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Steroid Inhaler : Safety In Pregnancy

Asthma is the most frequent chronic respiratory disease affecting pregnancy, occurring in approximately 4 – 8% of pregnant women. Poor control of chronic asthma and exacerbation of acute asthma during pregnancy can result in adverse maternal and fetal outcomes. Long-term use of inhaled steroids has been shown to decrease the risk of severe exacerbations and improve asthma control in asthmatic patient. Inhaled steroids have also been shown to reduce risk of hospitalization due to asthma during pregnancy.

What medication is safe to be taken during pregnancy?

The U.S. Food and Drug Administration (FDA) have classified all medications into categories based on their safety for the mother and baby. Medicine is rated A, B, C, D and X, where A is the safest and X is not safe.

According to FDA, no asthma drugs 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.

All medicines approved since 1980 are classified in one of these categories, and here are the categories relating to asthma medicines.

  • Category AThese are the medicines for which adequate, well-controlled studies in pregnant women have not shown an increased risk of fetal abnormalities. No medicines used to treat asthma fall into this category.
  • Category BCategory B indicates animal studies have revealed no evidence of harm to the baby, however, there are no adequate and well-controlled studies in pregnant women. Some asthma medications fall in this category, and category B asthma drugs are generally considered safe for both mother and child.
  • Category CCategory C is one in which animal studies have shown an adverse effect and there are no adequate and well-controlled studies in pregnant women. Most of the medicine used to treat asthma fall into this category, and are generally considered safe for both mother and child.
  • Category DCategory D medications show clear risk to the fetus, but there may be instances in which the benefits outweigh the risks in humans.
  • Category X 

    Category X medications show clear evidence of birth defects in animals and/or human studies and should not be used in pregnancy.

How to make decisions about medication during pregnancy?

Safety of asthma medications during pregnancy is a determination of risks and benefits to be made by a physician. In general, treatment of asthma during pregnancy is not different from guidelines for asthma in non-pregnancy.

Asthma is a disease in which intensity of symptoms can vary from day to day regardless of pregnancy. Therefore, a treatment plan should be chosen based on asthma severity and experience during previous pregnancy.  Though no asthma medication has been proven entirely safe for use during pregnancy, doctor will carefully balance medication use and asthma control.

The need to use steroid inhaler will be individualized so that potential benefits of medications outweigh the potential risks of these medications or of uncontrolled asthma. In general, asthma medications used in pregnancy are chosen based on the following criteria:

  • Inhaled medications are generally preferred because they have a more localized effect on the lungs with only very small amounts entering the bloodstream.
  • When appropriate, older medications are preferred since there is more experience with their use during pregnancy.
  • In general, the same medications used before pregnancy are appropriate during pregnancy.

Are inhaled steroids safe to be used during pregnancy?

Inhaled steroids are used daily to maintain control of asthma and prevent asthma symptoms, even when asthma is stable. They can prevent and reduce swelling in the airways and reduce mucus production. They improve asthma symptoms and lung function, and they have been shown to decrease the need for oral steroids and hospitalization. Commonly used inhaled steroids during pregnancy include:

  • Budesonide (category B) Budesonide is recommended as the inhaled steroids of choice for use during pregnancy due to a large amount of reassuring human pregnancy safety data.
  • Beclomethasone and Fluticasone (category C)These inhaled steroids have not been proven to be unsafe during pregnancy and can be
    continued in patients well-controlled by them prior to pregnancy.

Inhaled steroids are taken on a regular basis and only cause few side effects in usual doses. Oral thrush, a possible side effect, is a yeast infection causing a white discoloration of the tongue. Using a spacer with inhaled steroids and rinsing the mouth after inhaling the medicine reduces the risk of oral thrush.

Summary

It is important to remember that the risks of inhaled steroids are much lower than the risks of uncontrolled asthma, which can be harmful to both mother and baby. It is much safer for pregnant women to be treated with inhaled steroids than for them to have asthma exacerbations, requiring stronger therapies (with more potential side effects) in order to achieve control of an asthmatic attack. Regular follow up and evaluation of asthma symptoms and asthma medications is necessary throughout the pregnancy to maximize asthma control and to minimize medication risks.

References

  1. Blaiss MS. Management of Asthma During Pregnancy. Allergy Asthma Proc. 2004; 25:375-
    379.
  2. NAEPP Expert Panel Report. Managing Asthma During Pregnancy: Recommendations for
    Pharmacologic Treatment – 2004 Update. J Allergy Clin Immunol. 2005; 115:36-46.
  3. ACOG/ACAAI. The Use of Newer Asthma and Allergy Medications During Pregnancy. Ann
    Allergy Asthma Immunol. 2000; 84:475-480.
Last Reviewed : 6 November 2017
Writer : Dr. Ho Bee Kiau
Accreditor : Dr. Norhaya bt. Mohd Razali

 

 

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