Asthma & Pregnancy: Medications

Reviewed by David Tinkelman, MD

We would like to avoid all medicine during pregnancy. However, a pregnancy without medicine is not always possible or desirable. It is safer for pregnant women with asthma to be treated with asthma medications than for them to have asthma symptoms and exacerbations. Maintaining adequate control or asthma during pregnancy is important for the health and well-being of both the mother and her baby.


Medicine Safety Categories

The U.S. Food & Drug Administration has 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. All medicines approved since 1980 are classified in one of these categories, and here are the categories relating to asthma medicines.

  • Category A
    These 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 B
    Category B indicates animal studies have revealed no evidence of harm to the fetus, 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 C
    Category C is one in which animal studies have shown an adverse effect and there are no adequate and well-controlled studies in pregnant women; or, no animal studies have been conducted and there are not 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.


Making Decisions about Medication During Pregnancy

It is important that your asthma be controlled to assure your baby's oxygen supply and decrease your health risk. By working closely with your doctor, you will be able to take the least medicine necessary for good asthma control.

  • Review all the medicine you are taking with your doctor. This includes "over the counter medicine", vitamins, and any herbal supplement you may be taking. Even these seemingly harmless things can be harmful to your baby.

  • Ask your healthcare provider about any medicine before you take it.

  • Take only medicine your healthcare provider has approved or prescribed.


Long-Term Control Medicines and Pregnancy

Long-term control medicines are used daily to maintain control of asthma and prevent asthma symptoms, even when asthma is stable. They do not provide immediate relief of symptoms.

Inhaled Steroids
Common inhaled steroids used during pregnancy include:

  • Pulmicort® (budesonide) - category B
  • Vanceril®, Beclovent®, Qvar® (beclomethasone) - category C
  • Flovent (fluticasone) - category C

All other inhaled steroids not listed here are in category C. Inhaled steroids prevent and reduce swelling in the airways and may decrease mucus production. They are the most effective long-term control medicine now available. They improve asthma symptoms and lung function, and they have been shown to decrease the need for oral steroids and hospitalization. Inhaled steroids are taken on a regular basis and cause few, if any, side effects in usual doses. Thrush, a possible side effect, is a yeast infection causing a white discoloration of the tongue. Using a spacer with inhaled steroids (metered-dose inhaler) and rinsing your mouth after inhaling the medicine reduces the risk of thrush. Learn more about inhaled steroids.

Cromolyn Sodium and Nedocromil
Intal® (cromolyn) and Tilade® (nedocromil) are also long-term control medicines available in inhaled forms. They are in category B. They help to prevent asthma symptoms, especially symptoms caused by exercise, cold air and allergies. When used routinely, each helps prevent swelling in the airways. They are often taken on a regular basis, but may also be used as a pre-treatment before exposure to things that make asthma worse. They are much less effective than inhaled steroids and leukotriene modifiers. Learn more about cromolyn sodium and nedocromil.

Leukotriene Modifiers
Singulair® and Accolate® are category B long-term control medicine. They reduce swelling inside the airways and relax smooth muscles around the airways, and they are effective at improving asthma symptoms and lung function, but not as effectively as inhaled steroids. They are available as tablets. There have been fewer years of experience with this class of drugs than with other asthma medicine. For this reason, and because minimal data are currently available on the use of these drugs during pregnancy, they should be avoided. Learn more about leukotriene modifiers.

Common theophyllines include:

  • Slo-Bid®
  • Uniphyl®
  • T-phyl®

Theophylline relaxes the smooth muscles around the airways. Theophyllines are in category C. Studies and clinical experience confirm the safety of this drug at recommended doses that result in a serum theophylline level of 5-15 mcg/ml. But because of side effects (usually at higher serum levels) theophylline is not one of the first medicines used for long-term control of asthma. There are safer and more effective medicines available. Learn more about theophylline.


Quick-Relief Medicines and Pregnancy

Quick-relief medicines are used to treat asthma symptoms or asthma worsening.

Short-Acting Beta-Agonists
Common inhaled beta-agonists include:

  • Proventil®, Proventil HFA®, Ventolin® (albuterol)
  • Xopenex® (levalbuterol)
  • Maxair® (pirbuterol)
  • Combivent® (albuterol and ipratropium)

These medicines are category C but have been used for decades and are deemed to be safe for both mother and fetus. Short-acting beta-agonists provide quick relief by relaxing the smooth muscles around the airways. If you use more than one of these metered-dose inhalers in a month talk with your doctor. This is a sign that your asthma is poorly controlled and your long-term control medicine may need to be adjusted. Remember, your asthma needs to be consistently under good control since you are "breathing for two." Learn more about short-acting beta-agonists.

Oral steroids
Common steroid pills and liquids include:

  • Deltasone® (prednisone)
  • Medrol® (methylprednisolon)

A short term burst of oral steroids may be needed to decrease the severity of asthma symptoms and prevent an emergency room visit, but should be discontinued as soon as asthma control is achieved. Oral steroids are very effective at reducing swelling and mucus production in the airways. They also help other quick relief medicine work better. Sustained use of oral steroids has been associated with pre-eclampsia, an undesirable condition associated only with pregnancy. Learn more about oral steroids.

Inhaled Medicine Technique
It is crucial that you use your inhaled medicine correctly to get the full dosage and benefits from the medicine. If you are using a metered dose inhaler you should use a spacer. This is especially important with inhaled corticosteroids. Ask your healthcare provider to watch your techniques with the inhaled medicine to make sure you are using it correctly.


Other Asthma Related Medication Treatment

Annual influenza vaccine (flu shot)
The annual flu shot is recommended for pregnant women with asthma during the second or third trimester. Read more about the flu vaccine.

Immunotherapy (allergy shots)
Allergy shots should not be started during pregnancy. However, if you have been receiving allergy shots and have not shown any severe reactions, you may continue them at the same dose. Read more about allergy shots.

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