The basic principle asthma treatment during pregnancy will be to use the least number and dose of medication while keeping asthma under control. If necessary, the use of asthma medications should not be avoided. There are 6 steps in the use of asthma medications. As a result of the studies conducted for asthma medications, a safety scale has been established for use in pregnant women. Your doctor will formulate your treatment accordingly. In this article, we wrote about how asthma should be treated in pregnancy and how asthma medications should be used.
How should asthma treatment be during pregnancy?
The basic principle of asthma treatment during pregnancy is to use the least number and dose of drugs that keep asthma under control. It should not be avoided when using asthma medications when necessary.
In the treatment of a pregnant patient with asthma, it is necessary to keep the asthma of the pregnant woman under control as much as possible and to treat the fetus with the least harm in the same process. Treatment of the asthmatic pregnant patient should therefore be in balance.
How are asthma medications used in pregnancy?
Patients with asthma should use many medications to control allergic asthma before pregnancy. When asthmatic patients become pregnant, there are points that need to be considered in the use of some medications they have used before.
In pregnant patients with asthma, as in the asthma guide, step therapy is applied for asthma patients.
| Step | Recommended Therapy | Alternative Therapy |
| 1 | No need medicine | |
| 2 | Low dose inhaled corticosteroids | Leukotriene receptor antagonist (LTRA) Theophylline |
| 3 | Medium dose inhaled corticosteroids | Low-dose inhaled corticosteroids + long-acting β agonist (LABA), LTRA or theophylline |
| 4 | Medium dose inhaled corticosteroids + LABA | Medium dose inhaled corticosteroids + LTRA or theophylline |
| 5 | High-dose inhaled corticosteroids + LABA | Newly developed oma |
| 6 | High-dose inhaled corticosteroids + LABA | Newly developed oma |
Patients evaluated by allergists should use asthma medications as above. As a result of studies on asthma medications, the safety scale for use in pregnant women has been specified.
Since the drugs used in pregnant patients may have harmful effects on the fetus, it is necessary to be extremely careful. In this regard, FDA (Food and Drug Administration-USA’s supervisory board of drugs and foods) divided drugs into five different groups in terms of their effects on the baby during pregnancy:
Category A:
No harmful effects on the fetus were found in studies conducted in humans. There are very few drugs included in this group. Vitamins used in pregnancy are in this group.
Category B:
No harmful or adverse effects on animal fetuses were found in animal studies, but studies in humans are not available.
Or:
Adverse effects were found in animal studies, but these negativities were not confirmed in studies conducted in humans. Penicillin group antibiotics are in this group.
Category C:
Studies in animals and / or humans are insufficient.
Or: Adverse effects detected in animal studies, but no human data. Most of the drugs used in pregnancy are in this group.
Category D:
A negative effect on the human fetus has been found with drugs in this group. The drugs in this group are drugs that can be used when the profit / loss ratio is in favor of profit. The best example for the group is the drugs that expectant mothers with epilepsy should use.
Category X:
A negative effect on the human fetus was also found in drugs in this group. However, when the drugs in this group are used during pregnancy, they are drugs whose profit / loss ratio always favors the loss. Therefore, it should never be used during pregnancy (drugs such as DES and Thalidomide).
This classification is inadequate in many respects and does nothing but confuse. Because the classification does not take into account the period of pregnancy it is used, and includes guidance on treatment with the risk in the baby.
When looking at where asthma medicines fall within the scale specified by the FDA, most are in B and C categories.
| Groups of Drugs | Name of the drug / FDA category | Possible impact on pregnancy |
| Inhaled breath-opening, short-acting drugs | Albuterol / category C | Although it has safe usable information about humans, it may be associated with some specific malformations |
| Inhaled breath-opening long-acting drugs | Formoterol / category C Salmeterol / category C | There is data that it can be safe |
| Theophylline Systemic steroids | There is no increase in congenital malformations, but care should be taken in terms of toxicity. Oral defects such as cleft palate may also be associated with low birth weight, preterm labor, preeclampsia, and intrauterine growth retardation. There is confusing information that it can have serious effects | |
| Inhaled corticosteroids | Budesonide /Category B Beclometasone /Category C Fluticasone / C Mometasone / C Triamcinolone / C | There is information that it can be used safely, but at high doses there may be an increased risk of malformations. The most information on safe use is for budesonide. |
| Leukotriene receptor antagonist | Mon / B | There is moderate knowledge of how to use it safely |
| 5-LO inhibitor | Zileuton / C | There is not enough information that it can be used safely in animal studies, there is no human information. |
| Anti-IgE | Oma / B | There is inconclusive information that it may lead to increased risk in terms of preterm delivery and low birth weight. |
In the light of the information gathered about asthma medications used during pregnancy, the drugs that we can use during pregnancy should be arranged in a way that the pregnant woman and the fetus are least harmed.
