Table 1 Recommendations for treatment of asthma and allergies in pregnancy
From: Allergic diseases and asthma in pregnancy, a secondary publication
| Drug | Safety Data |
|---|---|
| Common asthma medications and safety data | |
| Inhaled bronchodilators (e.g. Albuterol, Formoterol and Salmeterol) | Human data generally reassuring for short acting and long-acting bronchodilators |
| Theophylline | Reassuring human data; serum levels must be monitored very closely to avoid toxicity |
| Systemic corticosteroids | Human data from smaller case control studies show increase in oral clefts. Larger prospective studies show increase in low birth weight, preterm birth, preeclampsia and intrauterine growth retardation. |
| Inhaled corticosteroids | Human data mainly reassuring. There may be an increased risk of malformations seen with higher doses. |
| Leukotriene Receptor Antagonist (e.g. Montelukast, Zafirlukast) | Human data are generally reassuring |
| 5-Lipoxygenase-Inhibitor | Generally avoided during pregnancy due to the available less reassuring animal data. |
| Omalizumab | Increased risk of low birth weight and preterm birth; likely severity of asthma may confound to these observations. |
| Common allergic rhinitis medications and safety data | |
| Oral antihistamines (e.g. Azelastine, Cetirizine, Chlorpheniramine, Dexchlorpheniramine, Fexofenadine, Diphenhydramine, Hydroxyzine, Loratadine) |
Human data are generally reassuring. Hydroxyzine should be used cautiously during first trimester based on animal data. Fexofenadine (an active metabolite of Terfenedine): no reports of increased congenital malformations, however, no epidemiologic studies in human pregnancy available. |
| Oral and Nasal Decongestants (e.g. Oxymetazoline, Phenylephrine, Phenylpropanolamine, Pseudoephedrine) |
Should be avoided during pregnancy: Oxymetazoline has been associated with possible uteroplacental insufficiency at higher doses. Phenylephrine has been associated with clubfoot and eye/ear malformations. Phenylpropanolamine associated with congenital malformations, gastroschisis and ventricular septal defect. Pseudoephedrine associated with gastroschisis, hemifacial microsomia and small intestinal atresia in some case–control studies. |
| Intranasal Antihistamines (e.g. Azelastine, Olapatadine) | Animal studies are reassuring. |
| Intranasal Corticosteroids (e.g. Budesonide, Fluticasone, Triamcinolone, Mometasone) | Substantial reassuring data for inhaled corticosteroids. Risk of increased malformations at high dose, but severity of allergic rhinitis may be a confounding factor for these outcomes. |