Is Rhinocort safe during pregnancy?

What does the evidence say about Rhinocort during pregnancy?

1. Congenital malformations were studied in 2,113 infants born to mothers who reported using intranasal budesonide in early pregnancy, and the overall malformation rate was similar to the general population rate at 4.5 percent versus 3.5 percent. 1
2. Systemic exposure from intranasal budesonide is six-fold lower than from inhaled budesonide, which is the technical reason a nasal spray is a smaller exposure than an asthma inhaler or an oral steroid. 1
3. Budesonide is the only intranasal corticosteroid with established safety in pregnancy, according to a Canadian Medical Association Journal clinical review. 2
4. Studies of inhaled corticosteroids as a class have found no overall increased chance of birth defects, and these medicines are absorbed into the body in lower amounts than medicine taken by mouth. 3
5. Some symptoms improve on the first day, but the over-the-counter label says it may take up to two weeks of daily use to feel the most relief, and directs anyone pregnant or breastfeeding to ask a health professional first. 4

Is Rhinocort safe in each trimester?

• First trimester. Registry data on intranasal budesonide covers use in early pregnancy specifically, the window when organs form, and found malformation rates close to the background rate. Systemic exposure from the nasal route is a fraction of what an inhaler delivers. If you need a steroid spray in the first trimester, this is the one with the record behind it.
• Second trimester. Congestion often climbs through the middle months as blood volume and nasal swelling increase, and this is when many people start a daily spray. Budesonide takes up to two weeks of consistent use to reach its full effect, so start it before you desperately need it rather than during a bad week.
• Third trimester. Once symptoms improve, the label suggests dropping to one spray per nostril per day, which is a sensible way to keep your dose at the lowest amount that works. Aim the spray away from the middle wall of your nose to reduce irritation and nosebleeds, which pregnancy already makes more likely.