Inhaled Corticosteroids
Inhaling steroid preventer drugs like beclomethasone, fluticasone and budesonide are considered to be safe during pregnancy. Drugs pass from mother to baby through the bloodstream and so less of these medications enter the bloodstream, going instead to the lungs. Beclomethasone is the preferred option as it has had the widest human research.Oral Steroids
If asthma continues to worsen, oral steroids may be needed. Oxygen deprivation is probably more dangerous than long-term steroids. Steroids cross the placenta into the foetus and human studies have shown a slight increase in low birth weights and premature births. Doses up to 5 mg per day are not considered harmful. If you take more it doesn't necessarily mean that it will harm the baby - just check with your doctor.Bronchodilators
As a group, the Beta-2 agonists have had extensive human use with no evidence of foetal injury. However, some animal studies where bronchodilators were given in high doses showed some effect. Terbutaline is often preferred due to negative animal studies. Salbutamol is also considered safe.Adrenaline-based drugs such as relievers should be used strictly on an "as needed" basis because adrenaline constricts blood vessels and therefore may reduce blood flow and oxygen to the foetus. Bearing this in mind, it is also dangerous to prolong asthma attacks because this can also reduce the amount of oxygen getting to the foetus.
Theophylline (Aminophylline)
If a more aggressive approach is needed theophylline has also had extensive favorable human experience. Some asthmatics may be able to restrict their use of theophylline to the times when asthma plays up. It is important to monitor the level of theophylline in the bloodstream for both effectiveness and toxicity.It is recommended that theophylline levels do not exceed 12 mg/L, since babies born to mothers with higher levels have found to have rapid heartbeat, vomiting and twitching.
Anti-Histamines
If you have asthma, you may also suffer from allergic nasal symptoms. To relieve this discomfort during pregnancy, antihistamines such as chlorpheniramine and tripelennamine are considered safe. If necessary, intranasal cromolyn or beclomethasone can also be taken to control nasal symptoms.Medications used for treating asthma or nasal problems that should be avoided during pregnancy include:
Antihistamines other than chlorpheniramine and tripelennamine
- Iodides
- Pseudoephedrine
- Sulfa antibiotics
- Tetracycline
Avoid non-selective B-agonists
These include epinephrine (adrenaline) and isoproterenol as animal studies have shown abnormal embryo development. Human studies have raised questions concerning their safety. A better alternative is B-2 agonists.Labour & Delivery
Before the actual birth, the doctor, midwife and nurses should be informed that you are asthmatic. Generally, asthmatics should continue their normal asthma medication during labour. It is important that if you are steroid dependent that you are given supplemental steroids to cope with the stress of labour.Epidurals and normal painkillers are considered safe for asthmatics. However, if an operation is performed it is important that the anaesthetist knows that you are asthmatic. This is incase you have a reaction or an asthma attack while under general anaesthetic.
Breast Feeding
Women with asthma should be encouraged to breast feed and there is nothing to stop you from doing so. Most of the commonly used drugs are safe for breast-feeding - the inhaled corticosteroids and bronchodilators are only present in minute quantities in the breast milk. However, anti-histamines and theophylline can make the baby irritable and unable to sleep.(published with permission in writing from:http://www.buteyko.co.nz/)
