Is albuterol (salbutamol) safe to use during pregnancy?

From the Guidelines

Albuterol is safe to use during pregnancy when necessary for managing asthma or other breathing conditions. According to the most recent and highest quality study available, maintaining asthma control during pregnancy is crucial for the health and well-being of both the mother and her baby 1. Uncontrolled asthma can increase the risk of perinatal mortality, pre-eclampsia, preterm birth, and low-birth-weight infants. The study recommends albuterol as the preferred short-acting beta 2-agonist due to its excellent safety profile and the greatest amount of data related to safety during pregnancy 1.

Key Points to Consider

• Albuterol is the preferred SABA for pregnant women, with the most data available on its safety during human pregnancy 1.
• Inhaled corticosteroids, such as budesonide, are the preferred long-term control medication, but albuterol may be used as needed for quick relief 1.
• Controlling asthma during pregnancy is crucial to prevent complications such as decreased oxygen to the fetus, preeclampsia, premature birth, and low birth weight 1.
• The standard dosing of albuterol remains the same during pregnancy: typically 1-2 puffs every 4-6 hours as needed via inhaler (90 mcg per puff) 1.

Monitoring and Management

• It is essential to monitor the level of asthma control and lung function during prenatal visits to adjust therapy as needed 1.
• Monthly evaluations of asthma will allow the opportunity to step up therapy if necessary and to step down therapy if possible 1.
• Healthcare providers should work closely with pregnant women to monitor both asthma control and pregnancy progress, using the lowest effective dose of albuterol and other medications as needed 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.

Albuterol should be used with caution during pregnancy, as it has been shown to be teratogenic in animal studies. The FDA drug label recommends that albuterol should only be used during pregnancy if the potential benefit justifies the potential risk to the fetus 2. Key points to consider include:

• Pregnancy Category C: Albuterol has been shown to be teratogenic in mice.
• No adequate and well-controlled studies in pregnant women.
• Potential risk to the fetus must be weighed against the potential benefit of using albuterol.

From the Research

Safety of Albuterol During Pregnancy

• The safety of albuterol (salbutamol) during pregnancy has been studied in several research papers 3.
• A study published in the American journal of obstetrics and gynecology in 1994 found that short-term circulatory effects of inhaled albuterol on maternal and fetal circulations were unaffected during the first 2 hours after dosing in 12 asthmatic patients between 33 and 39 weeks' gestation 3.
• There is no direct evidence in the provided studies that discusses the long-term effects of albuterol on the fetus or the mother during pregnancy.
• However, the studies suggest that albuterol can be used safely in non-pregnant patients with asthma, with minimal side effects when administered via metered-dose inhaler or nebulizer 4, 5, 6, 7.

Administration and Dosage

• The studies provided do not specifically address the administration and dosage of albuterol during pregnancy.
• However, they do discuss the administration and dosage of albuterol in non-pregnant patients, including the use of metered-dose inhalers, nebulizers, and dry powder inhalers 4, 5, 6, 7.
• A study published in The American review of respiratory disease in 1993 found that nebulized albuterol provided objective physiologic improvement in mechanically ventilated patients, while albuterol administered by metered-dose inhaler had no effect 6.
• Another study published in The Journal of asthma in 1998 found that albuterol delivered by Rotahaler device was more effective than the same drug delivered as an aerosol by either metered-dose inhaler or metered-dose inhaler with spacer 7.