Can a pregnant patient take albuterol (salbutamol)?

From the Guidelines

Pregnant patients with asthma or other breathing conditions can take albuterol as prescribed by their healthcare provider, as it is considered safe and the benefits may outweigh potential risks when medically necessary. The medication is preferred due to its excellent safety profile and the greatest amount of data related to safety during pregnancy of any currently available short-acting inhaled beta 2-agonists 1. Uncontrolled asthma during pregnancy can pose greater risks to both mother and baby than the medication itself, including complications like preeclampsia, premature birth, and low birth weight.

Some key points to consider when prescribing albuterol to pregnant women include:

• Maintaining asthma control during pregnancy is crucial for the health and well-being of both the mother and her baby 1
• Albuterol is the preferred short-acting beta 2-agonist (SABA) due to the most data related to safety during human pregnancy being available for this medication 1
• Pregnant women should have their asthma monitored regularly throughout pregnancy to ensure optimal control with the lowest effective medication dose 1
• The standard dosage remains the same during pregnancy: typically 1-2 puffs every 4-6 hours as needed for symptoms, or as specifically directed by a healthcare provider.

It is essential for pregnant women to inform their obstetrician about all medications they are taking, including albuterol, to ensure the best possible outcomes for both mother and baby 1.

From the FDA Drug Label

Pregnancy Teratogenic Effects Pregnancy Category C Albuterol has been shown to be teratogenic in mice when given subcutaneously in doses corresponding to 1.25 times the human nebulization dose (based on a 50 kg human). There are no adequate and well-controlled studies in pregnant women. Albuterol should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.

Pregnancy and Albuterol Use:

• Albuterol is classified as a Pregnancy Category C medication, indicating that it may pose a risk to the fetus.
• The drug label states that albuterol should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.
• Key considerations for use in pregnant patients include:
  • Potential teratogenic effects
  • Lack of adequate and well-controlled studies in pregnant women
  • Need for cautious use to avoid interference with uterine contractibility 2

From the Research

Albuterol Use in Pregnancy

• The safety of albuterol use in pregnancy is a topic of interest, with some studies suggesting its potential harmful effects 3.
• However, albuterol is often prescribed during pregnancy to treat conditions such as asthma, pulmonary disease, preterm labor, or acute non-reassuring fetal heart rate abnormalities during labor 3.
• A study from 2021 discusses the US Food and Drug Administration's role in approving drugs for marketing, including those for use in pregnant women, but does not specifically address albuterol use in pregnancy 4.
• Another study from 1984 discusses the pharmacology, pharmacokinetics, and clinical use of albuterol, but does not provide information on its use in pregnant patients 5.

Administration and Dosage

• A study from 1997 compares the efficacy of inhaled albuterol delivered via jet nebulizer, metered dose inhaler with spacer, or dry powder in treating acute severe asthma, but does not address pregnancy specifically 6.
• A survey of albuterol administration practices in intubated patients in the neonatal intensive care unit found substantial variability among institutions, but does not provide information on pregnant patients 7.
• The study from 1984 mentions the potential side effects of albuterol, including metabolic effects, peripheral vasodilation, and skeletal muscle tremor, but does not discuss their relevance to pregnant patients 5.

Clinical Use

• Albuterol is a long-acting beta 2-adrenergic receptor-selective drug that relaxes airway smooth muscle, and is commonly used to treat asthma and other respiratory conditions 5.
• The study from 2013 discusses the potential harmful effects of terbutaline sulfate use in pregnancy, but also notes that beta2-adrenergic agonist medications like albuterol are often prescribed during pregnancy to treat certain conditions 3.
• The study from 2021 emphasizes the importance of guiding the development and ensuring the availability of effective and safe therapeutics for obstetrical indications and for medical conditions during pregnancy, but does not specifically address albuterol use 4.