Concerns about using medication during pregnancy are natural. However, using an inhaler to manage asthma is strongly recommended by medical guidelines. Asthma is the most common chronic respiratory condition encountered during pregnancy, affecting between 4% and 8% of all pregnancies. Maintaining good control of this condition is fundamental to ensuring a healthy pregnancy for both the mother and the developing fetus. The benefits of keeping airways open and ensuring sufficient oxygen flow significantly outweigh the perceived risks of the medication itself.
The Greater Risk of Untreated Asthma
The primary danger of uncontrolled asthma during pregnancy is the risk of maternal and fetal hypoxemia, a condition where the oxygen levels in the blood fall too low. An asthma flare-up causes the airways to tighten, which in turn decreases the amount of oxygen in the mother’s bloodstream. Since the fetus receives all of its oxygen supply directly from the mother’s blood, any drop in maternal oxygen levels can impair healthy fetal growth and development.
The lack of oxygen associated with poorly managed asthma drives serious adverse outcomes. Uncontrolled asthma increases the risk of complications such as preeclampsia and gestational hypertension in the mother. For the baby, risks include low birth weight and premature birth (before 37 weeks of pregnancy). Severe asthma attacks during the first trimester have also been associated with an increased prevalence of congenital malformations.
Safety of Inhaled Medications During Pregnancy
Inhaled medications are the preferred and safest way to treat asthma in pregnant women because they deliver the drug directly to the lungs. This localized action means there is minimal systemic absorption into the bloodstream, resulting in very little medication reaching the developing fetus. The benefits of these medications in preventing a dangerous asthma attack far outweigh the minimal risk associated with their systemic absorption.
The quick-relief or “rescue” inhalers, known as short-acting beta-agonists (SABAs), are considered the first line of defense and are safe to use as needed during pregnancy. Albuterol is the most common SABA and is the preferred medication for treating sudden asthma symptoms or exacerbations. Extensive data from pregnancy registries and studies have shown no significant link between albuterol use at recommended doses and an increased risk of major birth defects.
For long-term control of persistent asthma, inhaled corticosteroids (ICS) are the standard treatment. Budesonide is the preferred inhaled corticosteroid during pregnancy due to the most extensive safety data available. Inhaled corticosteroids reduce inflammation in the airways, preventing asthma attacks before they start. When combination inhalers containing both an ICS and a long-acting beta-agonist (LABA) are needed for more severe asthma, they are continued, as the risk of stopping them is greater than the risk of the medication itself.
Continuous Monitoring and Care Adjustments
Managing asthma effectively throughout pregnancy requires continuous monitoring and a coordinated approach between the obstetrician and the asthma specialist. Asthma symptoms can change significantly during pregnancy, with approximately one-third of women experiencing worsening symptoms, one-third seeing improvement, and one-third remaining unchanged. Because the need for medication can fluctuate, close monitoring is necessary to adjust the treatment plan.
Regular assessment of lung function, often through simple tests like spirometry or peak flow monitoring, helps doctors differentiate between shortness of breath caused by pregnancy and that caused by worsening asthma. Expert panels encourage monthly monitoring of asthma control during prenatal visits. This allows for timely adjustments to medication dosage, either stepping up treatment if control is lost or stepping down if symptoms improve. Women with asthma should also have an up-to-date, written Asthma Action Plan that details how to manage symptoms and exacerbations at home. Patients must never stop taking their prescribed medication without first consulting their healthcare provider.