Are Symbicort (budesonide and formoterol) and Ventolin (albuterol) safe to use during pregnancy?

Safety of Symbicort and Ventolin During Pregnancy

Both Symbicort (budesonide/formoterol) and Ventolin (albuterol) can be safely used during pregnancy when clinically indicated for asthma management, with budesonide having the strongest safety profile among inhaled corticosteroids.

Symbicort (Budesonide/Formoterol) Safety

Budesonide Component

• Budesonide is the only inhaled corticosteroid with an FDA Pregnancy Category B rating, indicating greater safety than other inhaled corticosteroids which are Category C 1
• Extensive human pregnancy data from studies of over 6,600 infants whose mothers used inhaled budesonide during pregnancy showed:
  • No increased risk of congenital malformations
  • Normal gestational age, birth weight, and length
  • No increased rate of stillbirths or multiple births 2

Formoterol Component

• The FDA label for Symbicort notes that animal reproduction studies with formoterol showed teratogenic effects at extremely high oral doses (1600 times the maximum recommended human daily inhalation dose) 3
• However, no teratogenic or developmental effects were seen in rats at inhalation doses up to 375 times the maximum recommended human daily inhalation dose 3
• When used in the typical inhaled doses for asthma management, the systemic exposure is much lower than doses associated with adverse effects in animal studies

Ventolin (Albuterol) Safety

• Short-acting beta-agonists like albuterol (Ventolin) have a long history of safe use during pregnancy
• They are considered first-line rescue medications for acute symptoms during pregnancy

Clinical Recommendations

For Asthma Management During Pregnancy:

1. Maintain optimal asthma control - Poorly controlled asthma poses greater risks to both mother and fetus than medication use 3
2. Use lowest effective doses to maintain control
3. Prefer budesonide-containing inhalers when an inhaled corticosteroid is needed due to its Category B rating and extensive safety data 2, 1

Monitoring Recommendations:

• Regular assessment of asthma control
• Ultrasound monitoring of fetal growth when using beta-agonists like formoterol 4
• Consider serial echocardiography during second or third trimester if symptoms develop 5

Important Cautions:

• Beta-blockers (especially atenolol) should be avoided in pregnant women with asthma due to potential bronchospasm 4
• Uncontrolled asthma during pregnancy increases risks of:
  • Preeclampsia
  • Prematurity
  • Low birth weight
  • Small for gestational age infants 3

Conclusion

The benefits of maintaining good asthma control during pregnancy generally outweigh the potential risks of medication use. Symbicort and Ventolin have established safety profiles during pregnancy and should be continued if needed for symptom control, with budesonide being the preferred inhaled corticosteroid component due to its extensive safety data in pregnancy.