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1.5 Asthma and Pregnancy




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This article is from the Asthma FAQ, by Patricia Wrean and Marie Goldenberg mwg@radix.net with numerous contributions by others.

1.5 Asthma and Pregnancy

Many people have posted to ask about whether it is safe to become
pregnant while suffering from asthma, and in particular whether it is
safe to use their asthma medications while pregnant.

The general consensus (from the doctors I have consulted) is that
asthmatics can safely become pregnant without undue worry about whether
the mother and the baby will be all right. Most doctors talk about a
"rule of 1/3" by which they mean that roughly 1/3 of all asthmatics get
better while pregnant, 1/3 stay the same, and 1/3 find their asthma is
aggravated (I improved with one pregnancy, and stayed the same with the
next).

In any event, the bottom line when pregnant is ensuring that the baby
receives sufficient oxygen - and medications should be used as
appropriate to control the asthma and protect mother and child.
It is inadvisable to stop or reduce asthma medication solely because
of the pregnancy without careful supervision, as this can lead to
poorly controlled asthma, unnecessary ER visits, and poor outcome for
the baby and/or mother.

Most commonly-used asthma medications appear to be safe when used in
pregnancy; notable exceptions include the combination pills (Marax,
Tedral etc.) and those containing iodine (e.g. Theo-Organidin).
Many people are concerned in particular with the use of inhaled,
intranasal, and/or oral steroids but it has been my experience that
most doctors are quite willing to use these as needed, especially the
inhaled and intranasal steroids. It is my understanding that ephedrine
(alone or in combination drugs), and phenobarbital (an ingredient in
Tedral and other combination drugs) should be avoided.

There are choices in most classes of drugs, e.g., the bronchodilators,
and many doctors will elect to put their patients on those drugs with
the longest history of use in pregnant women - the assumption is that
the longer a drug has been in use, the likelier it is that any problems
would have become evident. For this reason, beclomethasone (Beclovent,
Vanceril) is the preferred inhaled corticosteroid. Cromolyn Sodium
(Nasalcrom, Intal) also appears to be safe for use in pregnancy.

In addition, if you need to use systemic steroids for a brief flareup,
old concerns over fetal abnormalities (cleft palate etc.) appear to
be less worrisome; I know of one case in which a woman used prednisone
for something other than asthma for several months while pregnant and
her baby had no problems.

Antibiotics may be used if needed; there are some such as tetracycline
which should be avoided but others (such as penicillin) appear to be
safe.

There is some anecdotal evidence from one contributer to the newsgroup
that Serevent, the longer-acting B2-agonist, might be related to several
cases of fetal abnormalities; I have not seen any official reports
supporting or denying this but it may be worth discussing with your
doctors if you use Serevent and are considering pregnancy.

Note: the above is a compilation of my own experiences as a pregnant
asthmatic, anecdotes from the newsgroup, and excerpts from The Asthma
Sourcebook and the National Asthma Education and Prevention Program
Expert Panel Report. It should in no way substitute for consultation
with qualified medical personnel.

 

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