Asthma Medications and Pregnancy
Inhaled corticosteroids use for asthma during pregnancy does not pose significant risk
Asthma has the potential to cause serious medical problems in pregnant women. Four to 7 percent of pregnant women take asthma medications. These women with asthma are advised to continue taking their asthma medication during pregnancy to maintain their healthy breathing that is vital for the developing baby, and the most recent National Asthma Education and Prevention Program guidelines recommend inhaled corticosteroids (ICS like Flovent, Pulmicort, Alvesco, Qvar, and Asmanex) for treating all levels of asthma severity in pregnant women. However, the safety of ICS use in pregnant women has not been confirmed. This can raise serious fears for asthmatic pregnant women and their medical caregivers who question what is the safe thing to do.
Breton and colleagues address this question as they evaluate whether pregnant women with asthma who are exposed to ICS during pregnancy are more at risk for perinatal mortality (infant death in the weeks just before and after birth.) The authors studied 13,004 pregnancies in Canadian women with asthma, 40% of whom took ICS in varying doses during their pregnancies. The researchers also looked at such factors as the womenâ€™s smoking habits and history of previous stillbirths to identify other effects on infant survival. The authors ultimately found no significant increased risk of perinatal mortality among pregnant women with asthma who used ICS during pregnancy. Women taking less than 250 ug ICS per day did not have a significant risk for the death of their fetus or newborn.
Although the study results associated with higher daily doses of ICS did show a higher risk than the lower doses, this was not considered significant due to the complexities related to controlling severe asthma and because there was not an adequate amount of data in this study to draw a firm conclusion. The authors recommend keeping pregnant women with asthma on the minimum effective dose of ICS to obtain optimal control of their asthma, but if higher doses are needed, the benefits of ICS outweigh the risks.
Marie-Claude Breton, MSc, Marie-France Beauchesne, PharmD, Catherine LemiÃ¨re, MD, Ãˆvelyne Rey, MD, MSc, AmÃ©lie Forget, MSc, Lucie Blais, PhD