (Sudafed PE) should be avoided.⁽⁵⁾⁽⁷⁾