What is known about treatment with cortisone nasal spray during pregnancy? Are any of the cortisone

Fråga: What is known about treatment with cortisone nasal spray during pregnancy? Are any of the cortisone nasal sprays better documented than the others? The question concerns a woman pregnant in week 22 with nasal congestion probably due to her pregnancy.

Sammanfattning: Nasal congestion during pregnancy is a common problem. Washing with sodium chloride solution is recommended. Nasal decongestants can be used temporarily. Nasal steroids have no documented effect for pregnancy nasal congestion. There should be no risks for teratogenicity of nasal corticosteroid treatment at week 22. There is more clinical experience of budesonide treatment compared to the other approved nasal corticosteroids during pregnancy.

Svar: There are four previous Drugline documents concerning nasal glucocorticosteroid treatment during pregnancy from 1995-1999 (1,2,3,4). None of the documents concerns treatment of non-allergic nasal congestion.

About one fifth of all pregnant women get a long-term nasal congestion, which they are relieved from after delivery (5). It is important to exclude sinuitis and to avoid long-term use of decongestant nasal sprays since long-term use of decongestant nasal sprays is associated with rhinitis medicamentosa. Washing with sodium chloride solution or use of nose wing dilator/external nasal dilator may be useful. Nasal steroids have no documented effect for pregnancy nasal congestion (5,6). Few studies have been performed to investigate the use of nasal steroids for pregnancy rhinitis. In an 8-week placebo-controlled treatment study using fluticasone in 53 pregnant women neither the daily symptom scores, nasal peak expiratory flow, nor acoustic rhinometry showed any difference between the groups (7).

In the Medical Birth Registry, 2394 women were reported to have used nasal budesonide during pregnancy, 424 women fluticasone, 137 women momethasone, 130 women beclomethasone and 16 women triamcinolone (8). The reported number of malformations in relation to nasal administration of these substances was at a slightly higher frequency (4%) as that of untreated women (3.6%). Heart malformations were reported in a higher number than expected among treated women compared with untreated women. The reports in the Medical Birth Register concerns mainly effects of drug usage early in pregnancy and is therefore not of relevance in this case. However, in accordance with the above, more clinical experience during pregnancy exists for budesonide treatment compared to the other registered nasal corticosteroids. In one review article, intranasal beclomethasone tapered to its lowest dose was the recommended treatment (9). However, it was also stated that there is no published efficacy data for its use.

The possibility of adrenocorticol insufficiency in the neonates of long-term corticosteroid treated women cannot be totally excluded, but the event is unlikely (10, 11) according to a recent Drugline answer regarding peroral budesonide treatment (12).