The safety of asthma and allergy medications during pregnancy,☆☆,,★★

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Abstract

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.)

Section snippets

Subjects and medications

Subjects were participants in the Kaiser-Permanente Prospective Study of Asthma During Pregnancy, the methodology of which has been previously described.11 Briefly, subjects registering for prenatal care at San Diego Kaiser-Permanente Health Care Plan between June 1978 and December 1989 were asked to complete a questionnaire regarding their history of asthma or symptoms of asthma. All subjects with asthma were recruited to enter the study, and control subjects without asthma who matched a

Results

The incidence of spontaneous abortion was higher in subjects with asthma than in control subjects (Table I). However, the significance of this observation is uncertain because subjects with asthma generally entered the study earlier in their pregnancies, according to the study protocol. The incidence of oral corticosteroid use in subjects with asthma experiencing spontaneous abortions (10.5%) was less than that in subjects with asthma not experiencing a spontaneous abortion (15.7%).

No

Discussion

No prior studies of asthma or allergy medications or asthma during pregnancy have reported an increased incidence of congenital malformations.4, 5, 6, 7, 8, 9, 10, 11, 14, 15, 16, 17, 18, 19 This study adds additional reassuring data regarding antihistamines (especially chlorpheniramine and tripelennamine), decongestants (especially pseudoephedrine), inhaled β-agonists (especially terbutaline and metaproterenol), theophylline, inhaled or intranasal cromolyn, inhaled or intranasal

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    From the Departments of Allergy, Obstetrics and Gynecology, and Research and Evaluation, Kaiser-Permanente Medical Center, San Diego.

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    Supported in part by Grant No. AI 20426 fron the Asthma and Allergy Branch of the National Institiute of Allergy and Infectious Diseases and a grant fron the Kaiser Foundation Hospital Research Foundation.

    Reprint requests: Michael Schatz, MD, Department of Allergy, Kaiser-Permanente Medical Center, 7060 Clairemont Mesa Blvd., San Diego, CA 92111.

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