Assessment of Inhaled Corticosteroid Therapy for Asthma Treatment during Pregnancy

Background: Inhaled corticosteroids (ICSs) have become widely used in asthma management during pregnancy since the publication of the NIH report Management of Asthma during Pregnancy in 1993. In the current study, the usefulness and safety of ICSs in the treatment of pregnant women with asthma were investigated. Methods: Of 11,358 women who delivered in our hospital between January 1987 and December 2003, 592 women had asthma. Their midwifery records, delivery records, and clinical charts retained in the outpatient clinic of the internal medicine department were reviewed to identify treatments provided, pregnancy/delivery course, and possible perinatal abnormalities. On the basis of these data, the usefulness and safety of ICSs were retrospectively investigated. Results: The percentage of pregnant women with asthma receiving asthma treatment was 17.5% from 1987 to 1989, 32.7% from 1990 to 1994, 43.8% from 1995 to 1999, and 40.7% from 2000 to 2003. Among those treated, the proportion treated with ICSs showed an increase (0% from 1987 to 1989, 10.0% from 1990 to 1994, 55.3% from 1995 to 1999, and 83.3% from 2000 to 2003). Intrapartum asthma attacks occurred in 1.38% of the asthma patients from 1995 to 1999, while there was no such occurrence in 2000 or later. In the untreated patients, the incidence of perinatal abnormalities remained unchanged with the guideline publication (31.6% before and 31.3% after). In contrast, the incidence of perinatal abnormalities in the treated patients decreased from 59.6% to 26.2% with the guideline publication. The incidence of perinatal abnormality among the treated was compared between the ICS therapy and non-ICS therapy groups. No difference was observed between the two groups from 1987 to 1994, but from 1995 to 2003, the total incidence of perinatal abnormalities was significantly higher in the non-ICS group. Conclusions: ICSs can be considered to be safe and useful for the prevention of asthma attacks during pregnancy and for decreasing perinatal abnormalities