Nasal Congestion
Nasal congestion is a normal symptom of common colds, allergies, sinus infections, and pregnancy. Pregnancy itself can cause nasal congestion that lasts for weeks, even months – without illness. This symptom is so frustrating for women that some researchers have indicated it needs more attention among HCPs.
Starting early in the first trimester, blood volume begins to increase significantly which causes more fluid to flow through the small capillaries in the nose, which swell, and leads to “stuffiness”.
Nasal congestion starts very early in pregnancy and tends to get progressively worse to term, before rapidly resolving after delivery. However, women can still experience nasal congestion due to other reasons unrelated to pregnancy.
Understanding the difference between all types/causes of nasal congestion is important for women to understand as the treatments are different.
Background
It is often recommended that all pregnant women be informed about gestational (pregnancy) rhinitis (stuffy nose/nasal congestion). This symptom often gets confused or mistaken for other conditions.
When women have a stuffy nose during pregnancy, it can be difficult to determine the cause as well as the proper management.
Rhinitis: medical term for inflammation and swelling of the mucous membrane of the nose, characterized by a runny nose and stuffiness and usually caused by the common cold or a seasonal allergy.
Rhinitis during Pregnancy: as described above, but occurs during pregnancy.
Women with nasal symptoms due to allergies during pregnancy will also have a runny nose, itching, and sneezing. A common cold may present with a sore throat, cough, and other chest/bronchial-related symptoms, as well as nasal congestion.
Nasal congestion caused by a cold or allergies can, in general, be made more severe during pregnancy, with potential mental health consequences due to a significant adverse impact to quality of life.
Gestational Rhinitis: inflammation and swelling of the mucous membrane of the nose caused by physiological changes of pregnancy, and not from any illness or allergen; “stuffy” nose is usually the only symptom.
It is estimated that 18% to 30% of pregnant women have nasal congestion due to pregnancy. Symptoms can appear at any point, but usually start and peak in severity during the third trimester. Symptoms tend to go away within ten days after delivery, as excess fluid is removed (through frequent urination).
Pregnancy-associated nasal congestion first received recognition in 1898, and formal publication in 1943. Despite this, it has not been well-recognized by the public as a pregnancy-associated symptom and is therefore not taken very seriously.
In 2005, a few researchers suggested the true overall knowledge of the effects of nasal congestion during pregnancy was probably confined to ear, nose and throat (ENT) physicians, and not obstetricians. Therefore, the main HCP women see during pregnancy may not be fully aware of the problem.
Since nasal congestion during pregnancy affects two specialties of physicians, research and information can help maximize the education of pregnant women regarding this symptom and they can seek adequate management with help of their HCP.
Causes
The capillaries in the nose, throat, and larynx become inflamed early in the first trimester, due to an increase in blood volume (leading cause), and possibly, to a lesser degree, hormones.
Total blood volume during pregnancy increases by about 1.5 liters (almost 40% to 50% increase, or about 1,250 to 1,500 ml) to support fetal and placental development and protection from blood loss during delivery. This increase begins at 6 weeks and the entire circulatory system – including the nasal capillaries – is affected. This extra blood volume swells the capillaries with extra fluid, leading to inflammation.
Did You Know: This swelling also helps viruses attach and makes it harder for immune cells in the nasal cavity to kill these pathogens.
Exactly how hormones affect nasal congestion and which hormones are responsible is not known. Higher circulating levels of estrogen and/or placental growth hormone have been identified through biopsy results of nasal membranes of pregnant women with congestion. However, other studies have not found blood levels of estrogen to be any higher than those who were not suffering from nasal stuffiness.
Smoking has been found to a be a serious risk factor for gestational rhinitis. Smoking is a significant irritant of mucus membranes and can compound the negative effects of pregnancy-related causes and worsen nasal congestion.
Signs, Symptoms, and Complications
While nasal congestion does not, by itself, lead to complications during pregnancy, left unmanaged, it can indirectly affect other aspects of pregnancy that could cause complications. Some women may not even know their congestion is all that significant until they notice other signs/symptoms.
Nasal congestion:
Can dramatically affect the quality of life of pregnant women; although it is mostly considered a relatively “trivial” problem in comparison to other pregnancy-related symptoms, congestion causes significant overall discomfort and can affect a woman's ability to eat, sleep, and be comfortable
Leads to a lack of sleep, which itself also leads to various other complications during pregnancy; congestion often gets worse when a woman is lying down, even on her side, and women can find it very difficult to get comfortable when they cannot breathe out of their nose (see Sleep)
Increases the risk of snoring, which has been suggested to have negative effects on the fetus
Leads to mouth breathing, which is associated with various sleep disorders based on how the nose, throat, and mouth regulate air temperature and oxygen into the body
Can reduce appetite and impact how things taste
Worsens sinusitis and asthma
Is linked to maternal obstructive sleep apnea syndrome
May lead to drug dependence; women often use nasal decongestant spray, which is very effective for the first 48 hours; however, extended use can cause dependence on the drug, which makes nasal congestion worse, which is less likely to resolve in the postpartum (read Cold Medications).
Can cause nose bleeds due to general nasal membrane engorgement, usually first thing in the morning
Management
Treatment for gestational rhinitis is different from rhinitis caused by an illness, although some of the same techniques may work with either condition.
First, the management of any “self-limiting” medical problem almost always begins with lifestyle changes:
Women should aim to stay hydrated and engage in routine physical activity. Exercise is one of the most well-established techniques to improve nasal congestion as exercise improves circulation and can help release extra fluid from blood vessels. Regular exercise can also help women experience better sleep.
It is often recommended that women raise the head of the bed (instead of just using pillows) at an angle of 30° or 45° to reduce congestion. Raising the head of the bed also helps women to continue to sleep on their sides which is difficult if women only use pillows.
Women who suffer nosebleeds along with gestational rhinitis may want to try a humidifier using distilled water. The most common cause of nose bleeds is dry air.
While a hot shower or steam may help reduce inflammation, this is likely only temporary; relief may last for only a few minutes afterward, depending on symptom severity.
If lifestyle changes fail to work, there are several medication options. Pregnant women should always talk to their HCP before taking any over-the-counter (OTC) medication.
Although some cold medications may help reduce inflammation, cold medications have not been studied regarding long-term use during pregnancy, therefore these medications are not recommended for gestational rhinitis. Further, some decongestants should only be used for 48 hours or less, or congestion could be made worse.
Intranasal corticosteroid (INCS) sprays are generally safe and effective for nasal congestion in the general population. However, the use of some of these sprays during pregnancy is still controversial, especially if the woman does not suffer from allergies. The only two INCS sprays over the counter are Nasacort® Allergy 24HR (triamcinolone acetonide) and Flonase® Allergy Relief (fluticasone propionate).
The use of nasal decongestants is also common during pregnancy, but women should not use them for prolonged periods or their congestion can worsen (read Cold Medications).
Nasal saline spray is safe during pregnancy. Women who use neti pots need to use them exactly as described; the water should only be distilled or previously boiled, then cooled (never use tap water which could contain pathogens). The pots should also be cleaned after every use. Misuse of these pots can lead to serious infections.
Action
Gestational rhinitis goes away within days to a few weeks after delivery, as excess fluid is gradually removed from the body in the postpartum period.
Women should try the lifestyle modifications described above, and see their HCP if symptoms do not improve. There is no optimal treatment for all women, so women should use what makes them the most comfortable, after a discussion with their HCP, to include the use of OTC medications.
Women should read Sleep for more information on lack of sleep, snoring, mouth breathing, and sleep apnea during pregnancy.
Women should also consider sharing and submitting their experience below regarding nasal congestion during pregnancy. This can help other women learn additional perspectives regarding this concern and how to potentially manage symptoms.
Partners/Support
Anyone who has ever had nasal congestion from a cold understands the misery. Pregnant women can have this misery for weeks or months with gestational rhinitis, which, can overall, make them incredibly uncomfortable. This can be compounded when it leads to a lack of sleep.
Although a woman's partner/support cannot necessarily improve her nasal congestion, they can help every other aspect of her life that may be affected by it. Partners should help women stay active and hydrated, and change family logistics just enough that she can obtain better sleep.
Further, if partners notice the woman snoring more often, or she is appearing to struggle with breathing while sleeping, partners/support should inform the woman she needs to call her HCP immediately for an assessment regarding the possibility of obstructive sleep apnea.