Department: ask an expert
Q: My patient has had persistent asthma since childhood. She's now pregnant and asking what effect her asthma medication may have on her unborn fetus. Is it safe for her to continue to use her prescribed inhalers?
A: Inhaled medications are the mainstay of asthma treatment. When a patient with persistent asthma is pregnant, she may worry that inhaled corticosteroids could cause damage to her unborn child. The risk versus benefits of medications during pregnancy is an important topic that needs to be individualized. Ideally, the patient and her healthcare provider should discuss how she can best manage and control her asthma before becoming pregnant. After becoming pregnant, the woman with severe persistent asthma should be monitored carefully.
Evidence suggests that infants born to mothers with poor asthma control have a higher incidence of premature birth and low birth weight. Poorly controlled asthma can also lead to perinatal mortality. Research shows that it's important to avoid asthma symptoms and exacerbations because they can be harmful not only to the mother, but also to her unborn child. Providing a safe intrauterine environment with adequate oxygenation for the fetus is the primary goal for asthma treatment during pregnancy.
Pregnant women should be encouraged to learn self-management techniques with the help of an asthma action plan. During pregnancy, the inhaled corticosteroid budesonide has been the most widely used medication in the controller class and albuterol in the rescue drug category. Less data are available on long-acting beta2-agonists and leukotriene modifiers.
The American College of Obstetrics and Gynecology supports good asthma control during pregnancy, recommending a preference for medications with a longer clinical history of safety during pregnancy and those administered by inhalation.
Learn more about it
Dombrowski MP, Schatz M. Asthma in pregnancy. Clin Obstet Gynecol. 2010;53(2):301–310.
Lim A, Stewart K, Konig K, George J. Systematic review of the safety of regular preventive asthma medications during pregnancy. Ann Pharmacother. 2011;45(7–8):931–945.
Rocklin RE. Asthma, asthma medications and their effects on maternal/fetal outcomes during pregnancy. Reprod Toxicol. 2011;3(2):189–197.