Asthma is common in pregnancy, occurring in 3% to 8% of pregnant women. While the course of asthma during pregnancy is variable, the objectives of asthma treatment do not change and aim to prevent acute exacerbations and optimize management. Uncontrolled asthma is associated with an increased risk of perinatal morbidity. Published guidelines on pharmacologic therapies during pregnancy recommend the same step-wise approach as in nonpregnant women.
Dr. Mariam Louis
Despite this, many providers are reluctant to prescribe medications during pregnancy, and data show a reduction of refills of asthma medications during pregnancy, likely due to safety concerns. Some recent studies have suggested an increase in major congenital anomalies among pregnant asthmatics using ICS (Garne E et al. BJOG. 2016;123[10]:1609-18), albeit with large confidence intervals. These findings have not been consistently confirmed (Kallen B et al. Eur J Clin Pharmacol. 2007;63:383-8). Furthermore, studies showing a dose response association of ICS with congenital anomalies (Blais L et al. J Allergy Clin Immunol. 2009;124[6]:1229-34) suggest that disease severity may be a confounder in these associations.
The diagnosis of asthma, the use of other concurrent medications, and medication compliance may all be potential confounders. ICS use in pregnancy was associated with endocrine and metabolic disturbances in the offspring in a national cohort (Tegethoff M et al. Am J Respir Crit Care Med. 2012;185[5]:557-63). However, this study did not report on systemic steroid use, asthma severity, or details of these disturbances.
Dr. Ghada Bourjeily
In summary, ICS use remains justifiable in pregnancy (Smy L et al. Can Fam Physician. 2014;60[9]:809-12) as the risk of untreated or poorly treated asthma outweighs the possible risk of ICS use, especially when alternative drugs such as systemic steroids are not without risk. Ultimately, it should be stressed that asthma control is the goal of treatment. This should be achieved with close interaction between the pregnant woman and her health-care provider.
