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Management of asthma during pregnancy

Michael Schatz, MD, MS
Steven E Weinberger, MD
Section Editors
Bruce S Bochner, MD
Charles J Lockwood, MD, MHCM
Deputy Editor
Helen Hollingsworth, MD


Asthma is one of the most common medical conditions encountered during pregnancy, occurring in 3 to 8 percent of pregnant women [1-3]. Pregnancy may be associated with changes in the course of asthma, and asthma may affect the outcome of pregnancy. When considering the use of asthma medications in a pregnant woman, the potential risk of a drug must be balanced against the effects of untreated asthma.

The management of asthma in pregnancy, including the safety data for specific asthma medications, general management, and recommended pharmacotherapy for acute and chronic asthma in pregnancy, is reviewed here. An overview of asthma management and the physiology and clinical course of asthma in pregnancy are discussed separately. (See "An overview of asthma management" and "Physiology and clinical course of asthma in pregnancy".)


Information about potential adverse effects must be interpreted with an understanding that the baseline frequency of complications in pregnancy is relatively high, even in the absence of asthma or other disorders. In the United States, major congenital anomalies occur in 2 to 4 percent of live-born infants. An overview of congenital malformations and a discussion of genetic and environmental causes are provided separately. (See "Birth defects: Approach to evaluation".)

There is a small but significant increase in complications of pregnancy in asthmatic women [4]. A large representative study suggests that asthmatic patients, on average, have a 15 to 20 percent increased risk of perinatal mortality, preeclampsia, preterm delivery, or low birth weight infants compared with non-asthmatic women, and that patients with more severe asthma have a 30 to 100 percent increased risk (table 1) [4].

For many years, the US Food and Drug Administration (FDA) has used five categories (A, B, C, D, and X) to describe a drug's potential for causing adverse effects during pregnancy (table 2) [5]. The categories are based upon the results of animal studies, human data, and consideration of whether the benefit of the drug's use during pregnancy outweighs the risk. The FDA has begun the phase-out of pregnancy risk categories from prescription drug labeling and now requires information from available human and animal studies about (1) known or potential maternal or fetal risks, (2) dose adjustments needed during pregnancy and the postpartum period, and (3) benefit/risk considerations [6]. While new medications include this information, the process of updating existing medications will likely take several years. In the interim, it is useful to have an understanding of the various categories.

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Literature review current through: Oct 2017. | This topic last updated: Sep 19, 2016.
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