USE OF INHALED CORTICOSTEROIDS IN PREGNANCY

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(Date of issue: December 2016, Version: 1.1)

This is a UKTIS monograph for use by health care professionals. For case-specific advice please contact UKTIS on 0344 892 0909. To report an exposure please download and complete a pregnancy reporting form. Please encourage all women to complete an online reporting form.

Summary

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.      
               
This document is regularly reviewed and updated. Only use full UKTIS monographs downloaded directly from TOXBASE.org to be sure you are using the most up-to-date version. The summaries of these monographs are openly available on UKTIS.org.

This is a summary of the full UKTIS monograph for health care professionals and should not be used in isolation. The full UKTIS monograph and access to any hyperlinked related documents is available to health care professionals at www.toxbase.org.

If you have a patient with exposure to a drug or chemical and require assistance in making a patient-specific risk assessment, please telephone UKTIS on 0344 892 0909 to discuss the case with a teratology specialist.

If you would like to report a pregnancy to UKTIS please click here to download our pregnancy reporting form. Please encourage all women to complete an online reporting form.

Disclaimer: Every effort has been made to ensure that this monograph was accurate and up-to-date at the time of writing, however it cannot cover every eventuality and the information providers cannot be held responsible for any adverse outcomes of the measures recommended. The final decision regarding which treatment is used for an individual patient remains the clinical responsibility of the prescriber. This material may be freely reproduced for education and not for profit purposes within the UK National Health Service, however no linking to this website or reproduction by or for commercial organisations is permitted without the express written permission of this service. This document is regularly reviewed and updated. Only use UKTIS monographs downloaded directly from TOXBASE.org or UKTIS.org to ensure you are using the most up-to-date version.