PREGNANCY

. Posted in SPECIAL PATIENTS

As any pregnant woman can tell you, along with the complicated change in her hormones comes body swelling. The changes in a woman’s body during pregnancy are designed to ensure the fetus adequate nutrition through the placenta and to protect the mother from trauma and blood loss at the time of delivery. Not only does a woman’s body swell on the outside, but her nose and sinus membranes swell inside as well.

Endocrine and hormonal changes can also cause CAID symptoms. Most pregnant women experience hormonal changes, especially in the second and third trimesters, that may lead to nasal congestion. This is often very uncomfortable and occasionally leads to a sinus infection. The good news is that the swelling typically goes away within 1 week of giving birth. Aside from the usual symptoms of sinus disease, rhinitis (congestion) of pregnancy can cause sleep difficulty, including apnea in which oxygen saturation can drop and ultimately lower oxygen available to the fetus.

The management of CAID symptoms during pregnancy is controversial. Avoidance measures should be used first, especially if you already know that you have specific allergies or are sensitive to particular irritants. There are currently no CAID medicines that are considered absolutely safe during pregnancy, as most will cross the placenta. However, for severe cases, the following guidelines can be used under the supervision of a doctor’s care:

■ Decongestants can be used, although an overdose may interfere with the blood flow to the fetus.

■ Nasal steroid sprays appear to be safe to use during pregnancy.

■ Various medicines, including loratadine, cetirizine, budesonide, montelukast, nedocromil, lodoxamide, ipratropium, and cromolyn are in the U. S. Food and Drug Administration’s Pregnancy Category B, which is defined as drugs that have not been shown to pose a risk to the fetus in studies in animals but that have not been adequately tested in pregnant women.

■ It is not advised that pregnant women take any OTC remedies without physician guidance.

■ Maintenance immunotherapy (allergy shots) may be safely continued during pregnancy if needed. Although immunotherapy is not known to harm the fetus, it is not a good idea to start such therapy during pregnancy. Immunotherapy doses are not increased and are often reduced until the postpartum period.

■ Irrigation with nasal saline sprays, a neti pot, or a nasal irrigator is safe and effective to use during pregnancy.

Nursing mothers also need to pay particular attention to their sinuses. Treatment options are just as limited for nursing mothers as they are for pregnant women because some medicines will cross over from the mother’s system and appear in the breast milk, which can have an adverse effect on the baby. Discuss any medicines that you take with your team of physicians, including your obstetrician-gynecologist (OB - GYN), pediatrician, and otolaryngologist. Together they should decide what you can take to treat your sinus disease.

I have had many patients who elected to have sinus surgery after their first pregnancy, because they did not want to suffer from recurring sinus infections in subsequent pregnancies. These are usually women who were treated for sinus problems before their first pregnancy and for whom surgery was recommended because medical therapy did not work. After surgery, and during their second pregnancy, most comment that they are glad that they went through with the surgery, because they did not experience the sinus discomfort that they experienced prior to surgery.

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