From the Guidelines
Pregnancy is associated with an increased risk of sinus congestion due to hormonal changes, particularly after the second month of pregnancy.
Causes of Sinus Congestion in Pregnancy
- Hormonal-induced rhinitis: Causes of hormonal rhinitis include pregnancy and menstrual cycle–related rhinitis, leading to significant nasal congestion 1.
- Nasal vascular pooling: Vasodilation and increased blood volume may account for worsening allergic rhinitis and increased sinusitis during pregnancy 1.
- Vasomotor rhinitis of pregnancy: A type of rhinitis unique to pregnant patients, which is 6 times more common in pregnant than nonpregnant women 1.
Management of Sinus Congestion in Pregnancy
- Nasal corticosteroid sprays: Continuing nasal corticosteroid sprays for chronic rhinosinusitis (CRS) maintenance is recommended 1.
- Pregnancy-safe antibiotics: Using pregnancy-safe antibiotics for acute rhinosinusitis and CRS exacerbations is recommended 1. The relationship between pregnancy and sinus congestion is well-established, with hormonal changes and nasal vascular pooling contributing to increased nasal congestion and sinusitis 1.
From the Research
Relationship Between Pregnancy and Sinus Congestion
- Pregnancy rhinitis, defined as nasal congestion in the last 6 or more weeks of pregnancy without other signs of respiratory tract infection and with no known allergic cause, is a common condition affecting one in five pregnant women 2.
- The pathogenesis of pregnancy rhinitis is not clear, but placental growth hormone is suggested to be involved, and smoking and sensitization to house dust mites are probable risk factors 2.
- Nasal congestion during pregnancy can be attributed to various factors, including hormonal changes, with oestrogen considered to cause nasal congestion during the menstrual cycle and pregnancy 3, 4.
- Studies have shown that nasal mucosal swelling and reactivity increase during pregnancy, with a connection between high oestrogen levels and nasal mucosal reactivity 4.
- The effects of pregnancy on nasal physiology have been evaluated, with findings indicating that pregnancy affects nasal physiology adversely and impairs nasal breathing in some women, although this may not be considered a disease without complementary symptoms 5.
- Treatment options for pregnancy rhinitis include nasal saline washings, exercise, and mechanical alar dilators, which are safe general means to relieve nasal congestion, while nasal decongestants can provide temporary relief but should be used restrictively to avoid rhinitis medicamentosa 2.