Treating Asthma and Comorbid Allergic Rhinitis in Pregnancy

Abstract

Women with severe or uncontrolled asthma are at higher risk for pregnancy complications and adverse fetal outcomes than women with well-controlled asthma. Recent evidence-based guidelines have concluded that it is safer for pregnant women with asthma to be treated pharmacologically than to continue to have asthma symptoms and exacerbations. According to the Asthma and Pregnancy Working Group (APWG) of the National Asthma Education and Prevention Program, optimal treatment of asthma during pregnancy includes treatment of comorbid allergic rhinitis (AR), which can trigger or aggravate asthma symptoms. In general, treatment of both asthma and AR during pregnancy should follow the same stepwise approach that is used in the general population. This article presents the specific recommendations from the most recent APWG report and from other systematic reviews about which asthma and allergic rhinitis drugs should be preferred during pregnancy. Of the corticosteroids, budesonide has the most data and is listed as Pregnancy Category B (no evidence of risk in humans). Other inhaled and intranasal corticosteroids have less data and are listed as Pregnancy Category C but may be continued during pregnancy if the patient's asthma was well controlled with the medication before pregnancy.

Fetal Exposure to Montelukast and Congenital Anomalies: A Population Based Study in Denmark

“…The prevalence of asthma has been increasing world‐wide and approximately 4 to 8% of pregnant women carry a diagnosis of asthma (Osur, ; Rocklin, ). Evidence suggests that there is a two‐sided relationship: asthma may impact the outcome of pregnancy and, conversely, the pregnancy may alter the clinical asthma status of the woman (Calderwood and Nelson‐Piercy, ; Yawn and Knudtson, ; Enriquez et al, ; Rocklin, ).…”

Allergic Rhinitis and its Impact on Asthma (ARIA) 2008*

“…Caution must be taken when administering any medication during pregnancy, as most medications cross the placenta (1794,1795). For most drugs, limited studies have been performed only on small groups without longterm analysis (1796,1797).…”

Intranasal triamcinolone use during pregnancy and the risk of adverse pregnancy outcomes

“…Intranasal corticosteroids have a low risk of systemic effect because of their pharmacokinetics, and all second-generation intranasal corticosteroids are considered similar with regard to safety at the recommended starting dose during pregnancy. 7 Nevertheless, in August 2004, the FDA upgraded intranasal budesonide, which is an intranasal corticosteroid, to pregnancy category B based on a review of 3 Swedish Birth Register studies containing pregnancy and neonatal outcomes from Sweden from 1995 to 2001. [8][9][10] All other intranasal corticosteroids used for the treatment of AR remained pregnancy category C because of insufficient human data.…”