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First-trimester exposure to asthma medications increases risk for birth defects

Exposure to inhaled beta-2 agonists during the first trimester of pregnancy appeared to increase the odds for congenital abnormalities, according to study results.

However, pregnant women should maintain using asthma medications because the risk for uncontrolled asthma may be much greater than the risk for certain birth defects, according to the researchers.

Ester Garne, MD, from the pediatric department at Hospital Lillebaelt Kolding in Denmark, and colleagues conducted a population-based, case-malformed control study to assess the increased risk for specific birth defects after exposure to anti-asthma medications during the first trimester of pregnancy.

The analysis included 70,205 registrations of birth defects from 13 population-based registries from 1995 to 2010. Of those registrations, 16,803 had a birth defect within one of the congenital anomaly subgroups, and 1,301 registrations reported exposure to one or more asthma medications.

Exposure to inhaled beta-2 agonists during the first trimester appeared to increase the risk for cleft palate (OR = 1.63; 95% CI, 1.05-2.52) and gastroschisis (OR = 1.89; 95% CI, 1.12-3.2) compared with nonchromosomal control registrations (n = 43,824).

Pregnant women should seek an alternative method to treat asthma other than beta-2 agonists, Garne and colleagues said.

“Use of prophylactic inhaled steroids seems to be the best solution for treatment of asthma in pregnancy to prevent exacerbations and to reduce the need for beta-2 agonists,” the researchers wrote.

The investigators said they can neither completely confirm nor deny that exposure to asthma medications caused the birth defects.

“Although fetuses were exposed to asthma medication, we cannot know whether it was the medication that caused the congenital anomalies or whether it was the maternal asthma because different types of anti-asthma medications are used for different severities of asthma,” the researchers wrote. – by Ryan McDonald

Disclosure: Garne reports receiving research support from the European Union Framework 7 Programme. Please see the full study for a list of all other authors’ relevant financial disclosures.