Nasal Steroids and Pregnancy: What You Need to Know

When you're pregnant and dealing with chronic allergies or sinus congestion, nasal steroids, prescription sprays that reduce inflammation in the nasal passages. Also known as intranasal corticosteroids, they're one of the most common treatments for year-round allergies. But the big question is: are they safe during pregnancy? You’re not alone in wondering this. Millions of pregnant people use them every year, and the data is clearer than you might think.

Not all nasal sprays are the same. budesonide, a specific type of nasal steroid used in brands like Rhinocort, has the most research backing its safety in pregnancy. Studies tracking thousands of pregnancies show no increased risk of birth defects or complications when budesonide is used as directed. Other sprays like fluticasone (Flonase) and mometasone (Nasonex) are also considered low-risk, but budesonide is the one most often recommended by OB-GYNs and allergists. That’s because it’s poorly absorbed into the bloodstream—most of it stays right where it’s sprayed, in your nose.

What about side effects? The biggest concern isn’t harm to the baby—it’s whether the spray even works well enough to help you breathe. If your congestion is bad, you’re not sleeping, and you’re constantly stressed, that’s worse for your pregnancy than the spray. Untreated allergies can lead to poor sleep, high blood pressure, and even preterm labor in rare cases. So the real trade-off isn’t drug vs. no drug—it’s better control vs. suffering. Many doctors will suggest trying saline rinses or antihistamines first, but if those don’t cut it, nasal steroids are the next logical step.

There’s a reason why organizations like the American College of Obstetricians and Gynecologists (ACOG) and the MotherToBaby service say these sprays are safe: they’ve looked at the data. It’s not guesswork. You’re not taking a pill that goes straight into your blood and crosses the placenta. You’re using a spray that delivers a tiny dose—less than 1% of it even gets into your system. That’s why you won’t find warnings like "avoid during pregnancy" on the labels of budesonide or fluticasone. You’ll find "use only if clearly needed," which just means: don’t use it if you don’t need it.

What you should avoid are oral steroids like prednisone, especially long-term. Those do enter your bloodstream and carry more risk. But nasal sprays? They’re in a different category. If you’ve been using one before pregnancy, don’t stop cold turkey. Talk to your doctor about switching to budesonide if you’re not already on it. If you’re new to treatment, ask about starting with the lowest effective dose. Most people need just one spray per nostril once a day.

And here’s something most people don’t know: pregnancy can make allergies worse. Hormones change how your immune system reacts. That runny nose you thought was a cold? It might be pregnancy rhinitis—a common, harmless condition that mimics allergies. Nasal steroids can help with that too. They’re not just for hay fever.

What you’ll find in the posts below are real, evidence-based answers about how nasal steroids interact with other meds, what alternatives exist, and how to use them safely without overdoing it. You’ll see how they compare to other treatments, what studies actually say about birth outcomes, and how to talk to your doctor without feeling dismissed. This isn’t speculation. It’s what people who’ve been there and studied the data have found.