Budesonide/Formoterol Dosing During Pregnancy
For pregnant women with asthma, budesonide/formoterol should be continued at the lowest effective dose that maintains asthma control, with budesonide being the preferred inhaled corticosteroid during pregnancy due to its extensive safety data. 1
Safety Profile During Pregnancy
- Budesonide is classified as FDA Pregnancy Category B and has the most safety data among inhaled corticosteroids during pregnancy 1
- At usual doses, budesonide has not been associated with increased risks of major malformations, intrauterine growth restriction, preterm delivery, or low birth weight 2
- Limited human data exists on formoterol use during pregnancy, but animal studies suggest low risk 2
- If a woman was well-controlled on formoterol before pregnancy, it is acceptable to continue the same medication during pregnancy 2, 1
Dosing Recommendations
- Use the lowest effective dose necessary to maintain asthma control 2, 1
- Standard dosing of budesonide/formoterol (Symbicort) for moderate persistent asthma is typically 160/4.5 mcg, 2 inhalations twice daily 3
- For patients already on budesonide/formoterol before pregnancy, continue the same dose if asthma is well-controlled 1
- Poorly controlled asthma poses greater risks to mother and fetus than potential medication risks 1
Monitoring During Pregnancy
- Regular assessment of asthma control is recommended throughout pregnancy 1
- Monitor lung function during prenatal visits, as asthma may improve in 1/3 of women and worsen in 1/3 of women during pregnancy 2
- Consider monthly evaluations to allow for therapy adjustments as needed 2
- Exacerbations during pregnancy should be managed aggressively due to potential fetal risks from maternal hypoxia 1
Clinical Considerations
- Maintaining asthma control during pregnancy is critical for maternal and fetal well-being 2, 1
- Uncontrolled asthma increases risks of perinatal mortality, pre-eclampsia, preterm birth, and low-birth-weight infants 2
- It is safer for pregnant women to be treated with appropriate asthma medications than to have uncontrolled symptoms and exacerbations 2
- For moderate persistent asthma, a combination of low-dose ICS and LABA is a preferred treatment option 1
Important Caveats
- Do not discontinue asthma medications during pregnancy due to unfounded safety concerns, as this can lead to poor asthma control and increased risks to mother and fetus 1
- Do not switch from formoterol to another LABA unnecessarily if the patient was previously well-controlled on formoterol 2, 1
- While salmeterol has historically been preferred due to greater experience during pregnancy, continuing formoterol is acceptable if the patient was previously well-controlled 2, 1
- Ensure aggressive management of any asthma exacerbations during pregnancy to prevent maternal hypoxia and adverse fetal outcomes 1