Fluticasone Nasal Spray in Pregnancy
Fluticasone propionate nasal spray is safe to use during pregnancy at recommended doses, and if you are already using it before pregnancy, you should continue without interruption. 1, 2
Safety Evidence
The safety profile of intranasal fluticasone during pregnancy is well-established:
A meta-analysis found no increased risk of major congenital malformations, preterm delivery, low birth weight, or pregnancy-induced hypertension with intranasal corticosteroid use during pregnancy 1, 2
In a controlled study of 53 pregnant women treated with fluticasone propionate nasal spray, maternal cortisol levels, fetal growth on ultrasound, and pregnancy outcomes were comparable to untreated controls 1, 3
Systemic absorption after intranasal administration is markedly lower than oral corticosteroids, supporting a favorable fetal safety profile 1
Fluticasone propionate has accumulated substantial safety data alongside budesonide and beclomethasone, making it one of the better-studied intranasal corticosteroids in pregnancy 1, 2
Clinical Decision Algorithm
If Already Using Fluticasone Before Pregnancy
Continue your current regimen without interruption using the lowest effective dose 1, 2, 4
Switching to another intranasal corticosteroid is unnecessary because no meaningful differences in efficacy or safety have been demonstrated among intranasal corticosteroids 1, 4
If Starting Treatment During Pregnancy
Budesonide is technically preferred as first-line therapy when initiating treatment during pregnancy due to its FDA Pregnancy Category B classification based on safety data from >6,600 pregnancies 1, 2, 4
However, fluticasone propionate is an acceptable alternative at recommended doses if budesonide is unavailable or not tolerated 1, 5
Recommended Dosing
Use the lowest effective dose that adequately controls symptoms throughout all trimesters 1, 2, 4
Do not exceed the manufacturer-recommended maximum daily dose 4
The FDA label classifies fluticasone as Pregnancy Category C (animal studies show adverse effects at high doses; human data are reassuring) 6
Critical Distinctions to Avoid Confusion
Intranasal vs. Oral Corticosteroids
Do not confuse intranasal with oral corticosteroids—oral steroids carry significantly higher risks in the first trimester, including cleft lip/palate, preeclampsia, preterm delivery, and gestational diabetes 1, 2, 4
Intranasal corticosteroids have negligible systemic absorption compared to oral formulations 1
What to Avoid
Avoid oral decongestants (pseudoephedrine, phenylephrine) in the first trimester, as they have been associated with gastroschisis and intestinal atresia 1, 4
Avoid intranasal azelastine due to limited human safety data 1
Avoid the azelastine-fluticasone combination spray during pregnancy because of limited safety data on the azelastine component 1
Alternative Treatment Options
If intranasal corticosteroids are not preferred:
Intranasal sodium cromolyn is an acceptable alternative for symptom control 1
Nasal saline lavage is safe and has demonstrated efficacy in reducing rhinitis symptoms and antihistamine use in pregnant women 7
Second-generation oral antihistamines (loratadine or cetirizine) may be used if needed, with extensive safety data 8, 9
Breastfeeding Compatibility
- Intranasal fluticasone is compatible with breastfeeding because minimal systemic absorption results in negligible drug transfer to breast milk 1, 4
Key Clinical Pitfall
Do not discontinue effective intranasal corticosteroid therapy before or during pregnancy, as untreated allergic rhinitis can impair quality of life and exacerbate comorbid asthma 1, 2