By Dr. Larry Chiaramonte
As I wrote not long ago, asthma is a major health problem for pregnant women. Yet, many asthmatic women risk their lives during pregnancy because they are afraid of the effects it will have on their baby. Unfortunately, their fears are augmented by faulty information. In the case of an otherwise-useful guide for expectant mothers, the fault is one of omission, not misstatement or falsehood.
This is what it says about medication:
“Many doctors encourage pregnant patients to increase their trigger avoidance so they can get by with lower doses of asthma medication while they are pregnant. There are asthma medications that are considered safe during pregnancy, including inhaled bronchodilators. Make sure your allergist or asthma doctor knows you are pregnant and discuss your medications with him. In general, having an asthma attack while pregnant is a greater risk for your baby than any possible side effects from your asthma medication. Do not stop taking asthma medications without instructions from your health care provider.”
Where is the S-Word—steroids? The author mentions bronchodilators, but bronchodilators are only part of the story. The efficacy of inhaled corticosteroids (ICS) as the go-to medication for controlling asthma is universally recognized. As I wrote in my original post, the evidence for ICS safety is scant because women are reluctant to participate in double-blind placebo-controlled studies during pregnancy, but the animal studies all point the right way.
Loss of control during pregnancy is a substantial risk to both mother and child. As I also wrote, “An (April 30, 2009) article in The New England Journal of Medicine shows that women with asthma have higher risks of preeclampsia, preterm birth, infants with low birth weight, intrauterine growth restriction, infants with congenital malformations, and perinatal death.”