Inhaled corticosteroids

(Date: December 2016. Version: 1.1)

This factsheet has been written for members of the public by the UK Teratology Information Service (UKTIS). UKTIS is a not-for-profit organisation funded by Public Health England on behalf of UK Health Departments. UKTIS has been providing scientific information to health care providers since 1983 on the effects that medicines, recreational drugs and chemicals may have on the developing baby during pregnancy.

What are they?

Corticosteroids are a group of medicines that reduce inflammation in the body and suppress the immune system. Inhaled corticosteroids (beclometasone, budesonide, ciclesonide, fluticasone, and mometasone) are mainly used to treat asthma.

Is it safe to use inhaled corticosteroids in pregnancy?

Inhaled corticosteroids can be used to treat asthma in pregnancy. There are now numerous studies in humans that do not show harmful effects on the baby, although because no study is perfect and a few studies have raised concerns, ongoing research is needed.

It is very important to keep asthma as well-controlled as possible in pregnancy, as asthma attacks are potentially harmful to both mother and baby. In some women symptoms of asthma improve as pregnancy progresses and a doctor might then advise that certain treatments can be reduced or stopped. For other women symptoms stay the same or get worse and treatment with inhaled corticosteroids throughout pregnancy might need to be continued or increased.

Studies of non-pregnant individuals have shown that high doses of inhaled corticosteroids (only usually prescribed for severe asthma on specialist advice) can produce similar side effects to corticosteroids taken by mouth, suggesting that high levels of inhaled corticosteroid can reach the blood. The studies of inhaled corticosteroid use in pregnancy (described below) include women using a broad range of dosages but do not analyse babies of women taking high dose inhaled corticosteroids separately. Women using high doses of inhaled corticosteroids are therefore advised to also read the bumps leaflet on use of corticosteroid tablets. For women taking low or medium doses of inhaled corticosteroids the information below should be relevant.

Do not alter the dose of any of your asthma medicines without medical supervision as this could lead to an asthma attack. Your doctor is the best person to help you decide what is right for you and your baby.

What if I have already used inhaled corticosteroids during pregnancy?

Inhaled corticosteroids are considered appropriate for the treatment of asthma or other medical conditions in pregnancy. However, if you are using any medicines in pregnancy it is always a good idea to let your doctor know that you are pregnant so that you can decide together whether you still need all the medicines that you are on and to make sure that you are taking the lowest dose that works.

Can using inhaled corticosteroids in pregnancy cause my baby to be born with birth defects?

A baby’s body and most internal organs are formed during the first 12 weeks of pregnancy. It is mainly during this time that some medicines are known to cause birth defects. 

Medicines can have different effects in humans and animals. Although studies have shown that treatment with corticosteroid tablets increases the occurrence of cleft lip and palate in baby rats, mice and rabbits, nine out of the 10 human studies that include a total of over 30,000 pregnant women using inhaled corticosteroids do not show overall that this increases the occurrence of cleft lip and palate in the baby. 

Five out of six studies of a total of over 23,000 pregnant women using inhaled corticosteroids found that their babies were no more likely to have a heart defect.

Two studies both agreed that the chance of a neural tube defect (such as spina bifida) was not increased following exposure in the womb to inhaled corticosteroids.

Two studies found that rates of anal atresia (where the baby’s anus is closed and does not join with the bowel) were increased in babies born to women using inhaled corticosteroids, but a further two studies have not agreed with this finding. More research into this subject is therefore required.

Rates of other specific birth defects have not been studied in a large enough number of pregnant women to assess whether there may be link to use of inhaled corticosteroids. Further research into the rates of other birth defects following exposure to inhaled corticosteroids in the womb is therefore required.

Can using inhaled corticosteroids in pregnancy cause miscarriage?

The only study carried out so far that has investigated the chance of miscarriage found no increased risk in around 100 pregnant women using inhaled corticosteroids. Further studies into this subject are required to confirm this finding.

Can using inhaled corticosteroids in pregnancy cause stillbirth?

The two studies carried out so far of a total of more than 3,100 pregnant women have provided no evidence that use of inhaled corticosteroids in pregnancy increases the risk of stillbirth.

Can using inhaled corticosteroids in pregnancy cause preterm birth?

None of 10 studies of a total of over 4,400 babies born to women using inhaled corticosteroids in pregnancy provided any evidence that such use increases the chance of preterm birth.

Can using inhaled corticosteroids in pregnancy cause low birth weight in the baby?

None of 10 studies of a total of over 5,000 babies born to women using inhaled corticosteroids in pregnancy provided any evidence that such use alters a baby’s growth in the womb.

Can using inhaled corticosteroids in pregnancy cause learning or behavioural problems in the child?

A baby’s brain continues to develop right up until the end of pregnancy. It is therefore possible that taking certain medicines at any stage of pregnancy could have a lasting effect on a child’s learning or behaviour.

No studies have yet investigated the learning and behaviour of children whose mothers used inhaled corticosteroids during pregnancy.

Will my baby need extra monitoring during pregnancy?

As part of their routine antenatal care most women will be offered a scan at around 20 weeks of pregnancy to look for birth defects and to check the baby’s growth.

There is no evidence that using an inhaled corticosteroid during pregnancy causes any problems that would require extra monitoring of your baby. However, pregnant women with severe asthma might receive extra monitoring during pregnancy to ensure that they remain healthy and that the baby is growing and developing as expected.

Are there any risks to my baby if the father has used an inhaled corticosteroid?

We would not expect any increased risk to your baby if the father used an inhaled corticosteroid before or around the time you became pregnant.

Who can I talk to if I have questions?

If you have any questions regarding the information in this leaflet please discuss them with your health care provider. They can access more detailed medical and scientific information from www.uktis.org.  

General information 

Up to 1 out of every 5 pregnancies ends in a miscarriage, and 1 in 40 babies are born with a birth defect. These are referred to as the background population risks.  They describe the chance of these events happening for any pregnancy before taking factors such as the mother’s health during pregnancy, her lifestyle, medicines she takes and the genetic make up of her and the baby’s father into account.

Medicines use in pregnancy

Most medicines used by the mother will cross the placenta and reach the baby. Sometimes this may have beneficial effects for the baby.  There are, however, some medicines that can harm a baby’s normal development.  How a medicine affects a baby may depend on the stage of pregnancy when the medicine is taken. If you are on regular medication you should discuss these effects with your doctor/health care team before becoming pregnant.

If a new medicine is suggested for you during pregnancy, please ensure the doctor or health care professional treating you is aware of your pregnancy.

When deciding whether or not to use a medicine in pregnancy you need to weigh up how the medicine might improve your and/or your unborn baby’s health against any possible problems that the drug may cause. Our bumps leaflets are written to provide you with a summary of what is known about use of a specific medicine in pregnancy so that you can decide together with your health care provider what is best for you and your baby.   

Every pregnancy is unique. The decision to start, stop, continue or change a prescribed medicine before or during pregnancy should be made in consultation with your health care provider. It is very helpful if you can record all your medication taken in pregnancy in your hand held maternity records.

   

www.medicinesinpregnancy.org

Disclaimer: This information is not intended to replace the individual care and advice of your health care provider. New information is continually becoming available. Whilst every effort will be made to ensure that this information is accurate and up to date at the time of publication, we cannot cover every eventuality and the information providers cannot be held responsible for any adverse outcomes following decisions made on the basis of this information. We strongly advise that printouts should NOT be kept for any length of time, or for “future reference” as they can rapidly become out of date.

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