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Safety of Asthma and Allergy Medications During Pregnancy

  • Christina ChambersEmail author
Chapter

Abstract

Asthma and allergy are among the most common chronic conditions occurring in pregnancy. Particularly for asthma, data strongly suggest that poor symptom control and/or exacerbations during pregnancy increase risks for a wide range of adverse maternal and infant outcomes. Conversely, adequate management of maternal disease during pregnancy improves outcomes. While most medications, including those used to treat asthma and allergy, have not been comprehensively studied in human pregnancy, there are some data available for a large number of the medications currently in use. In this chapter, pregnancy safety data for asthma and allergy medications are summarized, with the caveat that more data from good quality studies are needed. To that end, recent changes to the pregnancy section of labels for prescription products that are marketed in the USA call for inclusion of specific data from human studies. As these new data emerge and are synthesized with existing information, a number of resources are provided that clinicians can use for consultation.

Keywords

Pregnancy Asthma Allergy Medications Safety Birth defects 

References

  1. 1.
    Kwon HL, Belanger K, Bracken MB. Asthma prevalence among pregnant and childbearing-aged women in the United States: estimates from national health surveys. Ann Epidemiol. 2003;13:317–24.CrossRefGoogle Scholar
  2. 2.
    Kwon HL, Triche EW, Belanger K, et al. The epidemiology of asthma during pregnancy: prevalence, diagnosis and symptoms. Immunol Allergy Clin N Am. 2006;26:29–62.CrossRefGoogle Scholar
  3. 3.
    Wang G, Murphy VE, Namazy J, Powell H, Schatz M, Chambers C, Attia J, Gibson PG. The risk of maternal and placental complications in pregnant women with asthma: a systematic review and meta-analysis. J Matern Fetal Neonatal Med. 2014;27:934–42.CrossRefGoogle Scholar
  4. 4.
    Murphy VE, Wang G, Namazy JA, Powell H, Gibson PG, Chambers C, Schatz M. The risk of congenital malformations, perinatal mortality and neonatal hospitalisation among pregnant women with asthma: a systematic review and meta-analysis. BJOG. 2013;120:812–22.CrossRefGoogle Scholar
  5. 5.
    Namazy JA, Murphy VE, Powell H, Gibson PG, Chambers C, Schatz M. Effects of asthma severity, exacerbations and oral corticosteroids on perinatal outcomes. Eur Respir J. 2013;41:1082–90.CrossRefGoogle Scholar
  6. 6.
    Murphy VE, Gibson PG, Talbot PI, Kessell CG, Clifton VL. Asthma self-management skills and the use of asthma education during pregnancy. Eur Respir J. 2005;26:435–41.CrossRefGoogle Scholar
  7. 7.
    National Asthma Education and Prevention Program Working Group on Managing Asthma during Pregnancy. Recommendations for pharmacologic treatment: update 2004. NIH Pub No 05-3279. U.S. Department of Health and Human Services, National Institutes of Health, National Heart Lung and Blood Institute; 2005.Google Scholar
  8. 8.
    Park-Wyllie L, Mazzotta P, Pastuszak A, Moretti ME, Beique L, Hunnisett L, Friesen MH, Jacobson S, Kasapinovic S, Chang D, Diav-Citrin O, Chitayat D, Nulman I, Einarson TR, Koren G. Birth defects after maternal exposure to corticosteroids: prospective cohort study and meta-analysis of epidemiological studies. Teratology. 2000;62:385–92.CrossRefGoogle Scholar
  9. 9.
    Skuladottir H, Wilcox AJ, Ma C, Lammer EJ, Rasmussen SA, Werler MM, Shaw GM, Carmichael SL. Corticosteroid use and risk of orofacial clefts. Birth Defects Res A Clin Mol Teratol. 2014;100:499–506.CrossRefGoogle Scholar
  10. 10.
    Bandoli G, Palmsten K, Forbess Smith CJ, Chambers CD. A review of systemic corticosteroid use in pregnancy and risk of select pregnancy and birth outcomes. Rheum Dis Clin N Am. 2017;43:489–502.CrossRefGoogle Scholar
  11. 11.
    Namazy J, Schatz M, Long L, Lipkowitz M, Lillie M, Voss M, Deitz RJ, Petitti D. Use of inhaled steroids by pregnant asthmatic women does not reduce intrauterine growth. J Allergy Clin Immunol. 2004;113:427–32.CrossRefGoogle Scholar
  12. 12.
    Rahimi R, Nikfar S, Abdollahi M. Meta-analysis finds use of inhaled corticosteroids during pregnancy safe: a systematic meta-analysis review. Hum Exp Toxicol. 2006;25:447–52.CrossRefGoogle Scholar
  13. 13.
    Kallen B, Rydhstroem H, Aberg A. Congenital malformations after the use of budesonide in early pregnancy. Obstet Gynecol. 1999;99:392–5.Google Scholar
  14. 14.
    Norjavaara E, Gerhardsson de Verdier M. Normal pregnancy outcomes in population-based study including 2968 pregnant women exposed to budesonide. J Allergy Clin Immunol. 2003;111:736–42.CrossRefGoogle Scholar
  15. 15.
    Charlton RA, Snowball JM, Nightingale AL, Davis KJ. Safety of fluticasone propionate prescribed for asthma during pregnancy: a UK population-based cohort study. J Allergy Clin Immunol Pract. 2015;3:772–9.CrossRefGoogle Scholar
  16. 16.
    Cossette B, Beauchesne M-F, Forget A, Lemiere C, Larivee P, Rey E, Blais L. Relative perinatal safety of salmeterol vs formoterol and fluticasone vs budesonide use during pregnancy. Ann Allergy Asthma Immunol. 2014;112:459–64.CrossRefGoogle Scholar
  17. 17.
    Wilson J. Use of sodium cromoglicate during pregnancy: results on 296 asthmatic women. Acta Therap. 1982;8(Suppl):45–51.Google Scholar
  18. 18.
    Schatz M, Zeiger RS, Harden K, Hoffman CC, Chilingar L, Petitti D. The safety of asthma and allergy medications during pregnancy. J Allergy Clin Immunol. 1997;100:301–6.CrossRefGoogle Scholar
  19. 19.
    Tata LJ, Lewis SA, McKeever TM, Smith CJ, Doyle P, Smeeth L, Gibson JE, Hubbard RB. Effect of maternal asthma, exacerbations and asthma medication use on congenital malformations in offspring: a UK population-based study. Thorax. 2008;63:981–7.CrossRefGoogle Scholar
  20. 20.
    Bakhireva LN, Jones KL, Schatz M, Klonoff-Cohen HS, Johnson D, Slymen DJ, Chambers CD, Organization of Teratology Information Specialists Collaborative Research Group. Safety of leukotriene receptor antagonists in pregnancy. J Allergy Clin Immunol. 2007;119:618–25.CrossRefGoogle Scholar
  21. 21.
    Sarkar M, Koren G, Kalra S, Ying A, Smorlesi C, De Santis M, Diav-Citrin O, Avgil M, Lavigne SV, Berkovich M, Einarson A. Montelukast use during pregnancy: a multicentre, prospective, comparative study of infant outcomes. Eur J Clin Pharmacol. 2009;65:1259–64.CrossRefGoogle Scholar
  22. 22.
    Nelsen LM, Shields KE, Cunningham ML, Stoler JM, Bamshad MJ, Eng PM, Smugar SS, Gould AL, Philip G. Congenital malformations among infants born to women receiving montelukast, inhaled corticosteroids, and other asthma medications. J Allergy Clin Immunol. 2012;129:251–4.CrossRefGoogle Scholar
  23. 23.
    Cavero-Carbonell C, Vinkel-Hansen A, Rabanque-Hernandez MJ, Martso C, Garne E. Fetal exposure to Montelukast and congenital anomalies: a population based study in Denmark. Birth Defects Res. 2017;109:452–9.CrossRefGoogle Scholar
  24. 24.
    Namazy J, Cabana MD, Scheuerle AE, Thorp JM Jr, Chen H, Carrigan G, Wang Y, Veith J, Andrews EB. The Xolair pregnancy registry (EXPECT): the safety of omalizumab use during pregnancy. J Allergy Clin Immunol. 2015;135:407–12.CrossRefGoogle Scholar
  25. 25.
    Briggs GG, Freeman RK, Towers CV, Forinash AB. Personal communication in drugs in pregnancy and lactation. 11th ed. Philadelphia: Wolters Kluwer Health; 2017.Google Scholar
  26. 26.
    Schatz M, Dombrowski MP, Wise R, Momirova V, Landon M, Mabie W, Newman RB, Hauth JC, Lindheimer M, Caritis SN, Leveno KJ, Meis P, Miodovnik M, Wapner RJ, Paul RH, Varner MW, O'Sullivan MJ, Thurnau GR, Conway DL, Maternal-Fetal Medicine Units Network, The National Institute of Child Health and Development, National Heart, Lung and Blood Institute. The relationship of asthma medication use to perinatal outcomes. J Allergy Clin Immunol. 2004;113:1040–5.CrossRefGoogle Scholar
  27. 27.
    Munsie JW, Lin S, Browne ML, Campbell KA, Caton AR, Bell EM, Rasmussen SA, Romitti PA, Druschel CM. National birth defects prevention study. Maternal bronchodilator use and the risk of orofacial clefts. Hum Reprod. 2011;26:3147–54.CrossRefGoogle Scholar
  28. 28.
    Lin S, Munsie JP, Herdt-Losavio ML, Bell E, Druschel C, Romitti PA, Olney R, National Birth Defects Prevention Study. Maternal asthma medication use and the risk of gastroschisis. Am J Epidemiol. 2008;168:73–9.CrossRefGoogle Scholar
  29. 29.
    Garne E, Hansen AV, Morris J, Zaupper L, Addor MC, Barisic I, Gatt M, Lelong N, Klungsøyr K, O'Mahony M, Nelen V, Neville AJ, Pierini A, Tucker D, de Walle H, Wiesel A, Loane M, Dolk H. Use of asthma medication during pregnancy and risk of specific congenital anomalies: a European case-malformed control study. J Allergy Clin Immunol. 2015;136:1496–1502.e7.CrossRefGoogle Scholar
  30. 30.
    Lin S, Munsie JP, Herdt-Losavio ML, Druschel CM, Campbell K, Browne ML, Romitti PA, Olney RS, Bell EM, National Birth Defects Prevention Study. Maternal asthma medication use and the risk of selected birth defects. Pediatrics. 2012;129:e317–24.CrossRefGoogle Scholar
  31. 31.
    Wilton LV, Pearce GL, Martin RM, Mackay FJ, Mann RD. The outcomes of pregnancy in women exposed to newly marketed drugs in general practice in England. Br J Obstet Gynaecol. 1998;105:882–9.CrossRefGoogle Scholar
  32. 32.
    Eltonsy S, Forget A, Blais L. Beta2-agonists use during pregnancy and the risk of congenital malformations. Birth Defects Res A Clin Mol Teratol. 2011;91:937–47.CrossRefGoogle Scholar
  33. 33.
    Eltonsy S, Forget A, Beauchesne MF, Blais L. Risk of congenital malformations for asthmatic pregnant women using a long-acting β2-agonist and inhaled corticosteroid combination versus higher-dose inhaled corticosteroid monotherapy. Allergy Clin Immunol. 2015;135:123–30.CrossRefGoogle Scholar
  34. 34.
    Stenius Aarniala B, Riikonen S, Teramo K. Slow-release theophylline in pregnant asthmatics. Chest. 1995;107:642–7.CrossRefGoogle Scholar
  35. 35.
    Park JM, Schmer V, Myers TL. Cardiovascular anomalies associated with prenatal exposure to theophylline. South Med J. 1990;83:1487–8.CrossRefGoogle Scholar
  36. 36.
    Heinonen OP, Slone D, Shapiro S. Birth defects and drugs in pregnancy. Littleton: Publishing Sciences Group; 1977.Google Scholar
  37. 37.
    Aselton P, Jick H, Milunsky A, Hunter JR, Stergachis A. First trimester drug use and congenital disorders. Obstet Gynecol. 1985;65:451–5.PubMedGoogle Scholar
  38. 38.
    Weber-Schoendorfer C, Schaefer C. The safety of cetirizine during pregnancy – a prospective observational cohort study. Reprod Toxicol. 2008;26:19–23.CrossRefGoogle Scholar
  39. 39.
    Li Q, Mitchell AA, Werler MM, Yau WP, Hernández-Díaz S. Assessment of antihistamine use in early pregnancy and birth defects. J Allergy Clin Immunol Pract. 2013;1:666–74.e1.CrossRefGoogle Scholar
  40. 40.
    Saxen I. Cleft palate and maternal diphenhydramine intake. Lancet. 1974;1:407–8.CrossRefGoogle Scholar
  41. 41.
    Moretti ME, Caprara D, Coutinho CJ, Bar-Oz B, Berkovitch M, Addis A, Jovanovski E, Schuler-Faccini L, Koren G. Fetal safety of loratadine use in the first trimester of pregnancy: a multicenter study. J Allergy Clin Immunol. 2003;111:479–83.CrossRefGoogle Scholar
  42. 42.
    Kallen B. Use of antihistamine drugs in early pregnancy and delivery outcome. J Matern Fetal Neonatal Med. 2002;11:146–52.CrossRefGoogle Scholar
  43. 43.
    Jick H, Holmes LB, Hunter JR, Madsen S, Stergachis A. First-trimester drug use and congenital disorders. JAMA. 1981;246:343–6.CrossRefGoogle Scholar
  44. 44.
    Yau W-P, Mitchell AA, Lin KJ, Werler MM, Hernández-Díaz S. Use of decongestants during pregnancy and the risk of birth defects. Am J Epidemiol. 2013;178:198–208.CrossRefGoogle Scholar
  45. 45.
    Berard A, Sheehy O, Kurzinger M-L, Juhaeri J. Intranasal triamcinolone use and the risk of adverse pregnancy outcomes. J Allergy Clin Immunol. 2016;138:97–104.CrossRefGoogle Scholar
  46. 46.
    Adam MP, Polifka JE, Friedman JM. Evolving knowledge of the teratogenicity of medications in human pregnancy. Am J Med Genet C: Semin Med Genet. 2011;157C:175–82.CrossRefGoogle Scholar
  47. 47.
    Pernia S, DeMaagd G. The new pregnancy and lactation labeling rule. Pharm Ther. 2016;41:713–5.Google Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Departments of Pediatrics and Family Medicine and Public Health, School of MedicineUniversity of California San DiegoLa JollaUSA

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