Expecting a baby? Congratulations!
But are the treatments safe for your baby?
Good news for mums-to-beThe first question women ask when they know they are expecting a baby or hoping to be, is "But will the medicine harm my baby?"
The good news is that all the common allergy medicines are known to be remarkably safe in pregnancy.
Not only should you be able to enjoy your pregnancy without suffering unduly from asthma and allergies, but good asthma control is especially important when you are pregnant.
With newer medicines there is often no formal information about safety in pregnancy. Nowadays, when new drugs are tested, women who are or might become pregnant are not allowed to take part in the safety tests. This means that we do not have the same information on safety in pregnancy which we have for people who are not pregnant. The reason for this is obvious. No manufacturer wants to take the least risk with unborn babies.
But older medicines have been used for a long time before the thalidomide catastrophe taught us that unborn babies have a special risk. They were all used in pregnancy, and all the common ones amongst them are known to be safe in pregnancy.
In the case of newer medicines you should avoid them in pregnancy if possible, just in case. But there are usually older alternatives. In time it becomes obvious for each newer medicine that it must be safe, because many women do not know at first that they are pregnant, and so take common medicines like the rest of us. Willy-nilly, these women act as 'guinea pigs' for the rest of us. This may upset you; if you are a woman and are concerned about this, the rule is: don't take medicines which have not been used by millions of people and for at least three years if there is any possibility, however remote, that you might be pregnant. Unfortunately, human life being what it is, surprisingly many women do not admit to themselves that they might be or become pregnant when they have sexual intercourse.
In practice, there is a good choice of medicines which is either known to be highly safe in pregnancy or which must at least be safe enough for all ordinary purposes.
When a baby is conceived, you don't know whether it is going to be a boy or a girl. You
don't know whether it will be more clever or less so. We take the chance happily. Some
pregnancies, at the best of times, end in loss of the baby, and of course a few babies are born
with illnesses and defects, even to mums who have not been anywhere near medicines. That is part
of life. Again, we normally accept these chances when we decide we want a baby. The point is that
the overwhelming majority of problems have nothing at all to do with medical treatments.
But what about my medicine?Here is a little about the main medicines used in asthma.
Asthma when you are expecting a baby: the reasons why good treatment is specially importantFar from being dangerous in pregnancies, asthma medicines help to protect your baby and help it to develop normally.
There are no known harmful effects from inhaled steroids (or any preventer inhaler) and bronchodilators (or any reliever inhaler used within reason). And this is despite many serious attempts to check whether there might be some harm, and widespread experience of these drugs in pregnancy over decades.
Many experts over the years have looked at all the evidence. They have all come to the same conclusion; keeping asthma well treated in pregnancy pays dividends in protecting the unborn baby, and no side effect comes close to cancelling the real benefits from the treatment.
That's all very well, but doctors don't know everything. I'd like to keep medicines to a minimum anyway, specially whilst I am carrying my unborn baby.We understand. Here's what you can do.
First of all, don't smoke. Smoking is bad for your baby in several ways. Smoking causes asthma-like changes in your baby's lungs, for example. Smoking is also bad for your asthma. If you don't smoke you will probably need less medicine.
Smoking by others who are with you is also bad, though not as bad as smoking yourself.
Do what you can to avoid allergic causes of asthma such as pets and house dust mites. You can read about some of these in other parts of these web pages. By keeping away from the causes of asthma you will also reduce the amount of medicine you are likely to need.
Get good advice about your asthma, and take your regular treatment regularly. By doing this you will be less likely to have worsening of your asthma or even an emergency. In other words, regular steady preventer treatment means that you are much less likely to need big doses of drugs because of worsening asthma.
Will my asthma get worse, or better, whilst I am pregnant?Either of these things may happen. The asthma gets worse in about one third of pregnant women, occasionally severely so. If it improves, nothing to worry about. If it gets worse you will benefit from expert help. People will want to take specially good care of you whilst you are pregnant.
A few women get asthma for the first time whilst they are expecting. Or you may have had asthma as a child and get it again whilst you are expecting. These things can happen at any time of life, but because pregnancy sometimes has a bad effect on asthma, they may happen particularly at this time. There's no need to panic. Here's what you should do. Go to your doctor and make sure you get not just the same attention as anyone else with new asthma, but a bit more. After all, there are two of you to consider (at least!). If your asthma has just started or re-started, this means your lungs are basically very close to normal, so treatment should be very effective.
Just very rarely asthma can be vicious just in pregnancy, and the expectant mum has to be admitted to hospital to control the asthma. Although this is bad, such asthma gets much better again after pregnancy, so there is at least some good news. If you are in this situation, try to get treated by an asthma specialist, and not only the obstetrician or a general physician.
In short, the rules for dealing with asthma in pregnancy are basically the same as at other times, and the difference is mainly that you should just get more attention and care than most people get at other times.
What about treatments for other allergies such as hay fever if I am expecting?
The steroids which we use for sprays for the nose in hay fever and similar allergies are the same ones which are so safe in asthma . They should be just as safe when you use them for your nose, at least if you stick to normal doses.
The commonest antihistamines seem to be safe as well. The old sedative ones in common use were investigated in great detail, and turned out to be safe. The newer antihistamines, which don't make you sleepy, could not be investigated this way because women and doctors now avoid using drugs during pregnancy. But in practice it happens often that women take medicines without knowing that they are pregnant. If a baby is born with a malformation, people always enquire whether it could have been caused by a drug which the mother took whilst she was pregnant. This surely means that the commoner antihistamines of the newer generation which have been around for the longest time, such as fexofenadine and cetirizine, must be safe by all reasonable criteria. Some people might be puzzled at my inclusion of fexofenadine, a rather new drug. But it is not nearly as new as it seems. Its formerly widely used predecessor, terfenadine, was turned into fexofenadine in the body. So expectant mothers have probably been exposed to fexofenadine more than to any other antihistamine, and we know more about its safety.
It was updated on 2 April 1997 & corrected 14-4-97. Amendments: 20 March 98. New asthma 30 May 1998. 25 Jan 2001; allergy other than asthma.
Copyright © 1997, 1998, 2001 Martin Stern