Advertisement

Use of Asthma Medication During Gestation and Risk of Specific Congenital Anomalies

Published:October 27, 2022DOI:https://doi.org/10.1016/j.iac.2022.07.007

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribers receive full online access to your subscription and archive of back issues up to and including 2002.

      Content published before 2002 is available via pay-per-view purchase only.

      Subscribe:

      Subscribe to Immunology and Allergy Clinics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Cohen J.M.
        • Bateman B.T.
        • Huybrechts K.F.
        • et al.
        Poorly controlled asthma during pregnancy remains common in the United States.
        J Allergy Clin Immunol In Pract. 2019; 7: 2672-2680. e2610
        • Sawicki E.
        • Stewart K.
        • Wong S.
        • et al.
        Medication use for chronic health conditions by pregnant women attending an Australian maternity hospital.
        Aust N Z J Obstet Gynaecol. 2011; 51: 333-338
        • Rejnö G.
        • Lundholm C.
        • Gong T.
        • et al.
        Asthma during pregnancy in a population-based study-pregnancy complications and adverse perinatal outcomes.
        PLoS One. 2014; 9
        • Kwon H.L.
        • Belanger K.
        • Bracken M.B.
        Asthma prevalence among pregnant and childbearing-aged women in the United States: estimates from national health surveys.
        Ann Epidemiol. 2003; 13: 317-324
        • Hansen C.
        • Joski P.
        • Freiman H.
        • et al.
        Medication exposure in pregnancy risk evaluation program: the prevalence of asthma medication use during pregnancy.
        Matern child Health J. 2013; 17: 1611-1621
        • Wang G.
        • Murphy V.E.
        • Namazy J.
        • et al.
        The risk of maternal and placental complications in pregnant women with asthma: a systematic review and meta-analysis.
        J Maternal-Fetal Neonatal Med. 2014; 27: 934-942
        • Kim S.
        • Kim J.
        • Park S.Y.
        • et al.
        Effect of pregnancy in asthma on health care use and perinatal outcomes.
        J Allergy Clin Immunol. 2015; 136: 1215-1223. e1216
        • Murphy V.
        • Namazy J.
        • Powell H.
        • et al.
        A meta-analysis of adverse perinatal outcomes in women with asthma.
        BJOG: An Int J Obstet Gynaecol. 2011; 118: 1314-1323
      1. Global Strategy for Asthma Management and Prevention.
        Global Initiative for Asthma. 2020;
        • Dombrowski M.
        • Schatz M.
        ACOG practice bulletin: clinical management guidelines for obstetrician-gynecologists number 90, February 2008: asthma in pregnancy.
        Obstet Gynecol. 2008; 111: 457-464
        • Al Ghobain M.O.
        • AlNemer M.
        Assessment of knowledge and education relating to asthma during pregnancy among women of childbearing age.
        Asthma Res Pract. 2018; 4: 1-5
        • Powell H.
        • McCaffery K.
        • Murphy V.E.
        • et al.
        Psychosocial outcomes are related to asthma control and quality of life in pregnant women with asthma.
        J Asthma. 2011; 48: 1032-1040
        • Chambers K.
        Asthma education and outcomes for women of childbearing age.
        Case manager. 2003; 14: 58-61
        • Lim A.S.
        • Stewart K.
        • Abramson M.J.
        • et al.
        Management of asthma in pregnant women by general practitioners: a cross sectional survey.
        BMC Fam Pract. 2011; 12: 1-7
        • Rocklin R.E.
        Asthma, asthma medications and their effects on maternal/fetal outcomes during pregnancy.
        Reprod Toxicol. 2011; 32: 189-197
        • Yland J.J.
        • Bateman B.
        • Huybrechts K.F.
        • et al.
        Fetal Outcomes Among Women with Asthma during Pregnancy: Evidence from a Large Healthcare Database in the United States.
        J Allergy Clin Immunol. 2019; 143: AB422
        • Garne E.
        • Hansen A.V.
        • Morris J.
        • et al.
        Use of asthma medication during pregnancy and risk of specific congenital anomalies: a European case-malformed control study.
        J Allergy Clin Immunol. 2015; 136: 1496-1502. e1497
        • Blais L.
        • Forget A.
        Asthma exacerbations during the first trimester of pregnancy and the risk of congenital malformations among asthmatic women.
        J Allergy Clin Immunol. 2008; 121: 1379-1384. e1371
        • Crane J.P.
        • LeFevre M.L.
        • Winborn R.C.
        • et al.
        A randomized trial of prenatal ultrasonographic screening: impact on the detection, management, and outcome of anomalous fetuses.
        Am J Obstet Gynecol. 1994; 171: 392-399
        • Ramsay M.
        Genetic and epigenetic insights into fetal alcohol spectrum disorders.
        Genome Med. 2010; 2: 1-8
        • Torfs C.P.
        • Christianson R.E.
        • Iovannisci D.M.
        • et al.
        Selected gene polymorphisms and their interaction with maternal smoking, as risk factors for gastroschisis.
        Birth Defects Res A: Clin Mol Teratology. 2006; 76: 723-730
        • Mossey P.A.
        • Little J.
        • Munger R.G.
        • et al.
        Cleft lip and palate.
        Lancet. 2009; 374: 1773-1785
        • Hyoun S.C.
        • Običan S.G.
        • Scialli A.R.
        Teratogen update: methotrexate.
        Birth Defects Res Part A: Clin Mol Teratology. 2012; 94: 187-207
        • Diav-Citrin O.
        • Shechtman S.
        • Tahover E.
        • et al.
        Pregnancy outcome following in utero exposure to lithium: a prospective, comparative, observational study.
        Am J Psychiatry. 2014; 171: 785-794
        • Veroniki A.A.
        • Cogo E.
        • Rios P.
        • et al.
        Comparative safety of anti-epileptic drugs during pregnancy: a systematic review and network meta-analysis of congenital malformations and prenatal outcomes.
        BMC Med. 2017; 15: 1-20
        • Shanks N.
        • Greek R.
        • Greek J.
        Are animal models predictive for humans?.
        Philos Ethics humanities Med. 2009; 4: 1-20
        • Schardein J.L.
        Drugs as teratogens.
        CRC press, Cleveland1976
        • Robijn A.L.
        • Barker D.
        • Gibson P.G.
        • et al.
        Factors Associated with Nonadherence to Inhaled Corticosteroids for Asthma During Pregnancy.
        The J Allergy Clin Immunol In Pract. 2021; 9: 1242-1252. e1241
        • Schatz M.
        • Dombrowski M.P.
        • Wise R.
        • et al.
        The relationship of asthma medication use to perinatal outcomes.
        J Allergy Clin Immunol. 2004; 113: 1040-1045
        • Murphy V.E.
        • Clifton V.L.
        • Gibson P.G.
        Asthma exacerbations during pregnancy: incidence and association with adverse pregnancy outcomes.
        Thorax. 2006; 61: 169-176
        • Abdullah K.
        • Zhu J.
        • Gershon A.
        • et al.
        Effect of asthma exacerbation during pregnancy in women with asthma: a population-based cohort study.
        Eur Respir J. 2020; 55
        • Breton M.-C.
        • Martel M.-J.
        • Vilain A.
        • et al.
        Inhaled corticosteroids during pregnancy: a review of methodologic issues.
        Respir Med. 2008; 102: 862-875
        • Schatz M.
        • Zeiger R.S.
        • Harden K.
        • et al.
        The safety of asthma and allergy medications during pregnancy.
        J Allergy Clin Immunol. 1997; 100: 301-306
        • Silverman M.
        • Sheffer A.
        • Diaz P.V.
        • et al.
        Outcome of pregnancy in a randomized controlled study of patients with asthma exposed to budesonide.
        Ann Allergy Asthma Immunol. 2005; 95: 566-570
        • Bakhireva L.N.
        • Jones K.L.
        • Schatz M.
        • et al.
        Asthma medication use in pregnancy and fetal growth.
        J Allergy Clin Immunol. 2005; 116: 503-509
        • Perlow J.H.
        • Montgomery D.
        • Morgan M.A.
        • et al.
        Severity of asthma and perinatal outcome.
        Am J Obstet Gynecol. 1992; 167: 963-967
        • Alexander S.
        • Dodds L.
        • Armson B.A.
        Perinatal outcomes in women with asthma during pregnancy.
        Obstet Gynecol. 1998; 92: 435-440
        • Dombrowski M.P.
        • Schatz M.
        • Wise R.
        • et al.
        Randomized trial of inhaled beclomethasone dipropionate versus theophylline for moderate asthma during pregnancy.
        Am J Obstet Gynecol. 2004; 190: 737-744
        • Dombrowski M.P.
        • Brown C.L.
        • Berry S.M.
        Preliminary experience with triamcinolone acetonide during pregnancy.
        J Maternal-Fetal Med. 1996; 5: 310-313
        • Källén B.
        • Rydhstroem H.
        • Åberg A.
        Congenital malformations after the use of inhaled budesonide in early pregnancy.
        Obstet Gynecol. 1999; 93: 392-395
        • Källén B.
        • Olausson P.O.
        Use of anti-asthmatic drugs during pregnancy. 1. Maternal characteristics, pregnancy and delivery complications.
        Eur J Clin Pharmacol. 2007; 63: 363-373
        • Källén B.A.
        • Olausson P.O.
        Maternal drug use in early pregnancy and infant cardiovascular defect.
        Reprod Toxicol. 2003; 17: 255-261
        • Namazy J.
        • Schatz M.
        • Long L.
        • et al.
        Use of inhaled steroids by pregnant asthmatic women does not reduce intrauterine growth.
        J Allergy Clin Immunol. 2004; 113: 427-432
        • Blais L.
        • Beauchesne M.-F.
        • Rey É.
        • et al.
        Use of inhaled corticosteroids during the first trimester of pregnancy and the risk of congenital malformations among women with asthma.
        Thorax. 2007; 62: 320-328
        • Ericson A.
        • Källén B.
        Use of drugs during pregnancy—unique Swedish registration method that can be improved.
        Inf Swedish Med Prod agency. 1999; 1: 8-11
        • Olesen C.
        • Thrane N.
        • Nielsen G.L.
        • et al.
        A population-based prescription study of asthma drugs during pregnancy: changing the intensity of asthma therapy and perinatal outcomes.
        Respiration. 2001; 68: 256-261
        • Blais L.
        • Beauchesne M.-F.
        • Lemière C.
        • et al.
        High doses of inhaled corticosteroids during the first trimester of pregnancy and congenital malformations.
        J Allergy Clin Immunol. 2009; 124: 1229-1234. e1224
        • Norjavaara E.
        • de Verdier M.G.
        Normal pregnancy outcomes in a population-based study including 2968 pregnant women exposed to budesonide.
        J Allergy Clin Immunol. 2003; 111: 736-742
        • Gluck P.A.
        • Gluck J.C.
        A review of pregnancy outcomes after exposure to orally inhaled or intranasal budesonide.
        Curr Med Res Opin. 2005; 21: 1075-1084
        • Suissa S.
        • Ernst P.
        • Boivin J.-F.
        • et al.
        A cohort analysis of excess mortality in asthma and the use of inhaled beta-agonists.
        Am J Respir Crit Care Med. 1994; 149: 604-610
        • Garne E.
        • Vinkel Hansen A.
        • Morris J.
        • et al.
        Risk of congenital anomalies after exposure to asthma medication in the first trimester of pregnancy–a cohort linkage study.
        BJOG: An Int J Obstet Gynaecol. 2016; 123: 1609-1618
        • Eltonsy S.
        • Kettani F.-Z.
        • Blais L.
        Beta2-agonists use during pregnancy and perinatal outcomes: a systematic review.
        Respir Med. 2014; 108: 9-33
        • Cossette B.
        • Beauchesne M.-F.
        • Forget A.
        • et al.
        Relative perinatal safety of salmeterol vs formoterol and fluticasone vs budesonide use during pregnancy.
        Ann Allergy Asthma Immunol. 2014; 112: 459-464
        • Satia I.
        • Cusack R.
        • O’Byrne P.
        Paradigm shift in the management of mild asthma: Focus toward a patient centered approach.
        Can J Respir Crit Care Sleep Med. 2020; 4: 55-60
        • Cusack R.P.
        • Satia I.
        • O’Byrne P.M.
        Asthma maintenance and reliever therapy: Should this be the standard of care?.
        Ann Allergy Asthma Immunol. 2020; 125: 150-155
        • Eltonsy S.
        • Forget A.
        • Beauchesne M.-F.
        • et al.
        Risk of congenital malformations for asthmatic pregnant women using a long-acting β2-agonist and inhaled corticosteroid combination versus higher-dose inhaled corticosteroid monotherapy.
        J Allergy Clin Immunol. 2015; 135: 123-130. e122
        • Park-Wyllie L.
        • Mazzotta P.
        • Pastuszak A.
        • et al.
        Birth defects after maternal exposure to corticosteroids: prospective cohort study and meta-analysis of epidemiological studies.
        Teratology. 2000; 62: 385-392
        • Skuladottir H.
        • Wilcox A.J.
        • Ma C.
        • et al.
        Corticosteroid use and risk of orofacial clefts.
        Birth Defects Res Part A: Clin Mol Teratology. 2014; 100: 499-506
        • Howley M.M.
        • Papadopoulos E.A.
        • Van Bennekom C.M.
        • et al.
        Asthma Medication Use and Risk of Birth Defects: National Birth Defects Prevention Study, 1997–2011.
        J Allergy Clin Immunol In Pract. 2020; 8: 3490-3499.e9
        • Blais L.
        • Kettani F.-Z.
        • Forget A.
        • et al.
        Asthma exacerbations during the first trimester of pregnancy and congenital malformations: revisiting the association in a large representative cohort.
        Thorax. 2015; 70: 647-652
        • Spector S.L.
        Safety of antileukotriene agents in asthma management.
        Ann Allergy Asthma Immunol. 2001; 86: 18-23
        • Cavero-Carbonell C.
        • Vinkel-Hansen A.
        • Rabanque-Hernández M.J.
        • et al.
        Fetal exposure to montelukast and congenital anomalies: a population based study in Denmark.
        Birth defects Res. 2017; 109: 452-459
        • Sarkar M.
        • Koren G.
        • Kalra S.
        • et al.
        Montelukast use during pregnancy: a multicentre, prospective, comparative study of infant outcomes.
        Eur J Clin Pharmacol. 2009; 65: 1259-1264
        • Kim L.H.
        • Saleh C.
        • Whalen-Browne A.
        • et al.
        Triple vs Dual Inhaler Therapy and Asthma Outcomes in Moderate to Severe Asthma: A Systematic Review and Meta-analysis.
        JAMA. 2021; 325: 2466-2479
        • Busse W.W.
        NAEPP expert panel report: managing asthma during pregnancy: recommendations for pharmacologic treatment—2004 update.
        J Allergy Clin Immunol. 2005; 115: 34-46
        • Weinberger M.
        • Hendeles L.
        Theophylline in asthma.
        N Engl J Med. 1996; 334: 1380-1388
        • Barnes P.J.
        Theophylline.
        Am J Of Respir And Crit Care Med. 2013; 188: 901-906
      2. Genentech. Xolair (omalizumab): full prescribing information.
        (Available at:) (Accessed)
        • Namazy J.A.
        • Blais L.
        • Andrews E.B.
        • et al.
        Pregnancy outcomes in the omalizumab pregnancy registry and a disease-matched comparator cohort.
        J Allergy Clin Immunol. 2020; 145 (e521): 528-536
        • Yancey S.W.
        • Keene O.N.
        • Albers F.C.
        • et al.
        Biomarkers for severe eosinophilic asthma.
        J Allergy Clin Immunol. 2017; 140: 1509-1518
      3. Glaxosmithkline. Nucala (mepolizumab): summary of product characteristics. 2021.

        • Hom S.
        • Pisano M.
        Reslizumab (Cinqair): an Interleukin-5 antagonist for severe asthma of the eosinophilic phenotype.
        P T. 2017; 42: 564
      4. (Astrazeneca. Fasenra (benralizumab): prescribing information. Available at:) (Accessed)
      5. Regeneron. Dupixent (dupilumab): prescribing information.
        (Available at:) (Accessed)
        • Kage P.
        • Simon J.
        • Treudler R.
        A case of atopic eczema treated safely with dupilumab during pregnancy and lactation.
        J Eur Acad Dermatol Venereol. 2020; 34: e256-e257
        • Mian M.
        • Dunlap R.
        • Simpson E.
        Dupilumab for the treatment of severe atopic dermatitis in a pregnant patient: A case report.
        JAAD Case Rep. 2020; 6: 1051
        • Lobo Y.
        • Lee R.C.
        • Spelman L.
        Atopic Dermatitis Treated Safely with Dupilumab during Pregnancy: A Case Report and Review of the Literature.
        Case Rep Dermatol. 2021; 13: 248-256
      6. European Medicines Agency (EMA): assessment report; dupilumab. 2017.

        • Knudsen U.B.
        • Hansen V.
        • Juul S.
        • et al.
        Prognosis of a new pregnancy following previous spontaneous abortions.
        Eur J Obstet Gynecol Reprod Biol. 1991; 39: 31-36
        • Gray R.H.
        • Wu L.Y.
        Subfertility and risk of spontaneous abortion.
        Am J Public Health. 2000; 90: 1452
      7. European Medicines Agency (EMA): Summary of product characteristics. 2020.

        • Cusack R.P.
        • Whetstone C.E.
        • Xie Y.
        • et al.
        Regulation of Eosinophilia in Asthma—New Therapeutic Approaches for Asthma Treatment.
        Cells. 2021; 10: 817
        • Kabata H.
        • Moro K.
        • Fukunaga K.
        • et al.
        Thymic stromal lymphopoietin induces corticosteroid resistance in natural helper cells during airway inflammation.
        Nat Commun. 2013; 4: 1-10
      8. Astrazeneca. Tezspire™(tezepelumab) prescribing information: 2021.

        • Menzies-Gow A.
        • Corren J.
        • Bourdin A.
        • et al.
        Tezepelumab in Adults and Adolescents with Severe, Uncontrolled Asthma.
        N Engl J Med. 2021; 384: 1800-1809
        • Lupattelli A.
        • Spigset O.
        • Twigg M.J.
        • et al.
        Medication use in pregnancy: a cross-sectional, multinational web-based study.
        BMJ open. 2014; 4: e004365