Is Nasal Stuffiness in Pregnancy Normal?

Frederick R. Jelovsek, MD

Over 30% of pregnant women report frequent or constant nasal problems. That makes stuffiness a problem so common it is called rhinitis of pregnancy. Is it always due to pregnancy -- no! There can be other causes and often preexisting problems get worse during pregnancy. ER Ransom and others pointed out the different problems that should be considered rather than just attributing nasal congestion to pregnancy -- Ransom ER, Senior B, Ransom SB. Rhinitis of pregnancy. The Female Patient 1998; 23:11- 20.

Allergic causes of nasal congestion sometimes improve presumably due to the increased steroids of pregnancy. Other times, however, allergies get worse and steroid nasal sprays are needed. Bacterial rhinosinusitis is another cause of nasal congestion in pregnancy occurring in about 1.5% of women. It is characterized by yellowish or greenish nasal discharge, obstructed breathing and facial pain. Antibiotics are needed for this. Mechanical problems can also worsen in pregnancy such as a previously deviated septum when added to the slight swelling of the nasal skin can obstruct breathing. Preexisting nasal polyps often cause worsening of nasal breathing during pregnancy. An exam by an Ear, Nose and Throat specialist may be needed to diagnose polyps or other benign growths. Another cause of rhinitis has a complicated name -- rhinitis medicamentosa. This is a rebound rhinitis that results from excessive use of over-the-counter decongestant nasal sprays. It is a common pregnancy problem, perhaps because in pregnancy women avoid systemic medications to reduce nasal congestion and instead turn to topical sprays that they can get without a prescription.

On physical exam, the doctor looks at the nasal septum for deviation and then uses a rhinoscope to look at the anterior nose. Clear mucous discharge is more associated with allergic rhinitis, yellowish green with infection. Pale or bluish nasal skin is consistent with allergy while reddness is more likely with other causes. If any polyps are seen or if there is poor visualization due to swollen lining, a formal ENT exam with a flexible endoscope. Full nasal obstruction can cause ear infections and should be treated.

Be sure to get checked out if the nasal breathing is a problem.