Using Medication for Asthma While Pregnant

Asthma is a very common medical condition. In fact, about 4 to 8% of people who are pregnant can experience asthma symptoms during pregnancy.

People who have asthma usually need to take asthma medications to maintain good control of the condition during pregnancy. You might need some medication adjustments as your body changes throughout your pregnancy—your medication needs may change and some asthma treatments are not considered safe during pregnancy.

Asthma Control During Pregnancy

Some people experience an overall improvement of asthma symptoms during pregnancy, some have stable symptoms, and some experience worsening symptoms.

• Often, asthma is less severe throughout the course of pregnancy, usually with diminished symptoms during the last weeks of pregnancy.
• Worsening symptoms are most common between 29 and 36 weeks of pregnancy.
• Asthma attacks can be more common during the second and third trimesters.
• Significant asthma symptoms are uncommon during labor and delivery.

Your asthma course during pregnancy is likely to repeat itself over subsequent pregnancies. If your asthma improved or worsened during certain stages of your previous pregnancy, it tends to follow the same course with future pregnancies.

In general, your asthma severity before becoming pregnant is related to your asthma severity during pregnancy.

The Impact of Asthma on Pregnancy

The more severe your asthma, the more likely you are to have asthma complications. Respiratory distress and diminished oxygen levels in the mother can lead to reduced blood flow to the placenta and oxygen deprivation for the baby.

Poorly controlled asthma during pregnancy or asthma medications can lead to all of the following complications:

• Preterm delivery
• Low birth weight
• Complicated labor
• Preeclampsia
• Miscarriage
• Bleeding before and after delivery
• Blood clots or pulmonary embolism
• Congenital malformations

None of these risks should be taken to mean that those with asthma should not get pregnant. Good treatment and symptom control will minimize the risk of these complications.

Asthma Treatment in Pregnancy

Your asthma treatment in pregnancy is not all that different than your treatment in the non-pregnant state.

You need to:

• Attempt to avoid your asthma triggers, which can include irritants such as dust, dander, and dust mites
• Quit smoking if you smoke
• Regularly monitor your asthma symptoms
• Have an asthma action plan

One of the things that makes monitoring a little more difficult in pregnancy is the shortness of breath that is especially common in the late stages of pregnancy. However, coughing and wheezing are never normal symptoms of pregnancy and could be a sign of poor asthma control.

Monitoring asthma with peak flows or FEV1 may be helpful during pregnancy. Talk to your doctor about whether you should monitor yourself at home, how often, and when to get medical attention for changing results. A change may suggest that you are at risk of having an asthma exacerbation.

Medications During Pregnancy

In general, the benefits of maintaining good asthma control and preventing exacerbations outweigh the risks of most regularly used medications for the treatment of asthma.

Albuterol, beclomethasone, and budesonide have all been studied in pregnancy, and the outcomes have been reassuring. Prednisone can be beneficial for asthma control during pregnancy, and the risks and benefits in your specific situation need to be considered.

SABAs

Short-acting beta-agonists provide quick relief for asthma symptoms such as:

• Wheezing
• Chest tightness
• Cough
• Shortness of breath

While extremely high doses of SABAs have shown teratogenic (fetal harm) effects in animals, there is no data clearly demonstrating these effects in humans.

SABAs are sometimes used to prevent premature labor. Rather than inhaled, these drugs are given through an IV. The most common side effect seen with this route of administration is hyperglycemia (elevated blood sugar). When infants are born, they sometimes have elevated heart rates, tremors, and low blood sugar as a result of maternal SABA treatment. All of these side effects in the newborn are treatable and usually reverse fairly quickly.

LABAs

Salmeterol and formoterol, commonly used long-acting beta-agonists (LABAs), have not been shown to increase the risk of congenital anomalies.

As a result, it is reasonable in pregnancy to continue a LABA that was needed for asthma control in the pre-pregnant state. The risk of congenital malformations with a lower-dose combination of LABA and inhaled steroids appears to be similar to a medium- or high-dose steroid alone.

Epinephrine

Because of the risk of decreased blood flow to the placenta, the Working Group on Pregnancy and Asthma recommends that epinephrine only be used in the setting of anaphylaxis (severe allergic reaction).

Oral Steroids

Oral steroids are commonly used in pregnancy for a variety of conditions other than asthma. Hypertension and elevated glucose levels are the most common complications.

Less common, and severe risks of steroids include:

• Pregnancy-induced hypertension
• Gestational diabetes
• Low birth weight
• Increased risk of prematurity
• Neonatal adrenal insufficiency
• Congenital malformations (mostly cleft palate)

Inhaled Steroids

A registry study of the inhaled steroid budesonide in Swedish women showed no increased risk of malformations compared to the general population. The study also showed no complications related to fetal growth, mortality, or prematurity.

In another database-like study, fluticasone showed no increases in congenital malformations compared to other inhaled steroids. Two randomized controlled trials demonstrated improved lung function and decreased rates of readmission.

Leukotriene Modifiers

This class of drug, which includes Singulair (montelukast) is not commonly used during pregancy.

Anti-immunoglobulin E

Monoclonal anti-immunoglobulin E antibody or Xolair (omalizumab) is approved for patients with poorly controlled asthma with elevated levels of IgE despite the use of inhaled steroids.

There is not currently enough data to make a recommendation for its use in pregnancy.

Methylxanthines

There is extensive clinical experience with theophylline and aminophylline in pregnancy. While these drugs are clinically safe, their metabolism is changed significantly in pregnancy and levels must be monitored. The therapeutic range is very small, which makes dose adjustments difficult. during pregnancy

Immunotherapy

While it is not recommended that people start immunotherapy during pregnancy, it does not appear these treatments create additional risk to the mother or fetus, so they can be continued during pregnancy.

A Word From Verywell

According to the recommendations from the American College of Asthma, Allergy, and Immunology, inhaled asthma medications are safer than other forms of treatment during pregnancy. If possible, it is best to try to avoid asthma medication during the first trimester. However, asthma treatments are generally safe during pregnancy, so getting adequate treatment to avoid an asthma attack is an important priority during pregnancy.