Nasal congestion and pregnancy rhinitis

By trimester

Weeks 1–13

1st trimester

Congestion can start early in the first trimester. Try non-drug options first: saline sprays, a warm-mist humidifier, sleeping propped up, and plenty of fluids. Avoid oral pseudoephedrine now unless your provider directs otherwise.

Weeks 14–27

2nd trimester

Congestion often gets worse in the second trimester. A common next step, with your provider's direction, is layering a steroid nasal spray on top of saline.

Weeks 28–birth

3rd trimester

For many, this is when congestion peaks. It can affect your sleep by causing snoring, breathing disruptions, or daytime tiredness, so tell your provider if congestion is keeping you up at night.

What does the evidence show for nasal congestion and pregnancy rhinitis?

• Persistent nasal congestion is a common pregnancy complaint, and non-drug steps like saline, humidified air, and sleeping with your head elevated are the first thing to try. 1
• Steroid nasal sprays like fluticasone (Flonase) are absorbed into the bloodstream only in small amounts and have a reassuring pregnancy safety record at standard doses. 2
• Newer antihistamines like cetirizine and fexofenadine are broadly acceptable pregnancy options when allergies are adding to the congestion. 3
• Oral pseudoephedrine has been linked to rare vascular concerns and is usually set aside in the first trimester in favor of non-drug and nasal-spray options. 4
• Use distilled, sterile, or previously boiled water in any nasal rinse device, since tap water has been tied to rare but documented brain-infection risks. 5

When should I call my provider about nasal congestion and pregnancy rhinitis?

Call your provider for a fever over 100.4°F, facial pain or pressure with thick colored discharge, ear pain, congestion that lasts beyond 10 to 14 days without improving, or a severe headache or vision changes alongside the stuffiness. Plain pregnancy rhinitis does not cause fever, so a fever means something else is going on. None of these lists replace your own judgment: if this symptom worries you, that on its own is enough reason to check in with your healthcare provider.