Asthma, Allergies and Pregnancy…Oh My! Wait, Don't Panic!

shutterstock_15775762.jpgBy Mara Gaudette, MS, CGC, Teratogen Information Specialist, MotherToBaby

My friend Jackie, newly (and unexpectedly!) pregnant called in a bit of a panic. Her cardiologist was switching her high blood pressure medicine because often, the first choice medications used to treat adults with high blood pressure are not the safest ones to use during pregnancy. She was still waiting for her asthma doctor to call her back but she figured her asthma treatment plan was another of the many changes she needed to make to
accommodate pregnancy. “Does anything stay the same?!” she lamented.

Jackie was relieved to learn that at least in the case of asthma, the answer is, typically, YES! The general belief is that the medicines to treat asthma in a non-pregnant person are the same ones that should be used during pregnancy. The main concern with asthma is making sure the developing baby is getting a good supply of oxygen. Improving control of asthma is believed to be the best thing for both mom and baby.

Jackie had been taking an inhaled corticosteroid for the past five years, ever since she otherwise needed to use her fast-acting rescue inhaler almost daily, and it was clear her asthma had not been under control without the preventative inhaler. Fortunately for Jackie, if a daily preventative is needed, an inhaled corticosteroid like Pulmicort is the preferred treatment. Why? For one thing, it often works well to stop symptoms. Second, because it is inhaled, only a portion of the medicine is absorbed into the blood stream. For the same reasons, albuterol for relief of immediate symptoms is also considered a preferred treatment during pregnancy. Had
Jackie been on other types of inhalers when she became pregnant, they probably would not have needed to be changed either.

Maternal asthma is associated with higher rates of pregnancy complications, such as poor growth of the baby and earlier delivery. Therefore, it is important that asthma management during pregnancy includes medication that best control an individual’s asthma symptoms.

Thankfully, the next call I got from Jackie wasn’t panic-stricken. “It sounds like my doctor wants me to continue my asthma medicines.” Just like I had assured her, but this time, with a calmer tone to her voice and with a different sense of urgency to her words, she added, “although I would never be a guinea pig, it would be nice if I could help other women with asthma so they wouldn’t have to go through the scare I just went through!” I told her we can never have too much information when it comes to asthma and treatments during
pregnancy and let her know that at MotherToBaby we are still enrolling women with asthma, women taking asthma medicines, and even women without asthma. There is no cost and she would never be asked to take medication… guinea pigs need not apply! If this applies to your situation, call 877-311-8972 or email otisresearch@ucsd.edu for more information.

“Oh, what about my allergy medicine?” Jackie remembered to ask. “When I don’t take Claritin, my asthma acts up, and my allergies have been crazy this spring.” I let her know that antihistamines in general have relatively reassuring pregnancy profiles with the first generation ones (i.e. the ones that have been around the longest like chlorpheniramine or diphenhydramine) often being preferred for having the most pregnancy data. Claritin (loratadine) is a second generation antihistamine, but has still been around for a long time and its overall pregnancy data has been reassuring. For women whose allergies trigger asthma symptoms, it is especially important to consider treatment. It would, however, be best to skip the "D" component (oral decongestant) of Claritin-D during the first trimester due to possible, but unproven, small concerns.

More detailed medicine information can be found in the following fact sheets:

http://www.mothertobaby.org/files/Albuterol_Update_with_Link_6_13.pdf
http://www.mothertobaby.org/files/asthma.pdf
http://www.mothertobaby.org/files/Diphenhydramine_8_13_1.pdf
http://www.mothertobaby.org/files/Inhaled_Corticosteroids_7_13.pdf
http://www.mothertobaby.org/files/Loratadine_5_13_Update.pdf
http://www.mothertobaby.org/files/Prednisone_6_13_1.pdf

Mara Gaudette is a genetic counselor and received her Masters Degree from Northwestern University. Drawn to the satisfaction of providing immediate reassurance to worried women, she began educating the public about teratogens at MotherToBaby’s Illinois affiliate more than a decade ago. Today, she not only continues to counsel for MotherToBaby via phone, but she’s also using new technology as one of the first ever teratogen live chat counselors on MotherToBabyCA.org, MotherToBaby’s California affiliate website.

MotherToBaby is a service of the international Organization of Teratology Information Specialists (OTIS), a suggested resource by many agencies, including the Centers for Disease Control and Prevention (CDC). If you have questions about medications, alcohol, diseases, vaccines, or other exposures during pregnancy or breastfeeding, call MotherToBaby toll-FREE at 866-626-6847 or visit MotherToBaby.org to browse a
library of fact sheets and find your nearest affiliate.

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