Q&A: Are drugs for asthma safe in pregnancy?

The developing baby won't do very well if the expectant mother doesn't do well. Asthma is an illness that can be mild but can also be severe and life-threatening. Pregnancy, of course, is an additional physiological challenge that can affect the severity of asthma. I would recommend that you go with your obstetrician's advice, as he or she has probably had a lot of experience with pregnancy and asthma.

As far as cleft palates and other deformities in animal studies, the first thing you have to remember is that you cannot translate the risk in animals to the risk in humans. We compare them anyway, because any information is better than no information. Asthma medicines are not the only drugs that carry warnings. Every day, I and all other obstetricians use medicines that have some potential risk attached. Luckily, these risks are rarely encountered. As with any choice in medicine, the bottom line is risk versus benefit.

You've got to take care of Mom first, otherwise Baby will suffer, too. Treat your asthma and allow your doctor to choose the drugs that have benefits that outweigh risks. You're not going to find a completely risk-free medicine, not even Tylenol (which I recommend all the time). But remember that the risks from undertreated asthma are much worse for the baby than any of the drugs used to treat it.

For the record, in my practice, asthma and pregnancy have enjoyed a fairly harmless coexistence. Perhaps this is because I treat the mother first, allowing the baby to bask in the protection of good maternal health.

An added note: In pregnancy your immune system is somewhat blunted, otherwise you might reject the baby, but this means that little upper-respiratory infections may become worse, especially with an asthma history. In my practice, I'm fairly liberal with antibiotics in pregnant asthma patients who have upper respiratory infections.