Is albuterol (bronchodilator) safe to use during pregnancy?

Safety of Albuterol Inhaler During Pregnancy

Albuterol inhaler is considered safe and compatible with pregnancy, and it is safer for pregnant women to be treated with albuterol than to have untreated asthma symptoms and exacerbations. 1, 2

Evidence Supporting Albuterol Safety

The European Respiratory Society/TSANZ Task Force classifies salbutamol (albuterol) as "Compatible" during pregnancy, indicating it is considered a drug of first choice that should be tolerated during pregnancy, with sufficient anecdotal evidence through use in human pregnancies showing that embryo/fetal risk is very low or nonexistent. 1

The National Asthma Education and Prevention Program (NAEPP) expert panel report provides reassuring data regarding the safety of beta2-agonists during pregnancy, with more data available specifically for albuterol. 1 Their systematic review included six human studies with a total of 6,667 pregnant women, of whom 1,929 had asthma and 1,599 had taken beta2-agonists.

Risks of Untreated Asthma vs. Medication Use

Inadequately controlled asthma poses greater risks to both mother and fetus than the potential risks of asthma medications:

• Uncontrolled asthma increases risks of:
  • Perinatal mortality
  • Pre-eclampsia
  • Preterm birth
  • Low birth weight infants
  • Maternal hypoxia affecting fetal oxygenation 1, 2

FDA Pregnancy Category Information

The FDA pregnancy category for albuterol is C, which indicates:

• Animal studies have shown teratogenic effects at doses significantly higher than human therapeutic doses
• There are no adequate and well-controlled studies in pregnant women
• The drug should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus 3

Animal reproduction studies showed cleft palate formation in mice at doses 1.25 times the human nebulization dose, but this occurred at much higher systemic exposure than would be expected with inhaled therapy. 3

Dosing Recommendations During Pregnancy

For asthma exacerbations during pregnancy, albuterol can be administered as follows:

• Nebulizer: 2.5-5 mg every 20 minutes for 3 doses, then 2.5-10 mg every 1-4 hours as needed
• MDI with spacer: 4-8 puffs every 20 minutes for 3 doses, then every 1-4 hours as needed 2

Important Clinical Considerations

1. Monitoring: Monthly evaluation of asthma symptoms and pulmonary function is recommended during pregnancy 2

2. Short-term circulatory effects: Research has shown that maternal blood pressures, heart rates, and fetal parameters remain unaffected during the first 2 hours after albuterol dosing in pregnant women between 33-39 weeks' gestation 4

3. Risk of congenital malformations: A study of 13,117 pregnancies found no increased risk of congenital malformations associated with short-acting beta-agonist use during pregnancy (adjusted OR 1.04,95% CI 0.92-1.17 for any malformations; 0.93,95% CI 0.80-1.08 for major malformations) 5

Practical Recommendations

• Use albuterol as needed for symptom relief during pregnancy
• Maintain good asthma control to avoid the need for higher doses or systemic corticosteroids
• Use proper inhaler technique with a spacer device when possible to maximize delivery to the lungs while minimizing systemic absorption
• Do not discontinue asthma medications during pregnancy without medical advice, as uncontrolled asthma poses greater risks than medication use

In conclusion, the benefits of using albuterol to control asthma during pregnancy clearly outweigh the potential risks, and it should be used as needed to maintain good asthma control throughout pregnancy.