Can albuterol (bronchodilator) be used during pregnancy?

Albuterol Use During Pregnancy

Albuterol is safe and recommended for use during pregnancy, as the benefits of controlling asthma far outweigh any potential risks to the fetus. 1

Safety and Efficacy

• Inadequate control of asthma poses a greater risk to the fetus than asthma medications, including albuterol. Uncontrolled asthma can lead to decreased oxygen supply to the fetus, potentially causing serious complications 1
• Albuterol is the preferred short-acting beta-agonist (SABA) during pregnancy because it has the most safety data available compared to other SABAs 1
• Short-term studies show no significant adverse effects on maternal blood pressure, heart rate, or fetal circulation when albuterol is used at recommended doses 2

FDA Pregnancy Category

• Albuterol is classified as FDA Pregnancy Category C, indicating that animal studies have shown some teratogenic effects at high doses, but the potential benefit may justify the potential risk in humans 3
• Animal studies showed cleft palate formation in mice at doses 1.25 and 12.5 times the maximum human nebulization dose, but not at lower doses 3
• Despite the Category C classification, clinical experience and guideline recommendations support albuterol as the first-choice SABA during pregnancy 1

Dosing and Administration

• For quick relief of asthma symptoms during pregnancy, 2-4 puffs of albuterol via metered-dose inhaler (MDI) as needed is recommended 1
• For nebulizer treatment, the standard adult dose is 2.5 mg every 20 minutes for 3 doses, then every 1-4 hours as needed 1
• Only selective beta-agonists like albuterol are recommended during pregnancy 1

Monitoring and Management

• Monthly evaluations of asthma control and pulmonary function are recommended during pregnancy, as asthma symptoms may change (improve in 1/3 of women, worsen in 1/3) 1
• The goal of asthma treatment during pregnancy is to maintain control with minimal or no chronic symptoms, no exacerbations, no activity limitations, near-normal pulmonary function, and minimal use of rescue medications 1
• A team approach involving both the obstetrical care provider and asthma specialist is recommended for pregnant women with asthma 1

Potential Concerns

• Oral albuterol has been shown to delay preterm labor in some reports, so cautious use is required when given for bronchospasm relief to avoid interference with uterine contractility 3
• While rare congenital anomalies have been reported in offspring of patients treated with albuterol, no consistent pattern of defects has been discerned, and a relationship between albuterol use and congenital anomalies has not been established 3
• Excessive use of albuterol should be avoided as systemic administration may cause cardiovascular and metabolic adverse effects 1

Clinical Decision Making

• For pregnant women with asthma, maintaining proper control of asthma should be the priority, as this enables a normal pregnancy with little or no risk to mother or fetus 1
• If a pregnant woman requires frequent use of albuterol (more than twice weekly), this indicates inadequate control and the need to initiate or increase long-term control therapy 1
• For moderate to severe asthma during pregnancy, albuterol should be used alongside appropriate controller medications such as inhaled corticosteroids (preferably budesonide) 1, 4