Safety of Nasonex Nasal Spray During Pregnancy

Evaluation of Safety

The American College of Allergy, Asthma, and Immunology recommends that modern nasal corticosteroids, including mometasone (Nasonex), are considered safe for use during pregnancy at recommended doses 1, 2, 3
Although most intranasal corticosteroids have an FDA pregnancy category C classification, the gestational risk has not been confirmed in human observational data, with a strength of evidence level of moderate 4
A meta-analysis concluded that the use of intranasal corticosteroids during pregnancy does not increase the risk of major malformations, preterm birth, low birth weight, or pregnancy-induced hypertension, with a high strength of evidence 4

If an intranasal corticosteroid must be initiated during pregnancy, budesonide intranasal (pregnancy category B) may be preferred due to more extensive human safety data, with a moderate strength of evidence 4
However, if there is no substantial difference in efficacy and safety between available intranasal corticosteroids, it would be reasonable to continue any intranasal corticosteroid that adequately controlled the patient's symptoms before pregnancy, with a low strength of evidence 4
As with any medication used during pregnancy, intranasal corticosteroids should be administered at the lowest effective dose, with a high strength of evidence 4

Corticosteroids may cause maternal side effects, including hyperglycemia and potential gestational diabetes, hypertension, and an increased risk of pre-eclampsia with prolonged use, with a moderate strength of evidence 5