An asthmatic 25 years old woman would like to get pregnant. She is treated with Pulmicort (budesoni

Fråga: An asthmatic 25 years old woman would like to get pregnant. She is treated with Pulmicort (budesonide) 200 ug x2, Theo Dur (theophyllamine) 150 mgx3, Bricanyl (terbutaline), Lomudal (cromoglycate) and Berotec (fenoterol). Is there some risk for the foetus if the patient continues to be treated with these drugs?

Sammanfattning: The drugs used in this patient are considered safe during pregnancy. Special attention must be paid, at the end of the pregnancy, to the effects of theophylline and beta-sympathomimetics on the newborn. As a general rule, the patient should be treated with as small number of drugs as possible and preferably with inhalation therapy.

Svar: BUDESONIDE. The use of corticosteroids during pregnancy (mainly prednisone or prednisolone) has not been related to any increase in malformations. Only in women taking an oral dose during whole pregnancy has a small reduction in the weight of the children been reported (but these children are still in the normal weight ranges) (1). Beclomethasone inhalations has not been related to any risk (2-5), and it is considered a safe drug during pregnancy. There are not sufficient data to evaluate the risk with budesonide but no reports have been published.

THEOPHYLLINE is the bronchodilator of choice for asthma and chronic obstructive pulmonary disease in a pregnant patient (6-10). No reports linking the use of theophylline with congenital defects have been located. Some cases of transient side effects (transient takycardia, irritability, vomiting) have been found in newborns of mothers treated with theophylline, and are more likely to occur when maternal serum levels at term are in the high terapeutic range or above (6).

TERBUTALINE. No reports linking the use of terbutaline with congenital defects have been located (9, 11-12). When used as a tocolytic agent (as is the case with other beta-sympathomimetics (3)) it may cause fetal and maternal tachycardia (13-14). Some cases of neonatal hypoglycemia (due to an increase in serum insulin level in the mother) can be seen if maternal treatment has not been terminated prior to delivery (11).

DISODIUM CROMOGLYCATE. No reports on foetal damage have been found (3,8,15).

FENOTEROL. No reports on foetal damage have been found (3,15-16) (cf terbutaline).