The Working Group on Asthma and Pregnancy has reviewed all the existing studies on asthma medicine in pregnant woman and offers the following information. Remember: before you take any medication during pregnancy, talk to your doctor. Together, you will decide the medicine that’s right for you.
Quick Relievers
The most common quick relievers are short-acting be agonists. These drugs include albuterol (brand names: Proventil, Ventolin), pirbuterol acetate (Maxair), terbutaline sulfate (Brethaire), bitolterol mesylate (Tornalate), and metaproterenol sulfate (Alupent, Metrapel). When inhaled, short-acting beta agonists can stop an ongoing asthma attack, usually within 5 to 10 minutes.
Because these medications are used only as needed, you should not be taking them more than several times a week. At this level, the drugs do not appear to harm pregnant women or their unborn babies. Most research on these drugs, however, has involved women using the medication late in pregnancy. In some cases, the drugs can lead to tremors or hypoglycemia (low blood sugar) in newborns. These conditions can be treated and reversed.
An alternative drug is theophylline (Theo-Dur, Respbid, Slo-Bid, Theo-24, Theolair, Uniphy 1, Slo-PhylHn), which is released in your body over a period of hours. Theophylline does not work during an acute asthma attack. However, some people who normally wake up wheezing during the night find that taking theophylline before bedtime helps. It has been used extensively in pregnant women, and it does not appear to cause harmful side effects at normal doses.
Long-Term Controllers
In general, inhaled corticosteroids, or anti-inflammatory medications, do not appear to cause side effects in the mother or fetus. Inhaled medicine is best. There are at least three drug compounds available as inhaled asthma medication: beclomethasone (Bec-lovent, Vanceril), dexamethasone sodium phosphate (Decadron Phosphate Respihaler), triamcinolone acetonide (Azmacort), and flunisolide (AeroBidl, AeroBid-M).
Among inhaled corticosteroids, beclomethasone is the one pregnant woman have used most. For that reason, many doctors prefer to prescribe it over the others. It’s possible that this drug might enter your bloodstream, but researchers believe it’s unlikely that harmful amounts would reach your baby. By comparison, there’s little information about the effects of dexamethasone, triamcinolone, and flunisolide on pregnant women.
Oral (also called systemic) corticosteroids are sometimes used to help you get your asthma quickly under control. For pregnant women, these drugs are less safe than the inhaled variety. High doses of oral corticosteroids may lead to a baby that’s smaller than normal. In one study, women who took 10 milligrams of prednisone (Deltasone, Liquid Pred, Metocorten, Orasone, Panasol, Prednicen-M, Sterapred) throughout pregnancy had a slightly increased risk for low-birth weight babies.
Two common alternatives to corticosteroids are cromolyn sodium and nedocromil sodium. These drugs often are used before exercise to prevent exercise-induced asthma. They also might help ease asthma symptoms caused by inhaling cold air or sulfur dioxide. In pregnant women, cromolyn sodium appears safe. However, we have little information about nedocromil sodium.
In recent years, several new types of long-term controller medications have become available. We are still collecting information about their use during pregnancy. These drugs include long-acting beta2 agonists (Salmeterol) and leukotriene modifiers like zafirlukast (Accolate) and zileuton (Zyflo).
In review, the Working Group recommends these asthma drugs for pregnant women:
- Quick relievers: inhaled beta agonists, theophylline
- Long-term controllers: cromolyn sodium, beclomethasone, prednisone
Other recommended drugs include:
- Antihistamines: chlorpheniramine, tripelennamine
- Decongestants: pseudophedrine, oxymetazoline
- For cough: guaifenesin, dextromethorhpan
- Antibiotics: amoxicillin