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SELECTED ARTICLES FROM THE RECENT LITERATURE 2006
12/19/06
Inhaled corticosteroid effects during pregnancy
Summary
Background – There is an understandable concern in pregnant women about potential adverse effects on the fetus of any medication taken during pregnancy, including inhaled corticosteroids (ICS) used to treat asthma. This concern is particularly strong when medications are used during the first trimester of pregnancy.
Findings – Blais et al of the Univ of Montreal in Quebec carried out a population-based cohort study to see whether various doses of ICS used in the first trimester of pregnancy was followed by an increased frequency of congenital malformations (CM) in the offspring.
Following 4,561 pregnancies in asthmatic women, there was an overall 9.2% incidence of CM (major CM in 6% of pregnancies). The frequency of such CM in the 40% of the asthmatic women who were treated with ICS was actually lower than in asthmatic women not treated with ICS (Odds ratio (OR) for those on ICS 100-500 mcg/day = 0.77; OR for ICS dose 500-1000 mcg/day = 0.41; OR for ICS dose over 1000 mcg/day = 1.0). The frequencies of major CM were also lower in those using ICS 0-1000 mcg/day.
Reference
Thorax 2006, Nov 12 E Pub
Editor's Comments
These findings are encouraging indeed in face of the sizable evidence that persistent asthma can be controlled better with chronic ICS therapy. Indeed, the OR for CM were well below 1.0 following use of ICS in doses of 1000 mcg/day or less. This finding may be due to the fact that pregnant asthmatics not on ICS therapy may have had hypoxia due to uncontrolled asthma more frequently, possibly contributing to damage of the fetus in utero. However, the findings in this study suggest avoiding ICS doses above 1000 mcg/day if at all feasible.
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