The safety of asthma and allergy medications during pregnancy

• Published in: Journal of allergy and clinical immunology Vol. 100; no. 3; pp. 301 - 306
• Main Authors: Schatz, Michael, Zeiger, Robert S., Harden, Kathy, Hoffman, Clement C., Chilingar, Linda, Petitti, Diana
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01-09-1997; Elsevier
• Subjects: Administration, Inhalation; Adrenal Cortex Hormones - administration & dosage; Adrenal Cortex Hormones - adverse effects; Adrenal Cortex Hormones - therapeutic use; Adrenergic beta-Agonists - adverse effects; Adrenergic beta-Agonists - therapeutic use; allergy; Anti-Asthmatic Agents - administration & dosage; Anti-Asthmatic Agents - adverse effects; Anti-Asthmatic Agents - therapeutic use; asthma; Asthma - diagnosis; Asthma - drug therapy; Biological and medical sciences; corticosteroids; Drug toxicity and drugs side effects treatment; Female; Histamine H1 Antagonists - adverse effects; Histamine H1 Antagonists - therapeutic use; Humans; Incidence; Medical sciences; medications; Miscellaneous (drug allergy, mutagens, teratogens...); Multivariate Analysis; Nasal Decongestants - adverse effects; Nasal Decongestants - therapeutic use; Odds Ratio; Pharmacology. Drug treatments; Pre-Eclampsia - chemically induced; Pre-Eclampsia - diagnosis; Pre-Eclampsia - epidemiology; preeclampsia; Pregnancy; Pregnancy Complications - chemically induced; Pregnancy Complications - epidemiology; Pregnancy Trimester, First; Steroids - administration & dosage; Steroids - adverse effects; Steroids - therapeutic use; United States - epidemiology; United States; allergy; asthma; preeclampsia; corticosteroids; pregnancy; medications; Allergy; Agonist; Pregnancy disorders; Toxicity; Antiasthma agent; Antihistaminic; β-Adrenergic receptor; Cromoglicic acid; Complication; Xanthine derivatives; Obstructive pulmonary disease; Human; Immunopathology; Corticosteroid; Respiratory disease; Bronchodilator; Antiinflammatory agent; Pregnancy toxemia; Asthma; Pregnancy; Chemotherapy; Treatment; Preeclampsia; Nasal decongestant; Theophylline
• ISSN: 0091-6749; 1097-6825
• DOI: 10.1016/S0091-6749(97)70241-0

Background: Although no asthma or allergy medications can be considered proven safe for use during pregnancy, these medications are often used to prevent the potential direct and indirect consequences of uncontrolled asthma or allergy.
Objective: The safety of asthma medications, antihistamines, and decongestants was assessed in a prospectively monitored cohort of 824 pregnant women with and 678 pregnant women without asthma.
Methods: Medications used since conception were recorded on each subject's initial visit (< 28 weeks' gestation). Thereafter, diary cards for medications were completed by the patient through the time of delivery. Perinatal outcomes were compared in exposed versus unexposed individuals. A multivariate analysis accounted for the potential effects of age, parity, smoking, race, weight gain during pregnancy, maternal pulmonary function, acute asthmatic episodes, and multiple medication exposure.
Results: No significant relationships were identified between major congenital malformations and first trimester or any exposure to β-agonists, theophylline, cromolyn, corticosteroids, antihistamines, or decongestants. In the multivariate analyses, oral corticosteroids were independently associated with preeclampsia (odds ratio = 2.0,
p = 0.027), but no other independent associations were observed between asthma or allergy medications and adverse perinatal outcomes.
Conclusion: Use of most common asthma and allergy medications during pregnancy was not associated with increased perinatal risks. Maternal use of oral corticosteroids was independently associated with the occurrence of preeclampsia in this study, although the mechanism of this association is not clear. However, because prior observations suggest that severe asthma may be associated with maternal and/or fetal mortality, risk-benefit considerations still favor the use of oral corticosteroids when indicated for the treatment of asthma during pregnancy. (J Allergy Clin Immunol 1997;100:301-6.)