Pregnancy Rhinitis and Post-Nasal Drip

By Dr. Kenosha Gleaton, OBGYN

Did you know that a portion of pregnant people will experience congestion, runny nose, or increased mucus production during pregnancy? Let’s take a look at the causes and treatments for rhinitis and phlegm during pregnancy. 

What is pregnancy rhinitis?

Rhinitis, commonly known as a stuffy nose, is often a result of a cold, seasonal allergies, or other infections. Rhinitis of pregnancy is defined as irritation and swelling of the mucous membrane in the nose, with no known allergic cause or other signs of a respiratory tract infection. [1] It’s estimated that anywhere between 20% to 39% of pregnant women experience rhinitis during their pregnancy. [2,6] 

When does pregnancy rhinitis start and how long does it last?

Pregnancy rhinitis can appear at any time during gestation and often disappears within a few weeks after delivery. [1-2] One study found that rhinitis was usually found during the 13th and 21st week of gestation. [2] If rhinitis symptoms are still present weeks after giving birth, there may be an underlying infection or condition that is causing irritation and congestion. 

Rhinitis symptoms during pregnancy

What are the symptoms of pregnancy rhinitis? Symptoms can vary from person to person but the main symptoms are often sneezing, congestion, sinus pressure, runny nose, increased phlegm or mucus in the throat, and cough. [3] Some respiratory infections or the common cold may also have similar symptoms to pregnancy rhinitis, so it’s important to speak to your healthcare provider about your symptoms and their recommended treatments. Learn how prenatal vitamins help with immune defense. 

What symptoms aren’t tied to rhinitis?

It’s important to know what symptoms are to be expected with rhinitis vs symptoms that may indicate something else is going on. Even though rhinitis is characterized by congestion, you should still be able to breathe through your mouth. If you’re having difficulty breathing, you should see a healthcare provider right away. If you’re experiencing a fever, extreme fatigue,  or green or yellow mucus, you may have an infection. [4] Infections should be treated promptly with prescription antibiotics to prevent the worsening of symptoms. 

Is it normal to have itchy or dry eyes during pregnancy?

Having itchy or dry eyes is sometimes associated with rhinitis, but could also be separately occurring as a result of hormone changes, environment, underlying conditions, medications, etc. The rate of dry eyes is higher during pregnancy and is considered normal. [5] There are a few ways to treat dry eyes at home, such as using eye drops, reducing the use of fans, limiting screen time, etc. 

What causes rhinitis and excess mucus during pregnancy?

It’s not clear what the cause of rhinitis is during pregnancy, however, some research points to the increase in different hormones, such as placental growth hormone, estrogen, progesterone, etc. [1-2] Hormonal changes can lead to changes in our glands, nasal mucous membranes, and vasculature (blood vessels). [2] In other words, changing hormone levels can cause increased blood flow and mucus production, which results in rhinitis symptoms. [1-3] 

Treatment for pregnancy rhinitis 

While sometimes uncomfortable, pregnancy rhinitis doesn’t always need to be treated. If you are noticing an impact on your sleep or quality of life, you may want to move forward with finding ways to treat or manage your symptoms. 

Reducing congestion

Congestion can lead to other uncomfortable symptoms or infections. Pregnancy-safe methods for treating and managing congestion include [1,6]:

• Avoid allergy triggers such as chemicals, smoke, or polluted air
• Stay hydrated
• Use a humidifier 
• Elevate your head when lying down
• Use saline nasal spray
• Use nasal alar dilators
• Attempt light exercise, such as walking, biking, yoga, etc.
• You may find relief using nasal decongestants with your healthcare provider's approval. These are sometimes discouraged during the first trimester of pregnancy but may be an option for those experiencing congestion later in pregnancy. [7] 

Treating a cough and sore throat

Outside of congestion, you may experience a runny nose, cough, and potentially a sore throat from increased mucus production. [3] You may find relief from these symptoms by drinking tea, using cough drops, using a humidifier, etc. If you are unable to find relief with at-home remedies or are interested in what medications are safe for use while pregnant, speak to your healthcare provider about your options. 

Why do I have so much phlegm during pregnancy?

Phlegm or mucus production is likely tied to pregnancy rhinitis, or in some cases, other infections or conditions. Increased hormone levels may be causing your body to produce more mucus. [1-3] The color of your mucus may be able to provide more insight into your health. If your mucus is very yellow or green, that may be a sign of an infection. If you’re noticing more clear mucus, the cause of your phlegm may just be harmless overproduction. 

Tips for reducing mucus

Mucus plays an important role in the body by keeping the body hydrated and protected against unknown pathogens. When you have too much mucus buildup, it can cause difficulty breathing, headaches, sore throat, and more. Here are a few ways to reduce phlegm during pregnancy [8]:

• Use a humidifier: Dry air may worsen the irritation and lead to more mucus production
• Stay hydrated: Drink a lot of fluids to help thin out mucus
• Elevate your head: Lying flat may increase discomfort and cause mucus to collect at the back of the throat
• Gargle: Saltwater may help clear out some of your mucus and may soothe an irritated throat

Managing nausea caused by increased mucus production

One uncomfortable symptom associated with rhinitis is increased mucus production. Some people report that having excess phlegm causes or worsens feelings of nausea. Fortunately, there are ways to manage or reduce nausea, such as peppermint oil, ginger, vitamin B6, and other medications. [9-10] In some instances, your healthcare provider may recommend other prescription or over-the-counter medications. 

Is it normal to throw up phlegm during pregnancy?

Depending on when you’re experiencing rhinitis, you may also be fighting off morning sickness. It is normal to see some mucus in your vomit, especially if you’re experiencing an increase in mucus production. You should speak to a healthcare provider if you notice an increase in your vomiting, blood in your vomit, or if you’re unable to keep any foods down. Here’s what you need to know about severe morning sickness. 

Key takeaways

• Around 20% to 39% of pregnant people experience rhinitis.
• Rhinitis is defined as irritation and swelling of the mucous membrane in the nose, with no known allergic cause or other signs of a respiratory tract infection. 
• Symptoms can vary from person to person but the main symptoms are often sneezing, congestion, sinus pressure, runny nose, increased phlegm or mucus in the throat, and cough. 
• If you’re experiencing difficulty breathing through the mouth and nose, a fever, extreme fatigue, or green or yellow mucus, you should speak to a healthcare provider.
• Increased levels of hormones during pregnancy are thought to cause the increase in mucus production and congestion.
• Treating rhinitis can be done by managing symptoms. Using a humidifier, drinking plenty of fluids, nasal spray or dilators, and more are all great options for reducing congestion and improving symptoms. 
• Phlegm may worsen or cause nausea and vomiting. 
• Managing nausea can be done through nausea relief products such as ginger, vitamin b6, and peppermint. 

References:

1. Ellegård EK. The etiology and management of pregnancy rhinitis. Am J Respir Med. 2003;2(6):469-475. doi:10.1007/BF03256674
2. Dzieciolowska-Baran E, Teul-Swiniarska I, Gawlikowska-Sroka A, Poziomkowska-Gesicka I, Zietek Z. Rhinitis as a cause of respiratory disorders during pregnancy. Adv Exp Med Biol. 2013;755:213-220. doi:10.1007/978-94-007-4546-9_27
3. Nonallergic rhinitis. Mayo Clinic. March 14 2023. URL. Accessed May 2023. 
4. Laibl V, Sheffield J. The management of respiratory infections during pregnancy. Immunol Allergy Clin North Am. 2006;26(1):155-viii. doi:10.1016/j.iac.2005.11.003
5. Stoddard, J, Villines, Z. What to know about dry eyes during pregnancy. Medical News Today. June 30 2021. URL. Accessed May 2023. 
6. Pray, S. Pray, G. Self-Care of Rhinitis During Pregnancy. US Pharm. 2014;39(9):16-23. September 17 2014. 
7. Yau WP, Mitchell AA, Lin KJ, Werler MM, Hernández-Díaz S. Use of decongestants during pregnancy and the risk of birth defects. Am J Epidemiol. 2013;178(2):198-208. doi:10.1093/aje/kws427
8. Berry, J. Sampson, S. 19 home remedies for phlegm and mucus. Medical News Today. December 8 2022. URL. Accessed May 2023. 
9. Chittumma P, Kaewkiattikun K, Wiriyasiriwach B. Comparison of the effectiveness of ginger and vitamin B6 for treatment of nausea and vomiting in early pregnancy: a randomized double-blind controlled trial. J Med Assoc Thai. 2007;90(1):15-20.
10. Efe Ertürk N, Taşcı S. The Effects of Peppermint Oil on Nausea, Vomiting and Retching in Cancer Patients Undergoing Chemotherapy: An Open Label Quasi-Randomized Controlled Pilot Study. Complement Ther Med. 2021;56:102587. doi:10.1016/j.ctim.2020.102587