Inhaled steroids safe for pregnant asthmatics
Inhaled steroids safe for pregnant asthmatics
Avoid health risks to mother and baby
Women with asthma who fail to take their medications during pregnancy put themselves and their babies at greater risk of asthma-related complications.
That’s the sobering message delivered to the American Academy of Allergy, Asthma and Immunology (AAAAI) by Michael Schatz, MD, a staff allergist at Kaiser Permanente in San Diego.
The fear about taking medication during pregnancy can permeate the psyches of both patients and physicians, sometimes with fatal consequences. Paul Greenberger, MD, professor of medicine in the division of allergy-immunology at Northwestern University Medical School in Chicago tells the story of a woman in her third trimester who arrived in the emergency room concerned that her baby was not moving. The baby had died from lack of oxygen because of the mother’s uncontrolled asthma.
"I’ve seen the oxygen in a woman’s blood drop dramatically just after she coughed five times in a row," Greenberger says. "Many women may not be aware how much they can be hurting themselves and their babies by not controlling their asthma."
Guidelines issued in 1993 by the National Heart, Lung and Blood Institute in Bethesda, MD, underscore the importance of monitoring peak flows, controlling situations that trigger attacks, the use of medications, and patient education and reassurance that the medication is not harmful.
"Until recent years, it was not uncommon for physicians to approach asthma and pregnancy by recommending withholding medications," Schatz says. "They were more concerned about the medications than uncontrolled asthma.
"A number of studies are trying to reassure everyone and add data to the concepts that the medications are safer than uncontrolled asthma," Schatz says.
Greenberger, who has been compiling similar data for more than 20 years, says there is no question in his mind that beclomethasone is safe for pregnant women. "The key is in changing the behavior of physicians and patients," he says.
Schatz’s study of 128 pregnant women using four inhaled corticosteroids, including beclomethasone, showed the incidence of low-birth-weight babies is not different from the general population, using the National Center for Health statistics on more than 3 million singleton births in the United States in 1991.
A report to the AAAAI in 1998 found similar results in the use of albuterol in pregnant women with asthma.
Schatz is soliciting data as part of the AAAAI Registry for Asthmatic and Allergic Pregnant Patients (RAAPP) to increase statistical confidence in his results. Patients will be asked to register with their allergists during pregnancy. Information on their asthma will be collected, including demographics, smoking, medication use, acute asthma episodes, and pulmonary function during pregnancy.
Pregnancy information to be collected will include complications, gestational age, birth weight, and congenital malformations.
Schatz hopes allergists around the nation will enroll at least 800 patients in the study. "The study is being done to encourage allergists to be uniform in their approach to the patients," says Schatz.
The U.S. Food and Drug Administration lists beclomethasone as a "Category C" medication, indicating that birth defects have been associated with the use of the drug in animal studies. Package inserts advise physicians to consider the risks and benefits of the drug when prescribing it for pregnant women.
However, Greenberger says broad human experience shows the animal research is not relevant and that the benefits of the medication "far outweigh any risks."
The women in Schatz’s study used one or more medications during pregnancy: 56% used beclomethasone; 33% took triamcinolone; 21% used fluticasone; 14.6% took flunisolide and 24.2% used two medications. Only 4.7% of the babies showed a birth weight of less than 2500 g, reflecting a similar figure in the general population.
Uncontrolled asthma creates the risk of pre-eclampsia. In the mother, pre-eclampsia can cause kidney, brain, liver, and eye damage as well as seizures that could be fatal to both mother and child.
Greenberger has noted that uncontrolled asthma can have other effects, including the possibility that repeated episodes of uncontrolled hyperoxemia may impair fetal neurological development and has been linked to the development of cerebral palsy in the infant.
Schatz says other risks of uncontrolled asthma are premature birth, low birth weight, slow growth and stillbirth. He recommends inhaled steroids because of their minimal side effects and their general effectiveness. He cautions against the use of oral steroids, which have been shown to have greater risk of adverse side effects in pregnancy than inhaled medications.
[Michael Schatz can be reached at (619) 573-0299 and Paul Greenberger can be reached at (312) 908-8171.]
Subscribe Now for Access
You have reached your article limit for the month. We hope you found our articles both enjoyable and insightful. For information on new subscriptions, product trials, alternative billing arrangements or group and site discounts please call 800-688-2421. We look forward to having you as a long-term member of the Relias Media community.