Rhinitis
During Pregnancy : Risk Factors And Management
.........................................................................................................................
Mahmoud
Mashagbeh MD*
Ahmad Sbaihat MD**
Hind Harahsheh MD***
*Department of Obstetrics
& Gynecology, Royal Medical Services, Jordan.
** Department of otorhinolaryngology, Royal
Medical Services, Jordan.
*** Department of Radiology, Royal Medical Services,
Jordan.
Correspondence:
Dr. Ahmad Sbaihat, P.O Box 867 Amman 11953 Jordan.
Email: drsbaihat@hotmail.com
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ABSTRACT
Objective: To find out the risk
factors of rhinitis during pregnancy ,
discussion of a management strategy and
how to improve the quality of the pregnancy.
Patients and Methods: A total of two
hundred and fifty primigravida aged 19-28
years (mean age 25) who were referred
to otorhinolaryngology clinic as part
of antenatal care.
Results: Pregnancy can produce
nasal congestion and require modification
of treatment strategies. Rhinitis and
nasal congestion frequently occur during
pregnancy (30% ) and are related to hormonal
changes . Smoking and allergy (mainly
house dust) are considered the major risk
factors. Nasal saline washings are safe
to relieve nasal congestion. Nasal decongestants
give good temporary relief of the symptoms,
and nasal corticosteroids may be administered
to pregnant women when indicated.
Conclusion: Smoking and allergy
are the major risk factors for rhinitis
in pregnancy and a quality of pregnancy
can be improved by modification of treatment
strategies.
Key words: rhinitis, pregnancy,
allergy.
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Pregnancy rhinitis is a very
common condition(1) , it is defined as nasal
congestion in the last six or more weeks of
pregnancy, without other signs of respiratory
tract infection and with no known allergic cause,
with complete resolution of symptoms within
two weeks after delivery(2). About 30% of women
suffer from nasal symptoms during pregnancy(3).
Pregnant women should be informed about this
cause of nasal congestion, and how to handle
it. Although all kinds of medications should
be avoided during pregnancy, the majority of
pregnant women receive at least one drug and
6 % of them during the high-risk period of the
first trimester(4).
There is no cure known, but symptomatic treatment
may be needed. It is important to remember that
upper airway disease, if uncontrolled , has
a significant adverse effect on quality of pregnancy
and may affect the fetus(5,6).
The pathophysiology of pregnancy rhinitis is
not known but is possibly multifactorial(7).
It appears to result from the increased production
of estrogen(8), because of increased blood flow
to the nasal turbinates along with increased
nasal glandular activity and relaxation of the
nasal vascular smooth muscle (9).
The aim of our present study was to find out
the risk factors of rhinitis during pregnancy
and its management, to improve quality of pregnancy.
The sample of this study was conducted in the
period between March 2008 and April 2009 , in
Prince Zaid Ben Al-Hussein hospital in Al-Tafilah
city, 200 km south of Amman- Jordan.
THhe study sample was two hundred and fifty
primigravida women aged between 19 and 28 years
who were referred to the otorhinolaryngology
clinic as part of ante natal care. All ladies
underwent a detailed history taking and a thorough
general examination, systemic examination and
examination of the ear, nose and throat including
nasendoscopy.
All ladies asked about subjective nasal congestion
upon all visits during and after their pregnancy.
They also asked about the risk factors : smoking
, asthma, house dust, hay fever and month of
conception.
Patients who were diagnosed to have pregnancy
rhinitis were given antenatal care information
about their complaints and advised to do some
physical exercises that had a decongesting effect
on nasal mucosa like raising the head of the
bed 450 when the nose is congested. The patients
were advised to do washing of their nose by
saline solution (5 ml of salt in 0.5 L of water);
there were no restrictions on how often it may
be used.
The patients were also advised to use one of
the pharmacological agents , nasal decongestants,
oral decongestants or nasal corticosteroids.
Pregnancy rhinitis was present in 65 patients
(26%) of all ladies involved in our study.
The irritating effects of smoking was found
to induce nasal congestion, and 83% of the patients
who had rhinitis were smokers.
In pregnant women known to have allergy (house
dust mainly) it was found that 19% of them had
increasing allergic symptoms during their pregnancy
and returned to their normal pre-pregnancy state
after delivery.
No other risk factors were found to have a significant
correlation with rhinitis during pregnancy,
with respect to a hormonal effect.
Women who were informed on their first antenatal
care visit were found to be significantly less
worried about the nasal congestion during their
pregnancy.
The physical exercise measures and the position
of the head had a positive effect on sleep disturbances
caused by nasal congestion and it decreased
risk of snoring in most of the patients.
Nasal saline washings reduce the symptoms of
rhinitis in most of the patients and it gives
temporary relief, reduces the amount of secretions
and removes crusts that impair the nasal airway.
Patients who used nasal decongestants had a
good temporary relief for their symptoms. Some
patients were given oral decongestants (pseudoephedrine);
others were given intranasal corticosteroids
which also has a good effect on relieving the
symptoms.
Rhinitis and nasal congestion frequently
occur during pregnancy. Its incidence is
9-30 %(11,12), and it is related to hormonal
changes that occur during pregnancy(10,11)
. Although estrogen can produce nasal mucosal
edema through a cholinergic action, other
factors may also cause or influence nasal
congestion associated with pregnancy; these
include allergy, infection , stress and
rebound rhinitis(13).
In some studies, smoking had the most risk
factor for increased incidence of rhinitis
in pregnancy(2,14,15) ,whereas hayfever
and asthma had no significant influence
on incidence(14) .
Pregnant patients require careful consideration
in the choice of therapy. Ideally, no medication
should be used, particularly during the
first trimester. If symptoms of rhinitis
interfere with maternal well-being, pharmacologic
management is considered. The patients must
be advised that no drug can be considered
absolutely safe because most drugs cross
the placenta and can be measured in fetal
blood.
In our present study the major risk factors
for rhinitis in pregnancy are smoking and
allergy mainly to house dusts, and that
is concordant with some other studies.
Although the safe pharmacologic agents,
including oral or nasal, can be used in
special indications, we recommend initially
to educate the pregnant women in antenatal
care visits via a physical exercise (head
up position), and to use nasal saline washings
to improve the quality of pregnancy.
These recommendations are mentioned in several
other studies(5,8,15,18).
About 30 % of pregnant women suffer from nasal
symptoms. Smoking and allergy, especially house
dust, are major risk factors for these symptoms.
We can improve quality of pregnancy by antenatal
care information, and education of the pregnant
regarding physical exercises and nasal saline
washings.
In some special cases, nasal decongestants,
nasal corticosteroids and oral decongestants
can be used.
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