Pregnancy and Asthma

A trusted adage in management of pregnancy is to take as few medications as possible. This paradigm developed after the thalidomide disaster in the early 1960s that resulted in many horrifying birth defects. In managing diseases like asthma during pregnancy today, however, one can expect fewer birth defects by using appropriately selected medications. While there are still too few data assessing the actual risk of medications to unborn children, the past twenty years have shown how important it is to reduce swelling and inflammation in the lungs. Many studies have compared benefits of taking inhaled steroids versus not using preventative medication. Results consistently show better outcomes for both mother and baby by emphasizing this paradigm: "Keep mom free of asthma attacks and lessen the chance of dangerously low oxygen levels for the fetus." In other words, the danger of untreated asthma far outweighs the potential danger of the medication.

A few asthma medications, including Pulmicort and Singulair, are FDA Pregnancy Category B. The FDA Pregnancy Categories were established to aid physicians in selecting medications with the least risk for pregnancy. Although the categories are useful, "the letters imply a gradation of risk that doesn't necessarily exist," says Dr. Sandra Kweder, the FDA's deputy director of the office of new drugs. I don't know anything that is Pregnancy Category A except pre-natal vitamins. Category B may imply better safety than Category C or D, so we often consider using them first. Nonetheless, allergists are comforted by the consistently good safety results of Pulmicort. Does that mean every woman with asthma should change to Pulmicort before attempting pregnancy? No, that's a decision best left to the doctor and patient. So the take home message is, "Breathing for two can be made easier with appropriate use of medications."