They do have a role in some cases of asthma in pregnancy as maintenance therapy. Regarding safety, if prescribed, they should be used. In fact, in normal dosage, these steroids do not cross the placenta and therefore do not reach the fetus. In very high doses, minimal amounts may cross the placenta, but there is no undue adverse effect on the fetus.
What about the safety of medicines such as salbutamol (Ventolin®, Volmax®) used to treat attacks?
Salbutamol is safe to use in pregnancy. So are the other related preparations such as terbutaline (Bricanyl®).
If somebody has been using Theophylline to treat attacks of asthma, is there any need to switch to anything else if she becomes pregnant?
No. Theophylline (Slo-Phyllin®, Elixophyllin® Uniphyllin Continus®) and the related drug aminophylline (Phyllocontin Continus®, Truphylline®) are known to be safe for use in pregnancy. In fact, they are the more widely used anti-asthma drugs in the United States. However, sometimes pregnancy may necessitate adjusting the dose upwards.
In all cases of an asthmatic pregnant woman, a specialist physician (for respiratory conditions) will be involved in her care.
Asthma is not in itself an indication to induce labour. If intervention becomes necessary, it will be for the usual obstetric reasons.
If labour is being induced, prostaglandins may be used, provided the doctor ensures it is not Prostaglandin F, which could provoke an asthmatic attack. Prostaglandin E, which is perfectly safe, is the type in widespread use for induction.
Labour itself has no direct bearing on asthma and oxytocin (Syntocinon®) to augment labour may be used without fear. It is safe.
Ergometrine is a drug usually administered to facilitate delivery of the placenta and minimize bleeding after delivery. It will not be used in asthmatics; this is because it has the potential of provoking an attack. Oxytocin is normally an adequate substitute.
What about after delivery?
There is no increase in the risk of an attack following delivery but preventative treatment (if the woman has been on this ) should be maintained. The usual advice regarding physical activity in this period applies equally to asthmatics as to any woman who has just given birth. See Chapter 27, "Sport and exercise in pregnancy".
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