Sinusitis During Pregnancy

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What is Sinusitis?

Sinusitis is inflammation of the nasal cavity and sinuses (spaces within the skull bones). Also known as rhinosinusitis, the condition usually results from infection of one or more sinuses. Acute sinusitis is sinusitis with intense symptoms that develop rapidly, over hours to days. In contrast, chronic sinusitis, meaning ongoing, with symptoms being mild to moderate and waxing and waning over a long period. Infections causing sinusitis can be viral (caused by virus such as the type of virus that causes the common cold) or bacterial (caused by a bacterial species).

Particularly if sinusitis is bacterial, it can cause problems during pregnancy. Along with very bad headaches, sinusitis causes dripping in the back of your throat (called post nasal drip). This can result in frequent, small coughs that can interfere with sleep. Acute bacterial sinusitis furthermore causes high fever, which can lead to dehydration and further discomfort. High fever during pregnancy increases the risk of birth defects of internal organs, such as the heart. Some research has suggested that fever in a mother during the first trimester increases the risk of some birth defects and possibly of developing autism spectrum disorder.

How Common is Sinusitis During Pregnancy?

About 20 to 40 percent of women of child bearing age experience symptoms sinusitis, resulting from rhinitis, the common cold. Furthermore, 10 to 30 percent of pregnant women with colds develop acute sinusitis while still pregnant, whereas other others can develop chronic sinusitis during pregnancy. Additionally, changes in hormone levels can worsen sinusitis during pregnancy, or trigger a non-infectious kind of sinusitis.

What are the Symptoms of Sinusitis?

Sinusitis is usually a clinical diagnosis, which means that it is diagnosed based on your history of symptoms plus findings on the physical examination. During that exam, the examiner looks for symptoms such as runny nosed or stuffed nose, eyes that are red or irritated, as well as sneezing. Fever and headaches are very common too. Pain of sinusitis usually gets worse when you lean forward. In fact, checking how leaning forward affects you is part of the physical exam. Also during the exam, the examiner typically shines a light on the sinuses to assess the penetration of the light through them. Other tests include blood tests plus imaging, particularly computed tomography (CT).

Treatment of Sinusitis

In the case of viral sinusitis, treatment consists only of cold medications, such as decongestant pills and fever medication. Medication for fever includes acetaminophen in the United States and paracetamol in other parts of the world. Non-steroidal anti-inflammatory drugs (NSAIDs) include ibuprofen and naproxen. NSAIDs, and a related group of drugs called salicylates (including aspirin), are effective both against the fever and inflammation of sinusitis, but they may be harmful to an embryo or fetus, especially late in pregnancy. However, paracetamol and acetaminophen are thought to be safe. Other medications that you may be given include antihistamines and steroids.  Steroids are taken through the nose as a spray and are particularly useful in the case of chronic sinusitis. If cases of bacterial sinusitis during pregnancy, you may need to take antibiotics. These drugs can include penicillin and also non-penicillin medications, such as azithromycin or clarithromycin. Amoxicillin, clindamycin, and several other antibiotics are considered to be safe during pregnancy.

Certain antibiotics and other medications can enter breast milk in quantities large enough to affect a nursing infant, but other drugs are considered safe during breastfeeding. Acetaminophen, paracetamol, NSAIDs, certain antibiotics, and steroids are thought to be breastfeeding safe.

In some cases, sinusitis treatment may include surgical procedures, such as removal of nasal polyps can be helpful. In most cases, these operations can be delayed until after pregnancy

David Warmflash
Dr. David Warmflash is a science communicator and physician with a research background in astrobiology and space medicine. He has completed research fellowships at NASA Johnson Space Center, the University of Pennsylvania, and Brandeis University. Since 2002, he has been collaborating with The Planetary Society on experiments helping us to understand the effects of deep space radiation on life forms, and since 2011 has worked nearly full time in medical writing and science journalism. His focus area includes the emergence of new biotechnologies and their impact on biomedicine, public health, and society.

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