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Nasal Spray During Pregnancy: What Is Safe?

Nasal spray during pregnancy: which ones are safe? Learn about safe options, what to avoid, and when to consult your doctor during pregnancy.

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Nasal spray during pregnancy: which ones are safe? Learn about safe options, what to avoid, and when to consult your doctor during pregnancy.

Nasal Spray During Pregnancy

A blocked or runny nose is a very common complaint during pregnancy. Hormonal changes – particularly rising levels of oestrogen and progesterone – cause the mucous membranes inside the nose to swell, leading to a condition known as pregnancy rhinitis (Rhinitis gravidarum). Many pregnant women wonder which nasal sprays, if any, are safe to use during this sensitive time.

Types of Nasal Sprays and Their Safety During Pregnancy

Saline Nasal Sprays (Isotonic or Hypertonic)

Saline-based nasal sprays are considered the safest option during pregnancy. They contain no active pharmaceutical ingredients that could enter the bloodstream and pose no risk to the developing baby. They work by moisturising the nasal mucosa and helping to loosen mucus. Isotonic saline (0.9% NaCl) is the gentlest option, while hypertonic saline (e.g. 2.3% NaCl) has a slightly stronger decongestant effect and is also considered safe.

Decongestant Nasal Sprays

Decongestant nasal sprays contain active ingredients such as xylometazoline or oxymetazoline, which cause blood vessels in the nasal lining to constrict, temporarily relieving congestion. However, these substances can be absorbed through the mucous membranes into the bloodstream and may theoretically affect blood flow to the placenta. For this reason, decongestant sprays should only be used during pregnancy after consultation with a doctor, and only for short periods (a maximum of 3 days) at the lowest effective dose.

Corticosteroid Nasal Sprays

Corticosteroid nasal sprays such as budesonide or mometasone are commonly used to treat allergic rhinitis. They work locally to reduce inflammation. Budesonide is the most thoroughly studied corticosteroid nasal spray and is sometimes recommended by doctors during pregnancy when the benefit to the mother outweighs any potential risks. Medical advice is always required before use.

Seawater Nasal Sprays

Seawater nasal sprays are also safe to use during pregnancy. They work in a similar way to saline sprays but also contain natural minerals and trace elements from seawater, which may provide additional support for the nasal mucosa.

Pregnancy Rhinitis

Pregnancy rhinitis is not caused by an infection but by hormonal changes that lead to swelling of the nasal lining. It commonly develops during the second trimester and usually resolves on its own after birth. Typical symptoms include:

Persistent nasal congestion or a runny nose without signs of illness
Sneezing
Reduced sense of smell
Disrupted sleep due to difficulty breathing through the nose

Non-Medicinal Measures

Before reaching for a nasal spray, non-medicinal approaches are worth trying first:

Nasal rinsing with isotonic saline solution (e.g. using a nasal irrigation pot)
Using a humidifier in the bedroom
Sleeping with the head slightly elevated
Drinking plenty of fluids to keep the mucous membranes moist
Steam inhalation with plain water (avoid essential oils, as many are not considered safe during pregnancy)

When to Seek Medical Advice

Pregnant women should consult a doctor or midwife before using a nasal spray in the following situations:

If symptoms persist for several weeks
If symptoms are accompanied by fever, facial pain, or greenish nasal discharge (possible sinusitis)
If a decongestant nasal spray seems necessary
If there is a known allergy (allergic rhinitis)

Summary

Choosing the right nasal spray during pregnancy is particularly important. Saline and seawater nasal sprays are the safest options and can be used freely. Decongestant sprays (xylometazoline, oxymetazoline) should only be used on medical advice and for the shortest possible time. Corticosteroid nasal sprays also require a prescription and medical supervision. When in doubt, always consult your midwife, gynaecologist, or GP before using any nasal spray.

References

Bousquet J et al. - Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines 2016 revision. Journal of Allergy and Clinical Immunology, 2017.
Schaefer C, Peters P, Miller RK (eds.) - Drugs During Pregnancy and Lactation. 3rd edition, Academic Press, 2014.
NHS (National Health Service, UK) - Colds and flu during pregnancy. www.nhs.uk (accessed 2024).

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