Ask the Allergist: Pregnancy and Asthma Medications
Q: “Is it safe to take asthma and allergy medication during pregnancy?”
Maeve O’Connor, MD: It’s best to be cautious using any medication during pregnancy – especially during the first trimester. However, uncontrolled asthma is dangerous for both mother and child and medications may be necessary. The key is to work closely with both your board-certified allergist and obstetrician to develop a treatment plan that addresses not only taking medications but also avoiding triggers.
Most asthma medications, including albuterol and levalbuterol inhalers and inhaled corticosteroids, are listed by the U.S. Food and Drug Administration as category C, meaning that while there may be some risk using the medication, the potential benefits outweigh those risks for mother and baby.
The only asthma and allergy medications listed as category B – meaning “no evidence of harm to the fetus” – are budesonide, a corticosteroid available as Pulmicort in a dry powder inhaler, and montelukast, a leukotriene inhibitor available as Singulair.
Regarding allergy medications, if a mom-to-be has mild nasal allergy symptoms that are not interfering with her daily routine, my recommendation is to not take any medication. If she is experiencing recurrent infections due to uncontrolled allergic rhinitis, then medications are appropriate. Most antihistamines are category B while decongestants are either B or C.
Always consult with your allergist before taking any asthma or allergy medication during pregnancy and keep your obstetrician fully informed.
“What goes into an asthma or allergy treatment plan for expectant mothers?”
First and foremost, I encourage my female patients to meet with me prior to starting a family. It’s a great opportunity to review or adjust the Asthma Action Plan, discuss medications and find ways to alleviate potential symptom triggers before pregnancy.
Asthma and allergies are unpredictable in moms-to-be. Some find that their symptoms worsen, while others find that they improve or stay the same.
When an expectant mom with asthma or allergies comes to my office, first I want to find out if she is getting quality prenatal care and taking care of her general health. Is she eating healthy? Taking prenatal vitamins? Getting regular exercise and rest?
Depending on the patient, I typically prescribe minimal medications to start, while weighing benefit vs. risk. Then I follow the Asthma Action Plan to watch for any change in symptoms. If symptoms worsen or become uncontrolled, I will turn to more aggressive therapy.
Apart from medications, environmental control measures are the hallmark for managing asthma and allergy symptoms. During pregnancy, women must be extra careful to avoid anything that might cause a flare. This may include staying inside on high pollen days, eliminating mold from the home, installing dust mite covers on mattresses and pillows, and keeping pets out of bedrooms.
Some easy and benign treatments are saline irrigation of the nasal passages and eye drops for allergic conjunctivitis; both are safe during pregnancy.
I like to see my pregnant patients every three months. If they are feeling better with their asthma or allergies, we may be able to step down medication therapy – which of course is always the best approach in any patient, whether pregnant or not.
Maeve O’Connor, MD, FACAAI, is a board-certified allergist with Allergy, Asthma & Immunology Relief (AAIR) in Charlotte, N.C. She is a Fellow and serves on the Board of Regents with the American College of Allergy, Asthma & Immunology.
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Reviewed by Stanley Fineman, MD