Nasal Corticosteroid Use During Pregnancy

Introduction to Safety and Efficacy

The American College of Allergy, Asthma, and Immunology recommends that patients who are already using Nasonex before pregnancy can continue their current regimen if it has been effectively controlling their symptoms, as there is no substantial difference in efficacy and safety among available intranasal corticosteroids 3, 4, 5
The American College of Allergy, Asthma, and Immunology suggests that intranasal budesonide is the preferred first choice when initiating nasal corticosteroid therapy during pregnancy, due to its FDA Pregnancy Category B classification based on extensive human safety data 3, 4, 5

The American Academy of Allergy, Asthma, and Immunology states that mometasone is explicitly listed as safe by expert panels at recommended doses alongside budesonide and fluticasone 1, 2
A meta-analysis found no increased risk of major malformations, preterm delivery, low birth weight, or pregnancy-induced hypertension with intranasal corticosteroid use during pregnancy, according to the Journal of Allergy and Clinical Immunology 3, 4, 5

The American College of Allergy, Asthma, and Immunology recommends administering intranasal corticosteroids at the lowest effective dose that controls maternal symptoms adequately 3, 4, 5
The American College of Obstetricians and Gynecologists advises consulting with the patient's obstetrician when initiating or continuing therapy, particularly for complex cases 1, 2

The American Academy of Allergy, Asthma, and Immunology notes that mometasone has less accumulated safety data compared to beclomethasone, budesonide, and fluticasone propionate, though available data remain reassuring 3, 4, 5
The American College of Allergy, Asthma, and Immunology warns against discontinuing effective therapy unnecessarily, as untreated rhinitis can significantly impact maternal quality of life and potentially worsen comorbid conditions like asthma 3
The American Rhinologic Society advises against confusing intranasal with oral corticosteroids, as oral corticosteroids carry different and more significant risks, especially in the first trimester 1, 2