Asthma Medication Safety During Pregnancy

Thoughtful pregnant woman looking out the window

One of biggest mistakes that women with asthma make is to stop using their asthma medications once they find out they’re pregnant. While medications can certainly pose risks to the fetus, the risks of untreated asthma usually far outweigh the small risk of fetal malformations from most asthma medications. Another common mistake for pregnant asthmatics is to stop seeing their regular asthma doctors once they’re pregnant.

According to the Food and Drug Administration (FDA), there are no asthma medications that are considered completely safe in pregnancy. This is because no pregnant woman would want to sign-up for a medication safety study while she is pregnant. Therefore, the FDA has assigned risk categories to medications based on use in pregnancy.

Pregnancy Medication Categories

  • Category A medications are medications in which there are good studies in pregnant women showing the safety of the medication to the baby in the first trimester. There are very few medications in this category and no asthma medications.
  • Category B medications show good safety studies in pregnant animals but there are no human studies available.
  • Category C medications may result in adverse effects on the fetus when studied in pregnant animals, but the benefits of these drugs may out weight the potential risks in humans.
  • Category D medications show clear risk to the fetus, but there may be instances in which the benefits outweigh the risks in humans.
  • Category X medications show clear evidence of birth defects in animals and/or human studies and should not be used in pregnancy.

The FDA has now begun to shift away from this categorization to now include information about available human and animal studies, any known fetal or maternal risks, benefit and risk considerations, and any dose adjustments during pregnancy or the postpartum period.

Asthma Medications Breakdown

Rescue medications, used for the immediate relief of asthma symptoms, include inhaled bronchodilators such as albuterol. While this medication is category “C”, our experience with using these drugs in pregnant women is enormous and shows no evidence of adverse effects on the fetus.

Controller medications for persistent asthma include inhaled steroids, which are the preferred method to control the underlying inflammation of asthma. Other medications in this group include Advair (fluticasone/salmeterol), theophylline, cromolyn, and Singulair (montelukast).

The preferred inhaled steroids include Pulmicort (budesonide), the only category “B” inhaled steroid, and QVAR (beclomethasone), since this inhaled steroid has been around for so long, and experience with it is positive. However, it is reasonable to continue other types of inhaled steroids during pregnancy if the mother was well-controlled with using that medication prior to becoming pregnant.

A combination product such as Advair or Symbicort may be required in patients with more severe asthma. These medications combine inhaled steroids with a long-acting beta-agonist (albuterol-like medication) and is used as a controller therapy. Patients still require albuterol for “as needed” or rescue use.

Other controller medications such as theophylline (category “C”) and cromolyn, nedrocromil, and Singulair (all category “B”) are reasonable to continue during pregnancy if the mother has had good benefit from the medications prior to pregnancy. However, none of these medications would be considered a “first choice” to start during pregnancy.

Xolair (omalizumab), is an injectable medication used for the treatment of asthma as a controller therapy. It does have a category “B” status, although since this medication has only been available for a few years, it should be used with caution in pregnant asthmatics.

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