Published Online: July 25, 2015
Treatment decisions for pregnant women with asthma balance the benefits for mother and baby of disease control against the risks related to medication use. Based on current evidence, the general consensus is that uncontrolled asthma increases risks for pregnancy complications, while well-controlled asthma reduces these risks, but there is a relatively small evidence base on which to base decisions regarding the safest types of treatment.
In a study recently published in The Journal of Allergy and Clinical Immunology (JACI), Garne and colleagues studied the relationship between use of asthma medication in the first trimester of pregnancy and the risk of specific congenital anomalies. The study used data for 76,249 livebirths, fetal deaths, and terminations of pregnancy with congenital anomaly from 13 EUROCAT population-based congenital anomaly registries contributing to the EUROmediCAT central database 1995-2010. The researchers first identified all previously published associations between inhaled beta-2-agonists and/or inhaled corticosteroids and specific congenital anomalies, which need independent confirmation, and then tested these “signals” in the EUROmediCAT data by investigating whether exposure was more likely to be associated with these signal anomalies than other types of congenital anomaly.
Nine types of congenital anomaly were found to have been associated with inhaled beta-2-agonists in at least one previous study. Of these signals, two were confirmed in this study: both cleft palate and gastroschisis (an anomaly of the abdominal wall) were approximately twice as likely to have been exposed than other types of congenital anomaly. Of four signals identified for inhaled corticosteroids, none was confirmed. The frequency of cleft palate and gastroschisis in the background population is less than 1 per 1000 births and thus a doubling of risk gives a low absolute risk for an individual woman. This is very important, as the risks of uncontrolled asthma may be much greater.
For the health of the fetus, it is important that health services help women with asthma achieve good control prior to conception and during pregnancy. This should both prevent harmful effects of asthma exacerbations and prevent potential teratogenic effects of high dose or systemic anti-asthmatic medication. Use of prophylactic inhaled corticosteroids seems to be the best solution for treatment of asthma in pregnancy to prevent exacerbations and to reduce the need for beta-2 agonists.
The Journal of Allergy and Clinical Immunology (JACI) is an official scientific journal of the AAAAI, and is the most-cited journal in the field of allergy and clinical immunology.