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Asthma During Pregnancy - Topic Overview

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Many women also have allergies, such as allergic rhinitis, along with asthma. Treating allergies is an important part of asthma management.

  • Inhaled corticosteroids at recommended doses are effective and can be used by pregnant women.
  • The antihistamines loratadine or cetirizine are recommended.
  • If you are already taking allergy shots, you may continue getting them, but starting allergy shots during pregnancy is not recommended.
  • Talk to your health professional about using decongestants you take by mouth (oral decongestants). There may be better treatment options.

asthma medications and pregnancy

A review of the animal and human studies on the effects of asthma medications taken during pregnancy found few risks to the woman or her fetus. It is safer for a pregnant woman with asthma to be treated with asthma medications than for her to have asthma symptoms and asthma attacks.2 Poor control of asthma is a greater risk to the fetus than asthma medications are.2 Budesonide is labeled by the U.S. Food and Drug Administration (FDA) as the safest inhaled corticosteroid to use during pregnancy. One study found that low-dose inhaled budesonide in pregnant women seemed to be safe for the mother and the fetus.4

The following are recommendations from the U.S. National Asthma Education and Prevention Program (NAEPP) for using asthma medications during pregnancy.2

Recommendations for using asthma medicine during pregnancy
Severity Daily medicines needed to maintain long-term control

Severe persistent

Preferred:

  • High-dose inhaled corticosteroid, preferably budesonide AND
  • Long-acting inhaled beta2-agonist (such as salmeterol or formoterol) OR
  • A combination medication that contains both a high-dose corticosteroid and a long acting beta2-agonist (such as Advair Diskus) AND IF NEEDED
  • Corticosteroid tablets or syrup long-term (2 mg/kg/day, generally do not exceed 60 mg/day). (Make repeated attempts to reduce tablets or syrup, and maintain control with high-dose inhaled corticosteroids.) Treatment by a specialist is recommended if you are using oral corticosteroids long-term.

Alternative:

  • High-dose inhaled corticosteroids, preferably budesonide AND
  • Sustained-release theophylline to a serum concentration of 5 to 12 mcg/mL

Moderate persistent

Preferred:

  • EITHER low-dose inhaled corticosteroids and long-acting inhaled beta2-agonists OR
  • Medium-dose inhaled corticosteroid
  • IF NEEDED in women with recurring severe attacks, medium-dose inhaled corticosteroid and long-acting inhaled beta2-agonist

Alternative:

  • Low-dose inhaled corticosteroid and either a leukotriene modifier (also called leukotriene receptor antagonist) or theophylline (a methylxanthine)
  • Medium-dose inhaled corticosteroid and either a leukotriene modifier or theophylline, if needed

Mild persistent

Preferred:

  • Low-dose inhaled corticosteroid, preferably budesonide

Alternative:

  • Cromolyn (mast cell stabilizer) or a leukotriene modifier OR
  • Sustained-release theophylline to a serum concentration of 5 to 12 mcg/mL

Mild intermittent
  • No daily medication needed
  • Short-acting bronchodilator for relief of symptoms that come and go: 2 to 4 puffs short-acting inhaled beta2-agonists as needed for symptoms. Albuterol is the preferred medication. If you are using albuterol more than 2 days in each week, see your health professional for treatment of mild persistent asthma.
  • Severe episodes may occur, separated by long periods of normal lung function and no symptoms. A course of corticosteroid tablets, syrup, or injection is recommended for severe episodes.

Quick relief:   All patients
  • Short-acting bronchodilator: 2 to 4 puffs short-acting inhaled beta2-agonist as needed for symptoms. Albuterol is the preferred medication.
  • Intensity of treatment will depend on severity of attack; up to 3 treatments at 20-minute intervals or a single nebulizer treatment as needed. Course of corticosteroid tablets, syrup, or injection may be needed.
  • Use of short-acting beta2-agonists more than 2 times a week (except for exercise) or more than 1 canister in 3 months may indicate the need to start (or increase) long-term control therapy.

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