The management of a runny nose during pregnancy requires a cautious, evidence-based approach, as the safety of the developing fetus is paramount. Fortunately, the first-line treatments are non-pharmacological and highly effective. Simple elevation of the head during sleep using an extra pillow can reduce venous pooling in the nasal passages. The use of a cool-mist humidifier or saline nasal irrigation (using a neti pot or squeeze bottle with sterile water or saline) is exceptionally safe and helps to thin mucus and clear irritants. Nasal saline sprays can be used liberally. If these measures fail, clinicians may consider intranasal medications, which act locally and have minimal systemic absorption. Intranasal cromolyn sodium is considered safe for use during pregnancy. For more severe congestion, intranasal corticosteroids (e.g., budesonide) are the preferred pharmacological option, with extensive safety data supporting their use. In contrast, oral decongestants like pseudoephedrine should be used with extreme caution, particularly in the first trimester, due to potential associations with rare birth defects and concerns about vasoconstriction that could affect placental blood flow. Topical decongestant sprays (e.g., oxymetazoline) are generally avoided due to the risk of rebound congestion (rhinitis medicamentosa) and potential systemic effects.
Management focuses on symptom relief, as there is no "cure" other than delivery. Treatment follows a stepwise approach prioritizing safety for the fetus. runny nose during pregnancy