Special considerations in the treatment of pregnancy rhinitis

Abstract

Pregnancy rhinitis is a common condition that is not yet fully recognized by the public. This form of rhinitis affects approximately one in five pregnant women, can start in almost any gestational week, and disappears after delivery. However, as it reduces quality of life, and also possibly affects the fetus, treatment is often required. Saline irrigations, exercise and mechanical alar dilators are a safe and general means of relieving nasal congestion. Nasal corticosteroids have not been shown to be effective. As nasal decongestants provide good temporary relief, women tend to overuse them. Therefore, to avoid an additional rhinitis medicamentosa, nasal decongestants should be restricted to a few days use. Invasive methods of turbinate reduction may be effective, but are not recommended. The differential diagnosis towards sinusitis is often difficult. Antral irrigation is the ultimate diagnostic for purulent sinusitis and often needs to be repeated for therapeutic reasons. If beta-lactam antibiotics are used, an increased dosage is required during pregnancy.

The effects of pregnancy on nasal physiology

“…The effects of changes in hormone levels on nasal physiology and on quality of life in women have been evaluated in many studies . In a study by Philpott et al .…”

“…As a consequence of mouth breathing, they become regular snorers. In severe cases with OSA, the patients may develop gestational hypertension, preeclampsia and intrauterine growth retardation . Sleep breathing disorders in pregnant women may also adversely affect quality of life, especially in the third trimester .…”

“…Recently, nasal mucosal changes during pregnancy have also been attributed to increased levels of placental growth factor . Placental growth factor was suggested to induce overgrowth of nasal mucosa, which eventually leads to obstruction of the nasal airway . The mechanisms by which these hormones act on the nasal mucosa and cause nasal physiological changes are still under investigation.…”

Increased Epulis Gravidarum Prevalence in Women with Both Nasal and Oral Symptoms

“…2,3,6 Rhinitis, which is most frequently observed, is reported in the 22% of pregnant women. [7][8][9] Pregnancy rhinitis is defined as a nasal mucosal congestion present for at least six consecutive weeks, without any sign of infection, even in absence of allergy predisposition or endonasal neoformations. [5][6][7] Symptoms may develop in every stage of pregnancy and completely regresses within two weeks after partum.…”

“…[5][6][7] Symptoms may develop in every stage of pregnancy and completely regresses within two weeks after partum. [8][9][10] The probability to show pregnancy rhinitis is increased in smokers, with a 69% increase prevalence, in house dust mites sensitized women, and in chronic sinusitis. 7,8,10 Clinically, pregnancy rhinitis is characterized by classic symptoms: serious rhinorrhoea, nasal obstruction, headache, sleep disorders.…”