Due to the focus on various “typical” pregnancy complaints, pregnant women and doctors often ignore pregnancy rhinitis. However, this seemingly harmless ailment can negatively affect the health of the expectant mother and child.
Pregnancy rhinitis or pregnancy-induced rhinitis is an old diagnosis that Hippocrates already recognized and assumed that the inflammation of the nasal mucosa is a consequence of the hormonal changes that occur during pregnancy. Despite the fact that it is a long-recognized disease, the mechanisms of its occurrence, comprehensive clinical picture and epidemiological data are still insufficiently elucidated.
Symptoms of pregnancy rhinitis significantly disturb the quality of life in pregnant women. At the same time, there is evidence that the presence of pregnancy rhinitis affects the health of the pregnant woman as well as the child. There is some evidence of an association between pregnancy rhinitis and pregnancy complications such as preeclampsia and gestational hypertension or sleep disorders with apnoea. There is also evidence that pregnancy rhinitis affects intrauterine growth restriction of the child and that there are correlations with a worse APGAR score of the child born.
Cause of occurrence and frequency
In the nasal mucosa there are receptors for female sex hormones such as estrogen and progesterone. Their level changes significantly during pregnancy. This contributes to the development of inflammatory changes in the nasal mucosa, i.e. the development of pregnancy rhinitis.
According to various studies, the prevalence of pregnancy rhinitis ranges from 8 to 42%. Research conducted at the Clinical Hospital Center of the Sisters of Mercy under the leadership of Dr. Tomislav Baudoin and Dr. Tena Šimunjak, which included about 700 subjects, showed a prevalence of 32%. The results of that research were published in one of the strongest rhinology journals, the “American Journal of Rhinology and Allergy” under the title “Redefining pregnancy-induced rhinitis”. Based on the data of that research, a new definition of pregnancy rhinitis was created.
Symptoms
Pregnancy-induced rhinitis is a non-allergic, non-infectious symptomatic inflammation of the nasal mucosa caused by a hormonal imbalance during pregnancy lasting six or more weeks, which resolves spontaneously by the end of the fourth week after delivery. It is characterized by at least one of the following symptoms:
- nasal congestion
- runny nose
- itchy nose
- sneezing and/or impaired sense of smell
The first symptoms can appear at any time during pregnancy, but most often occur during the second trimester. They are most pronounced during the third trimester and last about 16 weeks on average.
The dominant symptom is nasal congestion, but almost all pregnant women have more than one symptom. Most often, nasal congestion is associated with nasal discharge or postnasal drip and nasal itching. In most cases, all symptoms disappear within seven days after delivery, and by the 30th day after delivery at the latest.
It is interesting to mention that, in the mentioned research, among those subjects who had some rhinitis before pregnancy (mostly allergic rhinitis), some had the same symptoms as before pregnancy, but the largest number was those whose symptoms worsened. However, the number of pregnant women whose symptoms of allergic rhinitis have improved or were absent during pregnancy is not negligible.
Treatment of pregnancy rhinitis
Therefore, rhinitis caused by pregnancy certainly has a strong negative impact on the quality of life of pregnant women, and it is neglected due to the focus of both pregnant women and doctors on pregnancy. Since about one third of pregnant women suffer from pregnancy rhinitis, a serious approach is needed, taking into account serious disorders of the health of pregnant women, as well as potential threats to the child. On the other hand, the limited possibility of taking medication during pregnancy raises questions about which therapy and for how long to give to pregnant women in order to suppress the symptoms of pregnancy rhinitis. The higher the stage of pregnancy, the lower the risk of potential side effects of topical nasal medications.
The first line of therapy is rinsing the nose with saline solution or hypertonic solution or inhalation with one of these two solutions several times a day. For some pregnant women, a saline solution will work better, and for some, a hypertonic solution.
Regarding decongestant drops and sprays, they have no recommendations for use during pregnancy. However, in case of severe symptoms of pregnancy rhinitis, it is possible to use some of them for a short time, up to three days after rinsing the nose with the aforementioned solutions. I suggest that these are children’s dosages or preparations, and it is good if they also contain some additives such as hyaluronic acid.
The third line is intranasal corticosteroids, of which only budesonide-based spray is approved for use in pregnancy. It should be applied properly, preferably in the evening when the complaints are most pronounced, but the pregnant woman should not lie down immediately after applying the spray, but about half an hour later. This allows the spray to be absorbed in the mucous membrane of the nose, and not flow down the throat and end up in the stomach, which definitely increases the absorption concentration and the risk of potential side effects. Of course, the use of this spray should be under the control of a doctor. Although budesonide is excreted in breast milk, an effect on the infant is not expected when using therapeutic doses of the drug. The drug can be used during breastfeeding.
So, pregnancy rhinitis is an additional problem that can make pregnancy difficult with possible consequences for the pregnant woman and the child. The impact of pregnancy rhinitis on the quality of life of a pregnant woman is great and should not be neglected, but requires appropriate treatment.
Find more professional advice at the polyclinic for the diagnosis and treatment of ear, nose and throat diseases and for minimally invasive aesthetic surgery of the head and neck in Alba Rubra.
This text was created in collaboration with portal “ADIVA – your portal for health”
