Best nasal spray for pregnancy congestion

How do the options compare?

Sprays are compared by class on how much reaches the bloodstream, what the pregnancy data show, whether a day limit applies, and what happens when you stop.

• Nasal irrigation with saline solution provides good temporary symptom relief for rhinitis in pregnancy, and educational and non-drug measures are the first choice, in part because symptoms resolve spontaneously after delivery. 1
• Many authors recommend using topical nasal decongestants for no more than five, or even three, days because of the proven risk of drug-induced rhinitis, which does not resolve after delivery. Budesonide is the intranasal corticosteroid with established safety in pregnancy. 1
• Oxymetazoline works by temporarily narrowing blood vessels where it is applied, and when used as directed in the nose, very little of the medication is thought to be absorbed into the body. Studies do not suggest a higher chance of birth defects at recommended doses in pregnancy. 2
• When sprayed in the nose, fluticasone is absorbed into the body in lower amounts than medication taken by mouth, and if it enters the bloodstream the amount is expected to be small. Studies show nasal fluticasone is not expected to increase the chance of birth defects. 3
• Nasal sprays are preferable to oral decongestants because they reduce the chance of exposure to the baby, depending on frequency and dose, and nasal irrigation should use only previously boiled, distilled or sterile water. 4

Which option makes sense?

Start with saline, step to a steroid spray if you need an active ingredient (budesonide has the established pregnancy record), and keep a decongestant spray to a three to five day run rather than a routine.

Disclosure: Pregnancy Smart offers a supplement that overlaps with one or more options above. This page describes the pregnancy evidence for each option on its own merits.