USE OF INHALED CORTICOSTEROIDS IN PREGNANCY

Corticosteroids are a class of hormones produced in the adrenal cortex which are involved in a range of physiological functions. Inhaled corticosteroids are commonly used to reduce inflammation and suppress the immune system in the treatment of conditions such as asthma.  Inhaled corticosteroids available in the UK include: beclometasone, budesonide, ciclesonide, fluticasone and mometasone.

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 spontaneous abortion, or adverse neurodevelopmental outcomes in the child following gestational exposure to inhaled corticosteroids.

If the use of inhaled corticosteroids is indicated at any stage of pregnancy treatment should not be withheld. Pregnant women with asthma should be counselled about the importance of maintaining good control of their asthma, including use of prescribed medication. Exposure to inhaled corticosteroids at any stage in pregnancy would not usually 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.