Pregnancy-Recognized Obstructive Sleep Apnea and Maternal–Fetal Outcomes: A Narrative Review of Gestational Rhinitis, Upper-Airway Mechanisms, and Treatment Evidence

Background/Objectives: Pregnancy-recognized obstructive sleep apnea (POSA) is an operational construct, not a validated biological phenotype, and remains underrecognized in prenatal care. This review synthesizes evidence on POSA-related outcomes, evaluates gestational rhinitis as a candidate contributor to upper-airway vulnerability, and distinguishes pregnancy safety from demonstrated efficacy for OSA-related endpoints. Methods: This structured narrative review, informed by SANRA criteria, used a structured PubMed search (7 March 2026) with targeted supplementary searches through 9 October 2026, across six predefined domains. Results: Pregnancy-recognized OSA is associated in observational studies with hypertensive disorders, preterm birth, impaired fetal growth (in small pregnancy-specific studies), and severe maternal morbidity; residual confounding by obesity precludes causal inference. In a 2024 meta-analysis of randomized and observational studies (n = 809), continuous positive airway pressure (CPAP) was associated with lower risks of gestational hypertension (RR, 0.65; 95% CI, 0.47–0.89) and preeclampsia (RR, 0.70; 95% CI, 0.50–0.98). Although secondary endpoints in individual trials suggested benefit, the pooled preeclampsia effect was fragile in sensitivity and subgroup analyses. Gestational rhinitis affects approximately one in five pregnant women and is a plausible but untested contributor to pregnancy-recognized OSA. Saline irrigation, budesonide (mainly inhaled-exposure data), and chlorpheniramine have gestational safety data, but the only randomized trial of an intranasal corticosteroid in gestational rhinitis was null, and we identified no study of OSA endpoints. Conclusions: Given the largely observational evidence, objective testing and individualized treatment may be considered in high-risk patients, pending adequately powered trials. CPAP is the standard treatment for objectively confirmed OSA.