Pregnant women with asthma who continued inhaled corticosteroids (ICS) during the first trimester did not have increased risks for adverse maternal or neonatal outcomes compared with those who discontinued treatment, according to a cohort study published in JAMA Network Open.

Despite guidelines recommending continued ICS use to maintain asthma control during pregnancy, nearly two thirds of women in the study stopped treatment during the first trimester.

“People who are not on appropriate therapy for their asthma are at high risk for complications to their health, including hospitalizations for breathing distress and asthma exacerbations that require higher levels of care like the ICU,” said Xiao-Yu Wang, MD, assistant professor of maternal-fetal medicine at Northwestern University Feinberg School of Medicine in Chicago, who was not associated with the study.

Asthma during pregnancy has been associated with preeclampsia or eclampsia, premature contractions, emergency cesarean sections, low birth weight, and small for gestational age.

The study took place between 2009 and 2023 in South Korea. Researchers analyzed health records from 2108 women aged 15-50 years (mean age, 33 years) who were pregnant, had asthma, and received at least two ICS prescriptions during the 6 months before their last menstrual period. Women who filled at least one prescription during the first trimester were considered to have continued use.

The medications included were beclomethasone, budesonide, fluticasone, triamcinolone, and ciclesonide, either alone or in combination inhalers.

Compared with discontinuation, continued use of the drugs was not associated with a statistically significant increased risk for preeclampsia, gestational diabetes, obstructed labor, antepartum hemorrhage, premature rupture of membranes, neonatal hypoxia or asphyxia, low birth weight, and congenital malformations.

“Asthma management during pregnancy should prioritize maintaining optimal disease control while incorporating individualized risk assessment, baseline severity, prior exacerbation history, and shared decision-making between patients and clinicians,” the researchers wrote.

The findings add to evidence supporting the safety of ICS during pregnancy even as many patients may be reluctant to continue medication because of concerns about fetal exposure. Previous research has shown a decline in asthma medication use during pregnancy.

“Ask every pregnant patient whether she has asthma, ask whether she’s still using her inhaler, check her technique, and tell her explicitly that continuing it is the recommended course,” said Yalda Afshar, MD, PhD, associate professor of obstetrics and gynecology at the David Geffen School of Medicine at UCLA, who was not associated with the study.

Afshar said many patients are not aware that ICS use is safe and stop taking it unless they are explicitly reassured. If their asthma worsens, they may ultimately end up needing to use oral corticosteroids, which carry greater risks during pregnancy.

Afshar tells reluctant patients, “Your baby doesn’t have its own oxygen supply. The safest baby is one with a well-oxygenated mother.”

Brittany Vargas is a journalist covering medicine, mental health, and wellness. 

The sources cited in this article reported no relevant disclosures.