Nasal Steroid Sprays During Pregnancy
Modern nasal corticosteroid sprays like budesonide, fluticasone, and mometasone are safe to use during pregnancy at recommended doses and should be continued if they effectively controlled symptoms before pregnancy. 1
Safety Profile of Nasal Corticosteroids During Pregnancy
Nasal corticosteroids have minimal systemic absorption when used as directed, making them safer options for treating nasal symptoms during pregnancy compared to oral medications.
- Budesonide has the most extensive safety data and is classified as FDA Pregnancy Category B (no evidence of risk in humans) 1, 2
- Fluticasone and mometasone are classified as Category C but have favorable safety profiles and can be safely used during pregnancy 1, 3
- No significant association with congenital malformations has been linked to intranasal use of budesonide, fluticasone propionate, fluticasone furoate, or mometasone 3
Evidence-Based Recommendations
The American College of Allergy, Asthma, and Immunology and the Rhinology Society support the use of nasal corticosteroids during pregnancy with the following guidance:
- Use the minimum effective dose to control symptoms 1
- Continue the same nasal corticosteroid that adequately controlled symptoms before pregnancy 1
- Avoid unapproved formulations such as budesonide irrigations or nasal drops 4, 1
- Prefer nasal corticosteroids over oral corticosteroids due to lower systemic absorption 1
Specific Medication Guidance
- First choice: Budesonide (most safety data, Category B) 1, 5
- Alternative options: Fluticasone furoate, mometasone (if they were effective before pregnancy) 3
- Avoid: Intranasal triamcinolone (has been associated with respiratory tract defects) 3
Important Considerations and Cautions
The benefits of symptom control with nasal corticosteroids generally outweigh the theoretical risks of appropriate use 1
Studies have shown that using nasal corticosteroids during pregnancy does not increase the risk of:
- Congenital malformations
- Preterm birth
- Low birth weight
- Pregnancy-induced hypertension 1
For women with both asthma and allergic rhinitis, treating both conditions is important as uncontrolled asthma poses greater risks to pregnancy outcomes than medication use 6
Limit use of nasal decongestants to no more than 7 days if needed 7
Alternative Options
If nasal corticosteroids are not preferred, cromolyn sodium (Category B) is a safe but less effective alternative, requiring application four times daily 1.
Remember that untreated severe nasal symptoms can significantly impact quality of life during pregnancy, and modern nasal corticosteroids used at recommended doses provide a favorable benefit-risk ratio.