Rhinitis: What to Do About Pregnancy Congestion

You expected swollen ankles during pregnancy, but swolen sinuses? What gives? Frustratingly, experts suggest that as many as 20 percent of pregnant people experience nasal congestion during pregnancy that can persist for weeks, lasting far longer than a typical viral illness or seasonal pollen flare.

This congestion, referred to as pregnancy rhinitis, can happen at any point during pregnancy. There are a few reasons why, but (of course!) hormonal changes are often to blame. Here’s what you need to know about pregnancy rhinitis, including what it feels like, how to differentiate it from actual illness and what you can do to safely treat it.

What Is Pregnancy Rhinitis?

Pregnancy rhinitis is one way the body responds to the many hormonal changes that occur throughout pregnancy. Per Johns Hopkins Medicine, “rhinitis” means inflammation of the nose, but it can also affect the ears, eyes and throat. Though rhinitis is usually caused by allergies or illness, it can happen during pregnancy without a clear cause.

When Does Congestion Start in Pregnancy?

Pregnancy congestion can happen at any point in pregnancy, says Omoikhefe Akhigbe, MD, an ob-gyn and medical director at Pediatrix Medical Group in Fulton, Maryland.

It may start from the moment you first find out you’re pregnant all the way until you’re getting ready to deliver baby. One study, from 2013, found that pregnant people were more likely to have rhinitis symptoms between weeks 13 and 21 (during the second trimester). But, in general, it’s common to experience it throughout pregnancy regardless of trimester. Moreover, it may recur intermittently throughout pregnancy or last up to six weeks at a time, adds Akhigbe.

What Causes Pregnancy Congestion?

According to Robert Atlas, MD, an ob-gyn and chair of the department of obstetrics and gynecology at Mercy Medical Center in Baltimore, Maryland, rhinitis is very common in pregnancy because of the increase in vascular blood flow throughout the body.

For the most part, it’s your hormones driving this change: rising levels of progesterone and estrogen increase blood flow during pregnancy, including to your nasal passages, notes the journal Circulation. Research indicates that your hormones can also increase inflammation in the mucous membranes of the nose, causing swelling and congestion.

Symptoms of Pregnancy Rhinitis

Akhigbe says the symptoms of pregnancy rhinitis include having a stuffy nose, post-nasal drip, snoring and possibly itchy eyes. You may also experience nosebleeds, according to the Allergy & Asthma Network. An increase in nighttime coughing could be a result of post-nasal drip too.

How to Know If It’s Pregnancy Rhinitis or Something Else

One of the quickest ways to assess what’s causing your congestion during pregnancy is by taking your temperature. Pregnancy rhinitis won’t give you a fever, so if you’re running a temp, it’s likely to be an illness, such as the common cold, the flu, or even a dreaded bout of COVID during pregnancy.

Other clues to look for? “While you can see [congestion or a runny nose] with COVID or a virus, these other conditions usually present with additional symptoms [like] fever, sore throat, cough [and] body aches,” says Courtney Barnes, MD, an ob-gyn at the University of Missouri Health Care.

You can also consider how long you’ve been feeling stuffed up for; if your congestion is annoying but not severe, and has been going on for more than seven to 10 days without getting any better or worse, it’s more likely to be related to rhinitis than illness.

How to Get Pregnancy Congestion Relief

Thanks to your hormones, you may not be able to completely rid yourself of rhinitis during pregnancy. Barnes says it can be helpful to remember that these symptoms are a result of pregnancy changes and that they’ll eventually resolve on their own.

But if your symptoms are interfering with your daily life, you can rely on some pregnancy-safe home remedies and over-the-counter medications to help you cope.

Home remedies for nasal congestion during pregnancy

To relieve your congestion in drug-free ways, Akhigbe recommends drinking plenty of fluids, using a humidifier, using a saline nasal spray or nasal rinse and elevating your head or laying on your side at night while you sleep.

You can also try nasal strips that promote freer breathing—like those used to prevent snoring at night—to open up your nasal passages while you sleep, advises the Allergy & Asthma Network. When used correctly and safely, a neti pot can provide some pregnancy rhinitis relief too.

Finally, Barnes says exercise has been shown to improve nasal congestion, so you may want to work more pregnancy-safe fitness into your daily routine.

Pregnancy-safe medicines for nasal congestion

If your home remedies aren’t cutting it, you might be wondering what medications you can safely take for congestion during pregnancy. Your options are a bit limited, but they’re not non-existent.

Common allergy medications like loratadine (Claritin) and cetirizine (Zyrtec) are generally considered safe for use during pregnancy, per a 2022 report, as are nasal steroid sprays like budesonide (Rhinocort). Benadryl is another common medication suggested for nasal congestion, and it may help you get better sleep.

If you’re choosing a spray, be mindful to use nasal corticosteroids versus nasal decongestants. Atlas says many people reach for nasal decongestant sprays like Afrin (oxymetazoline), but these medications can cause a rebound effect once you stop using it. Barnes adds that oxymetazoline can be used in the second and third trimesters in limited doses, if necessary, but also cautions against overuse and doesn’t recommend it in the first trimester. Talk to your doctor before turning to this option.

Oral decongestants, like behind-the-counter pseudoephedrine, should be avoided in the first trimester as well, and possibly for the duration of pregnancy. There is mixed evidence about pseudoephedrine’s safety in the second and third trimesters, and Barnes warns that expectant moms with blood pressure problems should avoid them entirely.

In otherwise healthy pregnancies, your ob-gyn may recommend you use an oral decongestant infrequently, in small doses, to mitigate some of your symptoms, but the bottom line is that you should always check with your ob-gyn before taking any over-the-counter or prescription medications during pregnancy. They can assess your individual benefits and risks based on your overall health.

How Long Does Pregnancy Congestion Last?

Again, your congestion may come and go throughout your pregnancy, or it may last for up to six weeks at a time. The good news is that most people experience relief from pregnancy congestion within two weeks of delivering, per Nationwide Children’s.

When to Reach Out to Your Doctor About Pregnancy Congestion

If you’re striking out trying to treat your pregnancy rhinitis with home remedies and approved medications, don’t hesitate to contact your provider. They can help you brainstorm more ideas for pregnancy congestion relief that are safe for you.

Barnes says you should also contact your doctor if your congestion is accompanied by other symptoms such as fever, shortness of breath, sore throat, chest pain or signs of a sinus infection, or if you have any concerns about the quality of your sleep during pregnancy because of your congestion.

Please note: The Bump and the materials and information it contains are not intended to, and do not constitute, medical or other health advice or diagnosis and should not be used as such. You should always consult with a qualified physician or health professional about your specific circumstances.