Flonase (Fluticasone) Use During Pregnancy
Flonase is safe to use during pregnancy for nasal congestion and allergies, with no increased risk of birth defects, preterm delivery, low birth weight, or pregnancy-induced hypertension. 1, 2
If You're Already Using Flonase Before Pregnancy
Continue your current Flonase regimen without interruption if it has been effectively controlling your symptoms. 1, 2 Discontinuing effective therapy unnecessarily can significantly impact your quality of life and potentially worsen comorbid conditions like asthma. 2 No substantial difference in efficacy and safety has been shown among the available intranasal corticosteroids, making continuation of your pre-pregnancy regimen reasonable. 1
If Starting Treatment During Pregnancy
Budesonide (Rhinocort) is technically the preferred first choice when initiating intranasal corticosteroid therapy during pregnancy due to its FDA Pregnancy Category B classification based on more extensive human safety data. 1, 2 However, fluticasone propionate has accumulated substantial safety data alongside budesonide and beclomethasone, making it one of the better-studied intranasal corticosteroids in pregnancy. 1, 2
The decision between budesonide and fluticasone when starting therapy often requires a discussion of benefits and risks with your obstetrician, though both are considered safe options. 1
Evidence Supporting Safety
A meta-analysis concluded that intranasal corticosteroid use during pregnancy does not increase the risks of major malformations, preterm delivery, low birth weight, or pregnancy-induced hypertension. 1, 2
Fluticasone propionate has demonstrated no convincing evidence of congenital defects in observational human data, despite animal studies showing theoretical risks. 1
Intranasal corticosteroids have much lower systemic exposure compared to oral corticosteroids, making them significantly safer. 1, 2
Dosing Strategy
Use the lowest effective dose that adequately controls your symptoms. 1, 2 The standard adult dose of Flonase is 1-2 sprays per nostril once daily (100-200 mcg total daily dose). 3 Avoid exceeding manufacturer-recommended dosing. 2
Critical Distinction: Intranasal vs. Oral Corticosteroids
Do not confuse intranasal Flonase with oral corticosteroids—they carry vastly different risk profiles. 2, 4 Oral corticosteroids carry significantly more substantial risks during pregnancy, especially in the first trimester, including increased risk of cleft lip/palate, preeclampsia, preterm delivery, low birth weight, and gestational diabetes. 2 Intranasal corticosteroids have negligible systemic absorption compared to oral formulations. 2
What to Avoid
Oral decongestants (pseudoephedrine, phenylephrine) should be avoided, particularly in the first trimester, due to conflicting reports of associations with gastroschisis and small intestinal atresia. 1, 5
Topical decongestants (oxymetazoline/Afrin) should be avoided throughout pregnancy due to concerns about fetal heart rate changes and lack of adequate safety studies. 5 Regular use beyond 3 days also leads to rebound congestion (rhinitis medicamentosa). 5
First-Line Non-Pharmacologic Treatment
Saline nasal rinses should be used as first-line treatment before or alongside any medication. 1, 5 Saline irrigation is proven safe with no fetal risk and is recommended by expert panels for maintenance therapy during pregnancy. 1, 5
Alternative Intranasal Corticosteroids
Budesonide (Rhinocort): Pregnancy Category B with the most extensive human safety data. 1, 2, 4
Mometasone (Nasonex): Explicitly listed as safe by expert panels at recommended doses, though with less accumulated data than budesonide or fluticasone. 2, 4
Beclomethasone: Has accumulated substantial safety data and is considered safe. 1
Common Pitfalls to Avoid
Do not discontinue effective intranasal corticosteroid therapy due to unfounded safety concerns. 2 The evidence strongly supports their safety profile.
Do not substitute with oral or topical decongestants thinking they are "safer." 1, 5 They carry greater fetal risks than intranasal corticosteroids.
Do not confuse pregnancy rhinitis (hormonal nasal congestion affecting 20% of pregnancies) with allergic rhinitis or sinusitis. 6, 7 Pregnancy rhinitis may not respond as well to corticosteroids but is self-limiting and resolves within 2 weeks postpartum. 6, 7
FDA Pregnancy Category Information
The FDA label classifies fluticasone as Pregnancy Category C based on animal studies showing fetal toxicity at high doses (embryonic growth retardation, cleft palate). 3 However, these animal findings have not translated to human risk in observational studies, and rodents are known to be more prone to teratogenic effects from corticosteroids than humans. 3 The label states fluticasone should be used during pregnancy "only if the potential benefit justifies the potential risk to the fetus," which clinical guidelines interpret favorably given the robust human safety data. 3