Asthma and Pregnancy

Most of the drugs that are taken by women during their pregnancy unfortunately have inadequate human data available to support decisions and alleviate or confirm concerns about the exact effects they may or may not have on pregnancy and the child.

Clinical decision-making regarding drug safety in pregnancy is a challenge at best and medications that are used for the treatment of asthma, rhinitis and similar conditions are not exceptions. Because asthma is one of the most common and potentially serious chronic diseases in women of reproductive age (occurring in 3.7% to 8.4% of all pregnancies) and allergy occurs in greater than 20% of women of child bearing age, the clinician frequently is required to interpret available data in the context of almost universal lack of comprehensive safety information on the medications that are used to treat these conditions- A world wide saga if you may.

So far the published studies of pregnancy outcome in asthmatic women who were treated with a variety of medications have produced inconsistent results. Increased risks for birth defects was noted overall, specifically; cleft lips and palates, spontaneous abortion or stillbirth, preterm delivery, preeclampsia, low birth weight, neonatal hypoxia, need for caesarean section, and haemorrhage .

Here we discuss some drugs of frequent concern, the first of which is theophylline; one of the older and more classic drugs yet no increased risks for congenital anomalies, low birth weight, preterm delivery, or preeclampsia were noted among theophylline-exposed women compared with asthmatics who did not use the drug (schatz M J Allergy Clin Immunol 2004).

The second group of anti- asthma medications are the short acting beta agonist drugs such as albuterol or terbutaline …etc. Many studies have shown no increased risk for major birth defects among b2 agonists users compared to those who did not use them and thus they are mostly given the O.K during pregnancy.

The next set of medications are the longer acting beta agonists like salmetrol, where Bracken and colleagues reported no increased risk for preterm delivery in pregnancies exposed to long-acting bronchodilators and no increased risk for low birth weight compared with unexposed asthmatic and non asthmatic women combined, many studies confirmed similar results.

Oral corticosteroids however, and in contrast to the generally reassuring data about older asthma medications, have raised some concerns. Schatz and colleagues showed that women who were exposed to oral, but not inhaled, steroids, had higher rates of pregnancy complications such as preeclampsia. Preterm delivery was significantly higher and so was the prevalence of low birth weight.

Four large case-control studies have also implicated oral steroids with respect to risk for a specific major birth defect – cleft lips and palates (Teratology 1998). This is not to say immediate discontinuation of the medication is mandatory but a discussion of pros, cons and alternatives would not hurt.

Last but not least is the use of inhaled steroids which studies have shown no increased risks for major congenital anomalies overall.

This information is helpful to women who struggle with asthma and are considering getting pregnant or are currently pregnant but are unsure of the effects specific asthma control medications have on the unborn child. Make sure you discuss everything with your attending physician before making any radical decisions.