Astmamedisiner og graviditet

Informasjon kun til helsepersonell

Pascal Demoly har skrevet en artikkel som gir en god oversikt over kunnskapen som finnes angående bruk av ulike astmamedisiner under graviditet:
Asthma therapy during pregnancy. [Demoly P et al 2003] .

Sammendrag av de viktigste punktene:

1. Corticosteroids (anti-inflammatory medications)
   No apparent risk of birth defects has been seen in the available studies in people, provided the steroid is inhaled in normal doses. This evidence is strongest for the corticosteroid budesonide(Pulmicort). There is a three to fivefold increased risk of birth defects for steroid tablets or injections during the first third of the pregnancy. However, if the steroid tablets or injections are used to treat a severe asthma exacerbation in an emergency, the benefits are far greater than the risks.
   
   
2. Cromones
   No apparent risk of birth defects has been shown in the available studies in people. This Evidence is slightly stronger for disodium cromoglycate than for sodium nedocromil.
   
   
3. Leukotriene antagonists
   Studies on people have not been published. Animal studies for montelukast and zafirlukast showed no side effects, whereas zileuton had an increased risk of birth defects. These medications should only be used in women with severe asthma where other medications have given unsatisfactory asthma control
   
   
4. ß2-agonists (airway openers)
   No apparent risk of birth defects has been shown in the available studies in people with normal use of a short-acting ß2-agonist. This also seems to be true for the long acting ß2-agonists, such as salmeterol, but this evidence is not as strong.
   
   
5. Theophyllines
   No apparent risk of birth defects has been shown in the available studies in people. However, since better alternatives are available, the overall importance of theophylline in asthma is diminishing.
   
   
6. Anticholinergic agents
   The most basic of these drugs, atropine, has not been shown to increase the risk of birth defects, but since human studies are unavailable for the most common variant of atropine, ipratroprium bromide, it is recommended that these drugs should be avoided during the first third of the pregnancy.
   
   
7. Specific immunotherapy
   Pregnancy is not a reason to stop an ongoing treatment with specific immunotherapy, as no apparent risk of birth defects has been shown in the available studies in people. However, it is not recommended that a specific immunotherapy treatment be started during pregnancy, because of the risk, however remote, of the mother having an anaphylactic shock and its possible dire consequences for the child.

Se godkjente norske preparatomtaler for oppdatert informasjon:

• Symbicort® preparatomtale
• Pulmicort® preparatomtale
• Oxis® preparatomtale
• Rhinocort® preparatomtale

Utarbeidet av AstraZeneca AS ved Cand. Scient. Anne Hilde Røsvik
Oppdatert 30.09.2005