USE OF INHALED CORTICOSTEROIDS IN PREGNANCY

Inhaled corticosteroids are commonly used in the treatment of asthma. Inhaled corticosteroids available in the UK include: beclometasone, budesonide, ciclesonide, fluticasone and mometasone.

Good control of asthma during pregnancy is crucial. Inhaled corticosteroids should not be withheld if clinically indicated. Pregnant women with asthma should be counselled about the importance of maintaining control of their asthma, including continued use of prescribed medication.

Systemic exposure to corticosteroids in pregnancy has been associated in some (but not all) studies with an increased rate of orofacial clefts in the infant. Overall, the available evidence does not demonstrate that use of inhaled corticosteroids in early pregnancy causes orofacial clefts or cardiovascular malformations in the offspring. Data on other specific malformations are too limited to confirm or refute associations. The current data on intrauterine death rates following in utero exposure to inhaled corticosteroids are reassuring but require confirmation with further research. The available data do not suggest that gestational exposure to inhaled corticosteroids increases the risk of pathological birth weight outcomes (low birth weight, intrauterine growth restriction, small for gestational age) or preterm delivery. Due to limited data, it is not currently possible to conduct an evidence-based assessment of the risks of miscarriage or adverse neurodevelopmental outcomes in the child following gestational exposure to inhaled corticosteroids.

Exposure to inhaled corticosteroids at any stage in pregnancy would not be regarded as medical grounds for termination of pregnancy or any additional fetal monitoring. However, other risk factors may be present in individual cases which may independently increase the risk of adverse pregnancy outcome. Clinicians are reminded of the importance of consideration of such factors when performing case-specific risk assessments.